Elite Health Plus

Q: What are advantages of Elite Health Plus Rider and why do I have to buy it?

A: Elite Health Plus Rider is a lump sum health insurance with high coverage benefit from 20-100 MB per year which will comprehensively satisfy health needs. It covers general diseases, critical illnesses in every stage, epidemics and cancer treatments of chemotherapy and targeted therapy. For hospitalization in standard single room or ICU room for 365 days, the benefit is provided as charged. For special single room, receive the benefit of 10,000-25,000 Baht per day. In addition, you can select the coverage area of your choice in case of overseas medical treatment. You will have no worries about medical expenses with worthwhile premium compared with the coverage you are entitled to. Entry age is from 11-90 years with long-term coverage period until the age of 99 years that gives you peace of mind when you have an illness when getting old.

Q: Who should apply for Elite Health Plus Rider?

A: If you would like to have comprehensive health coverage, Elite Health Plus Rider is for you. It is health insurance with high coverage which is designed for those who want to have no worries about medical expenses. For more information, you can contact the Company’s agents or call Tel. 1766, available 24 hours.

Q: What is the coverage of Elite Health Plus Rider?

A: Elite Health Plus Rider provides health coverage including room fee of 10,000-25,000 Baht per day, and the benefit will be paid as charged in case of hospitalization in standard single room and ICU room, inpatient benefits, emergency coverage, outpatient benefits (*) and targeted therapy for 24 hours with special services of MTL Global Doctors and MTL Global Connect which will give you comfort in case of any unexpected events.

Q: What is a standard single room?
Standard single room means starting price of a hospital single room for inpatient who is hospitalized in Thailand only.

Q : What is the coverage of Elite Health Plus Rider?

A: In case of hospitalization in Thailand
- In case of hospitalization in standard single room, the benefit will be paid as charged.
- In case of hospitalization in non-standard single room (special single room), the benefit of 10,000-25,000 Baht will be paid according to the chosen plan or up to standard single room fee (whichever is higher)
In case of hospitalization abroad
- Benefit of 10,000-25,000 Baht/day according to the chosen plan and coverage area.
Benefit of room, board, and hospital service expenses including ICU room fee will be provided up to 365 days.

Q: What is the targeted therapy?
A Cancer is the number one killer in Thailand and the world. Recently, the medical profession has discovered a new cancer treatment to replace chemotherapy and radiotherapy which is targeted therapy. It is the process of precision medicine to prevent the symptom on a cell level – the cause of cancer cell growth and division – thus reduce the side effects from cancer treatments. In addition, it can be used for the elderly who are not strong enough to receive chemotherapy. Its response rate is high at 80%.

Source: https://www.samitivejhospitals.com/th/precision-medicine/targeted-therapy/

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. In case of additionally purchasing Maternity Plus or Well-Being Plus, child delivery in a hospital or a medical center, and pre- and post-natal complications will be covered if they occur 280 days after the effective date. Cervical dilation and curettage in a hospital or a medical center in case of miscarriage will be covered if they occur 90 days after the effective date. Vaccination fee, dentistry fee and eye care fee will be covered 30 days counting from the effective date of this endorsement. Annual health checkup will be covered 1 year counting from the effective date of this endorsement.

Q: If I buy Elite Health Plus Rider and choose Thailand as the coverage area, will I get covered when falling ill abroad?

A: It provides coverage for 2 cases: Injury due to accident and illness which requires emergency treatment. It must occur within the first 90 days after leaving the coverage area.

Q: How can I request for claim if I choose the coverage areas in Asia, Worldwide (except USA) and Worldwide?

A: You can contact MTL Global Connect by calling Tel. +66 2290 2424 to ask for the network hospitals in the particular area, and the staff will help you to coordinate so you won’t have any worries when getting ill abroad.

Q: Is Elite 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.

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 Elite 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.