bupa private and confidential date if required1 bupa health insurance (thailand) public company...
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Bupa Private and Confidential Date if required 1
Bupa Health Insurance (Thailand) Public Company Limited
Present to : Khon Kaen University
By : Ms.Chanapat / Bupa Khon Kaen
Date :18/08/2014
Bupa’s purpose is ‘to help people live longer, healthier, happier lives’
As a leading international healthcare group, we offer health insurance and medical subscription products, run care homes, retirement villages, hospitals, primary care centres and dental clinics. We also provide workplace health services, home healthcare, health assessments and long-term condition management services.
We have over 26m customers in 195 countries. With no shareholders, we invest our profits to provide more and better healthcare and fulfil our purpose. We employ more than 70,000 people, principally in the UK, Australia, Spain, Poland, New Zealand and Chile, as well as Saudi Arabia, Hong Kong, India, Thailand, China and the USA.
For more information, visit www.bupa.com.
Bupa Private and Confidential Date if required 4
We have been established for over 35 years. Formerly known as Blue Cross Health Insurance, Bupa is the leading health insurance specialist in Thailand.
We now have over 250,000 members and more than 2,000 organizations. With our local knowledge and Bupa's world-wide presence, we ensure that our members have access to some of the best ideas and innovations in the world as well as global health care expertise.
To make quality healthcare accessible, we guarantee lifetime renewal (as per Bupa policy) , enable cashless treatment with our medical card and have the medical network more than 350 in Thailand.
Bupa Thailand
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What Is Covered
Covers expenses arising from
medical treatment that caused from
“INJURY” or “SICKNESS”INJURY means bodily injury which is caused directly and solely from an accident.
SICKNESS means that you have illness or disease.
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Benefit Structure
GETTING TREATED
In-Patient Benefit
Out-Patient Benefit
Personal Accident
You can choose to buy IPD only.Or both IPD and OPD.
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DEFINITIONS
INPATIENT / Hospitalization means you have a condition which justified the occupation of a bed for 6 hours or more.
OUTPATIENT means you require a treatment for a condition which does not require you to occupy a hospital bed.
In some circumstances you may have a surgical procedure which can be performed on an outpatient basis of which is called “Day Case” i.e. mole
excision, cauterization, upper GI endoscopy pterygium excision, breast mass excision. In these cases the actual surgery and its associated costs will be
paid out of your hospitalization benefits.
Per disability (Inpatient) means expenses relating to the continuous treatment in connection with or in relation to one previous injury or sickness arising from other causes occurred at the same time of one hospitalization,
those treatment will be counted as the same disability.
Benefits Description Sapphire Plan
A) Room an board including nursing charge (Max. payable per day)
ICU room and board including nursing charge1,400 Baht/day
2,800 Baht/day
B) Hospital General Expenses• Hospital general expenses including drugs, dressing, x-ray, lab test, physical therapy and use of operating theatre and emergency treatment & 30 days of follow up• ER Accident - first visit within 24 hrs. of emergency & 15 days follow up(including in hospital general expenses)
• Ambulance – maximum per disability
16,000 Baht/disability
2,200 Baht/accident
C) Surgical Fee - pay percentage of benefit in accordance with complexity of procedure as per policy schedule
22,000 Baht/disability
D) Physician ‘s Fee - inpatient physician’s fee for doctor visits (1 visit/day) 300 Baht/day
* MAJOR MEDICAL - pay 80% of benefit in excess of basic in-patient benefits (excluding room, board, nursing service) up to the maximum shown below
Maximum Payable of In-Patient Benefit
Overall maximum inpatient benefit payable under the plan300,000 Baht/ disability
E) Personal Accident - lump sump payment in the event of death or dismemberment cause of accident
20,000 Baht
IN-PATIENT Benefits
SAPPHIRE
Outpatient - Including doctor consultation, drugs, X-ray and laboratory tests (maximum benefit per visit)
• CLASSIC• PLUS• DELUXE
400 Baht/day
500 Baht/day
600 Baht/day
OUT-PATIENT Benefits
Allows 1 visit per day.
Maximum 30 visits per year.
1. Using your membership card at our network hospitals
Check the list of hospitals which are in Bupa network
Show your membership card along with your passport
Be covered under the benefit plan you bought
Room& Board 1,400 / DayHos.Service 16,000Surgery 22,000 (Per Schedule)Doctor’s Visit 300 / DayER Accident 2,200OPD 500
Contract no:50054733-00213113Period of cover : 20/08/2014-20/08/2015
Mark Zuckerburg
*Membership Card
Bupa Network in Khon Kaen
No. Hospital Name Direct Settlement (not to pay first)
In-patient Out-patient
1. Srinakarin Hospital (KKU) Government 2. Khon Kaen Hospital Government 3. Ratchapruek Hospital Private
Hospital 4. Khonkaenram Hospital Private
Hospital If you are admitted to a hospital which is on our hospital list, tell them that you are a Bupa member and show them your membership card, The hospital will contact us to recheck your cover and eligible for benefit.When eligible, hospital will send your bill directly to us for settlement.
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After the treatment, please pay the bill yourself
To obtain reimbursement, you will need to obtain a Doctor’s certificate showing diagnosis, Original receipt and Attending physician’s report.
Submit to Bupa’s Claim Department within 90 days after the treatment.
2. If you attend a hospital or clinic which is not on our list
For claim with no further investigation required will take not more than 10 working days. Bupa pays your claim by cheque or money transfer.
Bupa 16
What Is Not Covered
General Exclusions : Pre-existing conditions.
Treatment for congenital abnormalities. The following disease or conditions are not covered
during the first 6 months of cover in the first policy year – tumors or cancers, polyps, cysts or benign tumors,
hemorrhoids, hernia, pterygium pinguecula and cataract, tonsillectomy or adenoidectomy, stones, varicose veins,
hallux valgus, ganglion and endometriosis. Pregnancy delivery and Miscarriage. Birth control and
treatment infertility. Annual health checks, eye sight examination, eye sight laser treatment, dental and cosmetic treatment (acne,
melasma etc.) HIV / AIDS and HIV related diseases.
Appliances such as spectacle, lens, hearing aids or wheelchair.
Treatment arising from a self-inflicted injury, suicide attempt, alcoholism, drug abuse or sexually transmitted
diseases. Mental illness or stress related conditions.
17Bupa Cromwell Hospital – Business Update
Customers Service Center
Tel. 02 232 8666 Email : [email protected]
Our Service includes
• Medical consultation.Medical consultation.
• Check your benefit entitlement and eligibility.Check your benefit entitlement and eligibility.
• How to maximize your health benefit comparing How to maximize your health benefit comparing to the expected expense of your treatment.to the expected expense of your treatment.
• Pre-arrangement the treatment at your choice of Pre-arrangement the treatment at your choice of hospital or specialist ensuring it is suitable to your hospital or specialist ensuring it is suitable to your entitled benefit.entitled benefit.
Bupa Khon Kaen Branch
Ms.Chanapat Panyachatphol(Branch Manager)
Email : [email protected] : 043 000 666 ext.103Mobile : 089 145 2929