ประกันสุขภาพ My Elite COVID-19 -100,000 USD

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Table of Benefits Elite Series MY Elite COVID-19

Individual Health Elite Series – My Elite COVID (IPD only)

My Elite COVID - Elite Series for COVID 100,000 USD

ประกันสุขภาพรายเดี่ยว Elite Series - My Elite COVID (ไทย)

ความคุ้มครอง /Insuring Agreement	ทุนประกันภัย/ Sum insured (THB)
ความคุ้มครอง /Insuring Agreement	แผน 1/Plan 1
ความคุ้มครองสูงสุดต่อปี สำหรับการรักษาการเชื้อ ไวรัสโคโรน่า (โควิด–2019เท่านั้น ความคุ้มครองค่ารักษาพยาบาลที่เกิดจากการติดเชื้อไวรัสโคโรน่า (COVID-19) สำหรับการรักษาแบบผู้ป่วยในเท่านั้น Maximum limit per year for COVID-19 only Medical corona treatment from infections (Coronavirus (COVID-19)) for In-Patient-Department (IPD) only.	3,500,000
Deductible *Deductible apply on any treatment during the first 14 days after arriving Thailand	100,000*
Waiting period	There is no waiting period
Inpatient Benefit (Maximum limit per policy)	3,500,000
1. IPD - Room & Board including nursing care (Maximum 90 days)
1.1 Standard Room - Non intensive care room (Maximum 90 days)	8,000
1.2 Intensive care unit (ICU/CCU) (Maximum 30 days) (Maximum benefits for Standard room, ICU/CCU would not exceeding 365 days per any injury or illness)	Customary and reasonable medical charges
2. Hospital general expenses per disability
2.1 Costs of drugs and intravenous feeding 2.2 Costs of blood transfusion 2.3 Cost of ambulance for medical emergency (IPD only) 2.4 Cost of laboratory test / Cost of medical equipment / Physical therapy as inpatient / Cost of operating room and operating equipment / Anesthesiologist and nurse anesthetist / Specialist’s consultation fee when no surgery is performed / Take home drugs prescribed by physician on discharge 2.5 Follow up treatment within 30 days on discharge	Customary and reasonable medical charges
3. Surgeon’s operation fee per disability (Including Surgical consultation)
4. In-patient Physician's fees for doctor visits (Max 1 visit per day)
Lump Sum payment in the event of death or dismemberment including murder, assault, driving and being passenger on motorcycle	100,000
Premium Table
Insured Age	Premium in THB per month
15 days to 40 years old	3,000
41 - 60 years old	6,000
61 – 75 years old	10,000

Remarks : -

1. MY Elite COVID plan is limit the coverage for COVID only (not all kind of sickness) with deductible THB100,000 during the first 14 days after pass through Thailand Immigration.

2. DEDUCTIBLE, the insured person is responsible to the first fixed amount of eligible medical expenses per visit or per disability for which the covered person is responsible for paying as

stated in the policy schedule. Deductible apply on any treatment from COVID during the first 14 days after arriving Thailand.

3. Standard premium table for each age band for the first policy year only.

4. Eligible age to apply is 15 days up to 75 years of age.

5. MY Elite COVID plan cover is short-term plan. For example, if traveling 15 days, must purchase a full month and can buy a maximum up to 6 months.

6. This package is not cover any Out-Patient-Department (OPD) cases.

7. If the insured is admitted to a hospital as an inpatient suffering from Coronavirus Infection with Positive test during the insurance period, the company will pay the actual medical expenses

upto the limit of sum insured specified in the insurance policy.

8. This policy does not cover injury / illness / chronic disease which occur before effective date of policy which still not recover on the first effective date, and any unnecessary medical treatment.

9. Applicant must send the completed and signed health application form together with a copy of passport for company consideration, and premium must be paid before coverage can commence

and insurance document can be issued.

10. The company reserves the right to reject any application or accept with exclusions, according to underwriting standard of the company.

11. Renewal year premium will be adjusted according to changing age of each insured person. Some insured person may be applied higher premium subject to his/her claims experiences

(Loss Ratio) of the previous policy year or may not be renewed.

12. Health care card is not provided for this plan (re-imbursement only).

13. The policy will be terminated when the insured travel out of Thailand or on expiry date of the policy, whichever come first.

14. The benefit and coverage are subject to term &condition of policy.

15. Customers can have only one effective LMG Individual Health Insurance Policy.

16. This medical plan will not cover medical expenses provided for bone marrow transplant, organ transplant, and kidney dialysis.

17. Information in this brochure is only preliminary information provided for the applicant to consider for applying for health insurance.

18. This document is not part of any insurance policy. Please refer to the general terms, conditions and exclusions in the health insurance policy. Applicant should make understanding

of terms and conditions, as well as the exclusions before purchasing