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Cafeteria Plan - Benefits

Inpatient

UNIT : 1

Maternity

Thailand Zone

Outpatient

Optical Care

Dental Care

Personal Accident

Vaccination

Premium Fees

10,400 per month

COVERAGE & BENEFITS

1. MEDICAL & HOSPITAL BENEFITS PER PARTICIPANT	POLICY LIMIT Up to
Ambulance Services:	165,000
Hospitalization Costs:	11,000,000
Post – Hospitalization Treatment	Nil
Chronic Conditions:First Onset	1,000,000
Chronic Conditions:Ongoing Management	5,500,000
Maternity Care	Nil
Thailand Zone	Nil
2. OUTPATIENT BENEFITS PER PARTICIPANT EFITS PER PARTICIPANT	Up to
Outpatient Benefits	220,000
Optical Care	Nil
3. DENTAL CARE BENEFITS PER PARTICIPANT	Up to
Dental Care Benefits	Nil
4. PERSONAL ACCIDENT BENEFIT PER PARTICIPANT	Up to
Personal Accident Benefits	11,000,000

1. MEDICAL & HOSPITAL BENEFITS PER PARTICIPANT	POLICY LIMIT Up to
Ambulance Services:	165,000
Hospitalization Costs:	11,000,000
Post – Hospitalization Treatment	Nil
Chronic Conditions:First Onset	11,000,000
Chronic Conditions:Ongoing Management	5,500,000
Maternity Care	Nil
Thailand Zone	Nil
2. OUTPATIENT BENEFITS PER PARTICIPANT EFITS PER PARTICIPANT	Up to
Outpatient Benefits	440,000
Optical Care	Nil
3. DENTAL CARE BENEFITS PER PARTICIPANT	Up to
Dental Care Benefits	Nil
4. PERSONAL ACCIDENT BENEFIT PER PARTICIPANT	Up to
Personal Accident Benefits	11,000,000

1. MEDICAL & HOSPITAL BENEFITS PER PARTICIPANT	POLICY LIMIT Up to
Ambulance Services:	165,000
Hospitalization Costs:	11,000,000
Post – Hospitalization Treatment	Nil
Chronic Conditions:First Onset	11,000,000
Chronic Conditions:Ongoing Management	5,500,000
Maternity Care	Nil
Thailand Zone	Nil
2. OUTPATIENT BENEFITS PER PARTICIPANT EFITS PER PARTICIPANT	Up to
Outpatient Benefits	660,000
Optical Care	Nil
3. DENTAL CARE BENEFITS PER PARTICIPANT	Up to
Dental Care Benefits	Nil
4. PERSONAL ACCIDENT BENEFIT PER PARTICIPANT	Up to
Personal Accident Benefits	11,000,000

1. MEDICAL & HOSPITAL BENEFITS PER PARTICIPANT	POLICY LIMIT Up to
Ambulance Services:	165,000
Hospitalization Costs:	11,000,000
Post – Hospitalization Treatment	Nil
Chronic Conditions:First Onset	11,000,000
Chronic Conditions:Ongoing Management	5,500,000
Maternity Care (10 Month Waiting Period)	1,100,000
Thailand Zone:Hospitalization Costs	44,000,000
Thailand Zone:Transportation Costs	2,200,000
Thailand Zone:Transportation Costs for Treatment not available in the Geographic Area	5,500,000
Additional Deductible for Treatment outside the Geographic Area	55,000
2. OUTPATIENT BENEFITS PER PARTICIPANT EFITS PER PARTICIPANT	Up to
Outpatient Benefits	660,000
Optical Care	220,000
3. DENTAL CARE BENEFITS PER PARTICIPANT	Up to
Dental Care Benefits	220,000
4. PERSONAL ACCIDENT BENEFIT PER PARTICIPANT	Up to
Personal Accident Benefits	11,000,000

1. MEDICAL & HOSPITAL BENEFITS PER PARTICIPANT
	INPATIENT 1	INPATIENT 2	INPATIENT 3	INPATIENT 4	INPATIENT 5
Ambulance Services:	165,000	165,000	165,000	165,000	165,000
Hospitalization Costs:	11,000,000	22,000,000	33,000,000	44,000,000	55,000,000
Post – Hospitalization Treatment	Nil	Nil	Nil	Nil	Nil
Chronic Conditions:First Onset	11,000,000	22,000,000	33,000,000	44,000,000	55,000,000
Chronic Conditions:Ongoing Management	5,500,000	5,500,000	5,500,000	5,500,000	5,500,000
	MATERNITY 1	MATERNITY 2	MATERNITY 3	MATERNITY 4	MATERNITY 5
Maternity Care	1,100,000	2,200,000	3,300,000	4,400,000	5,500,000
	THAILAND ZONE 1	THAILAND ZONE 2	THAILAND ZONE 3	THAILAND ZONE 4
Thailand Zone:Hospitalisation Costs	44,000,000	66,000,000	88,000,000	110,000,000
Thailand Zone:Transportation Costs	22,000,000	22,000,000	22,000,000	22,000,000
Thailand Zone:Transportation Costs for Treatment not available in the Geographic Area	55,000,000	55,000,000	55,000,000	55,000,000
Additional Deductible for Treatment outside the Geographic Area	55,000	55,000	55,000	55,000
2. OUTPATIENT BENEFITS PER PARTICIPANT EFITS PER PARTICIPANT
	OUTPATIENT 1	OUTPATIENT 2	OUTPATIENT 3	OUTPATIENT 4	OUTPATIENT 5
Outpatient Benefits	220,000	440,000	660,000	1,100,000	1,540,000
	OPTICAL CARE 1	OPTICAL CARE 2	OPTICAL CARE 3	OPTICAL CARE 4	OPTICAL CARE 5
Optical Care	220,000	440,000	660,000	1,100,000	1,540,000
3. DENTAL CARE BENEFITS PER PARTICIPANT
	DENTAL CARE 1	DENTAL CARE 2	DENTAL CARE 3	DENTAL CARE 4	DENTAL CARE 5
Dental Care	220,000	440,000	660,000	1,100,000	1,540,000
4. PERSONAL ACCIDENT BENEFIT PER PARTICIPANT
	PERSONAL ACCIDENT 1
Personal Accident Benefit	11,000,000
5. VACCINATION
	VACCINATION 1	VACCINATION 2	VACCINATION 3
Vaccination Benefit	110,000	220,000	330,000