D Health Plus Coverage

Q: What are advantages of D Health Plus Rider and why do I have to buy it?
A: D Health Plus provides comprehensive coverage for both IPD benefit for hospitalization and OPD benefit for continuous treatment and rehabilitation with lump sum benefit up to 5 million Baht(1) for critical illnesses, general diseases, epidemics and accidents under the lump sum amount for standard single room fee, ICU room fee, doctor fee, medication fee, examination fee, surgery fee, physical therapy fee. It covers both minor or major surgery or injury from an accident within 24 hours even without being hospitalized. You can exercise the right for tax deductible for up to 25,000 Baht. If you get sick, you can feel at ease because you have a good helper to reduce the risk of medical expenses.

Q: Who should apply for D Health Plus Rider?
A: D Health Plus is suitable for anyone who wants to buy health insurance with easy-to-understand and uncomplicated conditions and details but with high coverage, for example, a person who does not have a welfare for their health and wants to purchase health insurance that pays lump sum benefit and provides IPD benefit as well as OPD benefit for continuous treatment and rehabilitation. A person whose welfare for their health is not enough who wants to increase the coverage limit can choose to pay only the exceeding amount from their existing welfare, so there is no need to pay double premiums. This health insurance is also suitable for people who want to purchase for their old parents. Entry age is 11-90 years old with long-term coverage until attaining the age of 99.

Q: Will it be effective immediately if I buy it?
A: The rider has the 30-day waiting period after the effective date. The following diseases will be covered if they occur 120 days after the effective date or the reinstatement date according to conditions stated in the contract: Tumors, cysts, or all types of malignancy/cancer, hemorrhoid, all types of hernia, pterygium or cataract, tonsillectomy or adenoidectomy, all types of stone, varicose vein and endometriosis.

Q: What is coverage of D Health Plus Rider in case of hospitalization?
A: Feel at ease when you are sick if you purchase D Health Plus Rider as it provides coverage for both IPD benefit when hospitalization and OPD benefit for continuous treatment and rehabilitation with lump sum benefit up to 5 million Baht.(1) It covers standard single room in any hospital, board, nursing service, ICU room up to 60 days (once room, board and nursing service fees are included, it must not exceed 180 days), doctor fee, medication fee, examination fee, surgery fee and physical therapy fee. It covers both minor or major surgery or injury from an accident within 24 hours even without being hospitalized. The benefits were paid based on actual expenses.

Q: What is deductible option, and do all plans of D Health Plus Rider have deductible options?
A: D Health Plus Rider has coverage plans with and without deductible option. It is based on the plan you choose.

Deductible is
It is the amount of medical expenses paid by the insured, other welfare or other policies (if any).
For example, you choose to apply for the plan with 30,000-Baht deductible.
Medical expenses and other expenses according to the coverage are 100,000 Baht.
You are required to pay for the first 30,000 Baht.
D Health Plus Rider provides coverage for 70,000 Baht but not exceeding the limit of the chosen plan.

Q: Is D Health Plus Rider eligible for tax deduction?
A: Yes, it is. The premium of this rider is eligible for personal income tax deduction according to the Notification of the Director-General of the Revenue Department on Income Tax No. 383.

Q : What additional coverage does D Health Plus provide?
A : You can choose the coverage of your choice such as Care Plus Coverage which takes care of cancer and chronic kidney failure in every stage including IPD and OPD benefits as well as mental illness coverage up to 10 million Baht(2) per year, OPD benefit up to 30 times per year (500-3,000 Baht per time), Well-Being Plus which provides coverage for health checkup, vaccination, eye care, or dental checkup), or Maternity Plus which provides coverage in case of pregnancy as the cost of childbirth is high, and there may be unforeseen risks such as cost of child delivery or miscarriage.

Q: What is the convertible option?
A: It is an option to reduce deductible (change for more coverage). The insured receives a privilege to not going through the underwriting process again (without the need to declare health information again). Moreover, waiting period and pre-existing conditions according to the changing plan will not be applied.

Q: What products are available for the convertible option?
A: At present, the Company provides the privilege for D Health Rider, D Health Rider (N) or D Health Plus
Rider Plan with Deductible, including D Kids Project or D Kids Plus Project (excluding those attached to unit-linked insurance) according to conditions specified by the Company.

Q: Is convertible option available for all plans?
A: No. Exercising the convertible option is subject to the convertible option criteria for rider and deductible reduction table. In this regard, the coverage plan after conversion is subject to the Company’s available rider/coverage plan at that time.

Q: Can the convertible option change benefit limit per any hospitalization?
A: No. Convertible option is an option to reduce deductible which the benefit limit must be equivalent to the original coverage plan.

Q: Which age range is eligible for convertible option?
A: The insured’s 2 eligible age ranges for convertible option are as follows:
• Age range 1: 11-15 years old
• Age range 2: 55-65 years old
The insured is entitled to exercise the convertible option only once per age range in a contract period. The insured must have held the current plan before exercising the convertible option for at least 5 consecutive years.

Q: For eligible age range of 11-15 years old or 55-65 years old for the convertible option, what are the criteria for that?
A: Considering from age based on policy year (year of birth – current year and count based on policy
anniversary)

Q: Is there any additional fee for the convertible option?
A: There is no fee for exercising the convertible option.

Q: How much is the premium for the convertible option?
A: The Company shall calculate the premium based on the new chosen plan. In this regard, the premium
schedule for the coverage plan after the conversion is subject to the Company’s available coverage plan at that time.

Q: When can the insured exercise the right for the convertible option?
A: If a customer is qualified for the convertible option, the Company will notify and send the request form to exercise the convertible option 3 months prior to the policy anniversary at the age of 11 or 55 years, according to each age range. If the customer wants to exercise the right when receiving the document, they can contact the Company immediately. However, the customer must notify the Company before the policy anniversary at the age of 16 or 66 years, according to each age range.

Pre-existing Condition

The Company shall not pay benefit under this rider for chronic disease, illness (including complications) or injury that is not cured before the effective date of this rider, unless

1) The insured has declared to the Company’s acknowledgment and the Company agrees to accept the risk without imposing exclusions to the coverage, or

2) Chronic disease, injury or illness (including its complications) is asymptomatic and has not been treated or diagnosed by a physician, or has not been seen or consulted a physician within 5 years before the initial effective date of this rider, and within 3 years from the initial effective date of this rider.

Exclusions of D Health Plus Rider from a total of 21 clauses

For Example, The rider shall not cover medical expenses or damages that incurred from injury or illness (including its complications), conditions, or abnormality that arise from:
- Cosmetic surgery or any other diagnosis or treatments for skin beauty purposes, pimple, blemish, and freckles treatment, dandruff and hair fall treatment, or weight control, or elective surgeries, except for reconstructive surgery required after an accident incurred whilst the rider is effective
- Anti-aging diagnosis, treatment or prevention by consuming drugs or substances, hormone replacement therapy for peri-menopausal and postmenopausal women, male or female sexual malfunction, any sexual disorder treatments and sexual reassignment surgery
-Treatment or rehabilitation for narcotic substance, cigarette, alcohol or psychotropic substances
- Treatment under experiment, treatment or diagnosis on obstructive sleep apnea, treatment or diagnosis on sleep disorders and snoring
- Expenses incurred from the diagnosis and treatment that the insured as physician prescribed for himself/herself and also such expenses that incurred from order of physician who is the insured’s father, mother, spouse or child

Policy Renewal on Anniversary Date

This rider may be renewed on the policy’s anniversary date without having to provide evidence, but the Company reserves the right to adjust the premium as specified in Section 14 Re: Premium Adjustment, as approved by the regulator, except in any of the following events, the Company shall reserve the right not to renew the rider. If the insured decides not to renew the rider, Company must inform the insured in writing at least 30 days before the end of the effective period.

1) In case there is the evidence that the insured omits the disclose any fact in the insurance application form or reinstatement form, health declaration form and other declarations related to the formation of health insurance rider which is material so that the Company may be induced to charge higher premium, or refuse to enter into the insurance contract, or provide the coverage with conditions.
2) The insured makes a claim from the fact that he/she has requested for the treatment for injury or illness without medical necessity.
3) The insured makes total claims from all companies for compensation from hospitalization higher than the actual income.

Premium Adjustment
The Company may adjust premium on the policy anniversary date according to the premium rate approved by the Registrar due to the following factors.
1) Age and occupation class of each person.
2) Higher medical expenses or overall claim experience of the portfolio of this rider whereby the Company shall notify the insured in writing via a registered mail or other means accepted by the insured at least 30 days in advance.

- Any illnesses which exist within 30 days counting from the effective date or the latest date of reinstatement of the rider, whichever is the latest; or
- Illnesses due to the following diseases which exist within 120 days counting from the effective date or the latest date of reinstatement of the rider, whichever is the latest.
- Tumors, cysts, or all types of malignancy/cancer
- All types of hernia
- Tonsillectomy or adenoidectomy
- Varicose vein- Hemorrhoid
- Pterygium or cataract
- All types of stone- Endometriosis

Buyers should understand the details, coverage and conditions before deciding to make insurance every time.