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SmartCare Optimum - Your Ultimate Health Insurance Protection With as charged benefits that pays up to Baht 5 Million a Year.
Pay for your medical Bill with “ As charged” Plan
Most policy set limits on how much you can claim per disability, but SmartCare Optimum is an as-charged* plan that pays you in full for number of days in Hospital Room & Board charged, ICU charges, Surgeon’s fees, Dr.’s Visit, Specialist Consultation and Hospital Miscellaneous Expenses.
* Refer to : Cover normal, usual and customary charges.
Great Value for your money
Making every Baht work for you. SmartCare Optimum also includes coverage for :Organ Transplant (Bone Marrow, Heart, Kidney, Liver & Lung)
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Outpatient Kidney Dialysis and Outpatient Cancer Treatment
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Outpatient Dental Treatment due to accident
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Miscarriage due to accident
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Prosthesis Benefits
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Dread Disease Recuperation Benefits for Cancer, Coronary Artery By-Pass Surgery, Heart Attack and Stroke
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Special Grant (Death Benefit)
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Personal Accident Insurance (Continental Scale – PA.2)
Territory Limit
With SmartCare Optimum, you can be assured of medical cover. SmartCare Optimum is extended to cover while you are traveling overseas** for a period not exceeding 90 days. In addition; you can enjoy greater peace of mind during your travel with Emergency Medical Evacuation, and Repatriation benefits.
** Refer to : This policy will cover the insured whilst traveling anywhere aboard for business or personal trip (Except for travel made expressly for treatment outside Thailand) and the company’s liability is limited to the reasonable charged for equivalent treatment in Thailand if those medical expenses are lower than the actual charges incurred aboard.
Sample of Exclusions
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Any treatment within the first 30 days of cover ( except for accidental injury)
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Any treatment for Hypertension, Hernias, Cardiovascular Diseases, Tumours or cysts, Tonsils requiring surgery, Hemorrhoids, Diabetes, Cholecystitis, Cholelithiasis and Calculi of the Urinary organs within the first 180 days of cover.
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Pre-Existing Conditions which refers to an injury or an illness which existed prior to the effective date of cover.
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Other standard Health and Accident exclusions, e.g. AIDS, pregnancy, dental treatment (except due to accident), Congenital conditions, suicide and routine physical examinations.
Eligibility
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Thai Citizens, permanent resident of Thai, employment pass holders or work permit holders
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Adult age 18-59 years. (Renewal up to 75 years subject to yearly review)
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Children from age 6 months (inclusive), and at least one parent must be included with the same plan and benefits.
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The company has the right to consider the insurance cover, or insurance premium subject to the applicant’s reserved occupation, illness and other medical information or record
Renewal Term (Premium subject to change)
1. This policy is annual renewal.
2. Only for the applicant who kindly provide to us an updated medical report at the time of application for insurance (minimum requirement for medical report as stipulated by the company)
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If the applicant join before the age of 55 years, Renewal is guaranteed for a lifetime or up to the company’s max. limit of liability for renewal.
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If the applicant join as from the age of 55 years, Renewal is guaranteed up to 75 years old or up to the company’s max. limit of liability for renewal.
Table of Benefits
Benefits |
Maximum limit (Baht/Person/Year) |
|
BASIC |
CLASSIC |
DELUXE |
|
Policy Annual limit |
1,500,000 |
2,500,000 |
5,000,000 |
A.Hospitalisation & Surgery
1. Daily Room& Board, General Nursing
Services(Max./day) |
8,000 |
10,000 |
12,000 |
2. Intentive Care Unit
3. Hospital Miscellaneous Services
4. Pre-Hospital /Surgery Specialist Consultation
(Up to 30 days before admission)
5. Pre-Hospital /Surgery Dinogsis Services
(Up to 30 days before admission)
6. Post-Hospital /Surgery Treatment
(Up to 60 days after admission)
7. Anesthetist's Fee
8. In-Hospital Physician’s Visit ( Max.1 visit/ day)
9. Surgeon’s Fee
10. Prosthesis Benefit |
As charged |
11. Special Nursing and/or Home Nursing- (per
disability)(Max. payable 1,500.-/day)
12. Emergency Out-Patient Treatment Due to Accident
(Including follow up treatment 30 days as from the
accident)
13. Miscarriage due to Accident ( per accident)
14. Organ Transplants (annual Limit) |
Max 30 days
30,000
15,000
500,000 |
Max 45 days
50,000
15,000
700,000 |
Max 60 days
70,000
15,000
1,000,000 |
B. Outpatient Dental Treatment Due to accident ( per
accident) |
15,000 |
25,000 |
50,000 |
C. Dread Disease Recuperation Benefit; Heart Attack,
Cancer, Stroke,Coronary Artery
ByPassSurgery,(one time lump-sum payment) |
50,000 |
70,000 |
100,000 |
D. Outpatient Kidney Dialysis and Outpatient Cancer
Treatment
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Outpatient Kidney Dialysis ( lifetime limit)
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Outpatient Cancer Treatment (lifetime Limit)
|
150,000
150,000 |
300,000
300,000
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500,000
500,000
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E. Personal Accident (one time lump-sum payment)
Full cover for Murder-Assualt & Motorcycling |
100,000 |
100,000 |
100,000 |
F. Special Grant
1. Special Grant ( Death Benefit - one time lump-sum
payment)
2. Emergency Assistant*
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Emergency Medical Repatriation, Repatriation*
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Repatriation or Local Burail*
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30,000
2,500,000 |
30,000
2,500,000
|
30,000
2,500,000
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G. Overseas Annual limit |
750,000 |
1,500,000 |
2,500,000 |
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H. Company's Liability for Life-time Limit |
10,000,000 |
15,000,000 |
25,000,000 |
OPTIONAL BENEFITS
OUTPATIENT BENEFIT & PERSONAL ACCIDENT INSURANCE
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Outpatient Benefit (OPD)
Including doctor consultation, X-ray and Laboratory test, MRI, CT and ECG |
Annual limit (Baht) |
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20,000 |
30,000 |
50,000 |
Personal Accident Insurance (PA)
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50 % for Murder-Assault & Motorcycling
Optional benefit of PA will not applicable to children
aged below 18 years |
Sum Insured (Baht) |
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1,000,000 |
2,000,000 |
3,000,000 |
Note:
1) The policy annual limit shall apply to all benefits, except Emergency Assistant* in item F.
2) For section A14, excluding the cost of acquisition of the organ and all costs incurred by the dornor
3) For section G. Overseas Annual limit shall apply to all benefits,except Emergency Assistant* in item F.
4) For section H. Company's Liability for a Life-time Limit shall apply to all benefits,except Emergency Assistant* in item F.
5) Overseas finance payment direct to providers can be arranged where claims exceed Baht 100,000.-
6) Day Surgery will be paid under the outpatient benefit, unless such surgery has been authorized by our Hotline Service in advance.
For the authorized case, the expenses will be charged under section A. Hospitalisation&Surgery Benefits.
7) This insurance premium is applicable for Occupation Class I, II & III only.
8) The Personal Accident Insurance Policy will be issued for the optional PA.
Table of Premium
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"BASIC" PLAN |
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Age Range (Years) |
STANDARD COVER |
STANDARD COVER and OUTPATIENT BENEFIT |
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OPD-20 |
OPD-30 |
OPD-50 |
6 months - 5
6 - 10
11 - 15
16 - 20
21 - 25
26 - 30
31 - 35
36 - 40
41 - 45
46 - 50
51 - 55
56 - 60
61 - 65* |
23,190
22,086
14,472
14,472
19,822
20,813
23,983
27,153
31,908
35,078
41,418
47,759
61,828
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41,847
34,954
21,550
21,550
28,185
29,176
32,990
38,090
44,775
49,876
58,146
66,416
80,485
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47,030
38,528
23,515
23,515
30,509
31,500
35,491
41,129
48,349
53,985
62,792
71,598
85,667
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51,175
41,388
25,088
25,088
32,366
33,358
37,493
43,558
51,209
57,274
66,509
75,744
89,813
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" CLASSIC" PLAN |
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Age Range (Years) |
STANDARD COVER |
STANDARD COVER and OUTPATIENT BENEFIT |
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OPD-20 |
OPD-30 |
OPD-50 |
6 months - 5
6 - 10
11 - 15
16 - 20
21 - 25
26 - 30
31 - 35
36 - 40
41 - 45
46 - 50
51 - 55
56 - 60
61 - 65*
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24,896
23,710
15,519
15,519
21,274
22,338
25,748
29,157
34,272
37,681
44,500
51,320
66,444
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43,553
36,578
22,596
22,596
29,637
30,701
34,755
40,095
47,139
52,479
61,228
69,977
85,101
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48,735
40,152
24,562
24,562
31,961
33,024
37,256
43,133
50,713
56,588
65,874
75,159
90,283
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52,881
43,012
26,135
26,135
33,818
34,882
39,258
45,563
53,573
59,877
69,591
79,305
94,429
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"DELUXE" PLAN |
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Age Range (Years) |
STANDARD COVER |
STANDARD COVER and OUTPATIENT BENEFIT |
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OPD-20 |
OPD-30 |
OPD-50 |
6 months - 5
6 - 10
11 - 15
16 - 20
21 - 25
26 - 30
31 - 35
36 - 40
41 - 45
46 - 50
51 - 55
56 - 60
61 - 65*
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29,697
28,283
18,494
18,494
25,373
26,642
30,716
34,790
40,900
44,974
53,122
61,269
79,333
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48,354
41,151
25,571
25,571
33,736
35,005
39,722
45,727
53,766
59,771
69,849
79,926
97,990
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53,536
44,725
27,537
27,537
36,060
37,328
42,224
48,765
57,340
63,880
74,496
85,108
103,172
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57,682
47,585
29,110
29,110
37,917
39,186
44,226
51,195
60,200
67,169
78,213
89,254
107,318
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PERSONAL ACCIDENT INSURANCE (Optional Benefit) |
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Age Range ( Years) |
PA 1MB |
PA 2MB |
PA 3MB |
19-60
61-65* |
1,857
2,579 |
3,714
5,158
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5,571
7,737
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Family Discount !!!! |
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Min. 2 persons |
5% |
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Min.4 persons |
10% |
Note: * Renewal Only
1) Family discount will be calculated from the premium before TAX& Stamp Duty.
2) Family discount will be applicable to the applicants in the same family ;
husband, wife and children.( join at the same time)
For a free quotation or enroll SmartCare Optimum, please contact your agent, broker or AXA Insurance PCL at 0-2679-7600 ext. 2171-2174
Download application form
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+66 2679 7600
+66 2285 6383
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