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Commissioner Order No. 56/2562 and 14/2564

The Commissioner issues the order that requires life insurance companies to use standardized contents in health riders attached to a life insurance policy in order to have a standard contract and be in line with present-day technology and changing medical treatment methodology. This order shall come into force from 8 November 2021 henceforth.

New Health Standard
In accordance with the announcement of the Office of Insurance Committee (OIC) about the Commissioner Order No. 56/2562 requiring all life insurance companies to use standardized texts in health insurance riders attached to the main life insurance policy and to ensure that its protection conditions are in line with the changing technology, medical treatment methods and evolution, which will take effect from 8 November 2021 onward, the Company; therefore, has briefly summarized key conditions of New Health Standard as detailed below:

Table of benefits: The benefits are divided into Hospitalized and Non-hospitalized cases

Hospitalization Benefits

Section 1: Hospital Room & Board, Hospital Services

  • ICU (Intensive Care Unit)
  • Hospital Room & Board
  • Meal (In-patient)
  • Hospital Services (In-patient)

 

Section 2: Medical Service Fee

  • Medical Service Fee for Diagnosis
  • Medical Service fee for Treatment
  • Fee for Physician Interpreting the Results
  • Fee for Blood Service and Blood Components
  • Fee for Nursing Care Service, excluding Special Nursing Care
  • Fee for Physical Therapy and Occupational Therapy
  • Fee for Drugs & Parenteral Nutrition
  • Fee for Radiotherapy, Nuclear Medicine, including Brachytherapy
  • Fee for Medical Equipment Service
  • Fee for Prosthetic and Orthotic Service (excluding Devices)
  • Fee for Packaged Medical Service
  • Fee for Take-home Medication and Disposable Medical Supplies (Medical Supplies 1)

 

Section 3:  Fee for Physician Evaluation & Management Services

  • Doctor Fee

 

Section 4: Fee for Surgical and Medical Procedures

  • Fee for Opertaing Room and Procedure Room
  • Fee for Drugs & Parenteral Nutrition
  • Fee for Medical Supplies, Surgical & Procedural Equipment
  • Surgeon Fee for Surgery
  • Surgeon Fee for Procedure; Surgical Assistant Fee, Anaesthetic Fee
  • Fee for Organ Transplantation

 

Section 5: A major Surgery that does not Require Hospitalization (Day Surgery)

  • The benefit will be paid as if the Insured is admitted as an in-patient in the hospital
Outpatient Benefits

Section 6: Fee for Medical Service before and after Hospitalization

  • Fee for Diagnostic Tests directly related to Hospitalization - within 30 Days before or after Hospitalization
  • Out-patient Treatment after Hospitalization (Follow-up Treatment) - within 30 Days after Hospitalization

 

Section 7: Fee for OPD Treatment of Injury within 24 Hours of each Accident

  • Medical Expense Benefits - Injury caused by an Accident
  • Received Treatment in the Emergency or Out-patient Department of the Hospital
  • Received Treatment within 24 Hours of each Accident

 

Section 8: Fee for Rehabilitation after Hospitalization

  • Fee for Rehabilitation, Physical Therapy Service, Occupational Therapy
  • Medical Professional Fee for Rehabilitation Physician or Physical Therapist
  • Fee for Equipment and Medical Supplies for Continuous Treatment in the Out-patient Department after Hospitalization

 

Section 9: Medical Service Fee for Treatment of Chronic Renal Failure 

  • Hemodialysis Treatment

 

Section 10: Medical Service Fee for Cancer Treatment

  • Chemotherapy, Interventional Radiology
  • Nuclear Medicine, Brachytherapy
  • Medical Professional Fee for Radiologist performing radiotherapy

 

Section 11: Medical Service Fee for Cancer Treatment by Chemotherapy

  • Medical Expenses of Chemotherapy including Medical Service Fee
  • Targeted Therapy
  • Medical Professional Fee for Physician Providing Treatment

 

Section 12: Emergency Ambulance Service Fee

  • Emergency Ambulance to Transport to and from Hospital according to Medical Necessity on Emergency Ambulance
  • Drugs, Medical Supplies, Medical Professional Fee Incurred during the Transportation of the Insured before being admitted to the Hospital as an In-patient

 

Section 13: Minor Surgery Fee

  • For Medical Expenses Arising from Injury or Illness - Treatment by Minor Surgery 
Renewal

The Company reserves the right not to renew this supplementary contract:

  • There is evidence showing that the Insured did not disclose facts in the application/ reinstatement form or health declaration form, which are material and may cause the Company to charge higher premiums or refuse to enter into the contract.

  • The Insured files a claim for medical treatments that are not medically necessary.

  • The Insured claims for hospital income benefits from all insurers with all combined amount of benefits higher than actual income.

  • The Insured commits an insurance fraud.

 

1) 30-day Waiting Period

  • The Company will not provide coverage for any medical conditions arising out of any diseases during 30-day waiting period from the effective date of this supplementary contract, or on the date that the Company has approved to increase the benefit amounts of this supplementary contract, whichever occurs the latest.

 

2) 120-day Waiting Period

  • Any of the following illnesses that occur during the 120-day period after the effective date of this supplementary contract, or on the date that the company has approved to reinstate this supplementary contract, whichever occurs the latest: Tumor, Cyst, or all types of cancer, Hemorrhoid, All types of hernia, Pterygium or Cataract, Tonsillectomy or Adenoid, All types of stone diseases, Varicose veins in the leg, Endometriosis

 

3) Exclusions and noncoverage

  • General exclusions as specified in this supplementary contract such as birth defects, treatment which is the phases of clinical trials, infertility treatment (including diagnosis and treatment), rehabilitation, or rest cure.

  • Any exclusions, or noncoverage as specified in each of coverage agreement

  • Pre-existing conditions

  • The insured commits an insurance fraud

 

The above statements are only summary of important coverages and exclusions.

For additional details, please refer to the official insurance policy or endorsement.

 

Should you require any further information or intend to transfer your current plan to New Health Standard, please contact your insurance agents and complete the Requisition Form. For additional details, please contact our Customer Service Center  Tel. 1621, Monday – Friday 08:30 A.M. – 07:00 P.M. and Saturday 08:30 – 04:00 P.M. (Service is not available on public holidays)