Page 1 of 52 Insurance Policy for Traveling Aboard: SOMPO Travel By relying on the statement in the request for insurance, which is a part of this insurance policy and to repay the insurance premium that the insured shall pay under the requirements of general conditions and provisions, coverage conditions, exclusions, and addendums of this insurance policy, the Company makes promises to the covered recipient as follows: Section 1 Definition The statements and the explanations with specific definition that are given in any parts of this insurance policy shall be considered as having the identical definition, whether they appear in any parts, unless specified otherwise in this insurance policy. 1.1 Insurance Policy means Policy Schedule, general conditions and provisions, coverage agreements, general exclusions, addendums of insurance policy, request form for insurance, endorsement of insurance policy and summary documents for conditions, coverage agreements, and exclusions of this insurance policy that shall be considered as a part of this insurance contract. 1.2 Company means The Company that issues this insurance policy. 1.3 Insured means An individual with the name as Insured in the Policy Schedule, which is the individual who receives the coverage according to this insurance policy. 1.4 Accident means The incident that occurs suddenly from the external factors and affects the Insured without intention or anticipation. 1.5 Injury means The physical injury, which is the direct result from the accident that occurs individually and independently from other causes. 1.6 Illness means Symptoms, abnormalities, illnesses, or diseases that occur with the Insured immediately, suddenly, or unexpectedly by which it shall occur after this insurance policy is effective. Hence, it shall be clearly shown that it occurs by oneself and independent from other causes.
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Page 1 of 52
Insurance Policy for Traveling Aboard: SOMPO Travel
By relying on the statement in the request for insurance, which is a part of this insurance policy and to repay the
insurance premium that the insured shall pay under the requirements of general conditions and provisions, coverage conditions,
exclusions, and addendums of this insurance policy, the Company makes promises to the covered recipient as follows:
Section 1 Definition
The statements and the explanations with specific definition that are given in any parts of this insurance policy
shall be considered as having the identical definition, whether they appear in any parts, unless specified otherwise in this
insurance policy.
1.1 Insurance Policy means Policy Schedule, general conditions and provisions, coverage
agreements, general exclusions, addendums of insurance policy,
request form for insurance, endorsement of insurance policy and
summary documents for conditions, coverage agreements, and
exclusions of this insurance policy that shall be considered as a part
of this insurance contract.
1.2 Company means The Company that issues this insurance policy.
1.3 Insured means An individual with the name as Insured in the Policy Schedule,
which is the individual who receives the coverage according to this
insurance policy.
1.4 Accident means The incident that occurs suddenly from the external factors and
affects the Insured without intention or anticipation.
1.5 Injury means The physical injury, which is the direct result from the accident that
occurs individually and independently from other causes.
1.6 Illness means Symptoms, abnormalities, illnesses, or diseases that occur with the
Insured immediately, suddenly, or unexpectedly by which it shall
occur after this insurance policy is effective. Hence, it shall be
clearly shown that it occurs by oneself and independent from other
causes.
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1.7 Deductible means The amount that the Insured shall be responsible for according to the
coverage agreements and/or the addendums of insurance contract (if
any).
1.8 Doctor means A person who graduates from Doctor of Medicine with registration
from the Medical Council of Thailand and the authorization to
perform the medical professional in the locality that provides the
medical or surgical service.
1.9 Nurse means A person who receives the nursing professional license.
1.10 Inpatient means A person who is admitted in the hospital or the medical health
facility for no less than 6 hours in which the person is needed to be
registered as inpatient by receiving the diagnosis and the suggestion
from the doctor according to the indicators that is the medical
standard in the appropriate period for the treatment, injury, or
illness. It shall include the acceptance as inpatient and then pass
away before completing 6 hours.
1.11 Outpatient means A person who receives the service of the medical treatment in
outpatient department or in emergency room of the hospital or the
medical health facility or the clinic in which there is no necessity
according to the diagnosis and the indicator that is the medical
standard in receiving the treatment as inpatient.
1.12 Hospital means Any infirmary that provides the medical service in which the patient
can stay overnight with the components in terms of place and the
adequate number of medical personnel, including the complete
service management, especially the room for major surgery that
receives the authorization to register as a hospital according to the
health facility law of the territory.
1.13 Medical health facility means Any health infirmary that provides the medical service in which the
patient can stay overnight and receives the authorization to register
as a medical health facility according to the law of the territory.
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1.14 Clinic means The health facility of the conventional medicine that receives
authorization to operate by which the doctor will perform the
medical treatment and diagnose the disease, but is unable to accept
the patient overnight and receives the authorization to register as a
clinic according to the law of the territory.
1.15 Medical standard means The rules or the practical guidelines of the universal conventional
medicine that bring about the treatment plan that is suitable with the
patients according to the medical necessity and conforms with the
summary of the history of injuries, illnesses, detections, biopsy
results, or others (if any).
1.16 Medical necessity means The medical services with the conditions as follows:
(1) It shall conform to the diagnosis and the treatment according
to the condition of injury of illness of the customer;
(2) It shall contain the medical indication clearly according the
current standards of medical practice;
(3) It shall not be done for the convenience of the customer or the
family of the customer or the medical service provider solely; and
(4) It shall be the service of medical treatment according to the
proper standards of patient care according to the necessity of the
condition of injury or the illness of the customer.
1.17 Necessity and reasonable
expense
means The medical treatment and/or any expenses that should be when
comparing with the service providing that the hospital, the medical
health facility, or the clinic has charged from the general patients of
the hospital of the medical health facility, or the clinic that the
Insured has received the treatment.
1.18 Pre-existing condition means The diseases (including complications), symptoms, or abnormalities
that occur with the Insured within 12 months prior to each traveling
date with the importance of seeking for the diagnosis, care, or
treatment.
1.19 AIDS means Acquired Immune Deficiency Syndrome that comes from AIDS
infection, including the opportunistic infection, malignant
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neoplasm, or diseases or any illnesses with the blood test result as
positive of HIV (Human Immuno Deficiency Virus). The
opportunistic infection shall include but not be limited to the disease
that causes organism or chronic enteritis, virus, and/or disseminated
fungi infection. The malignant neoplasm shall include but not be
limited to Kaposi’s Sarcoma, Central Nervous System Lymphoma,
and/or other critical illnesses, which are currently known as
Acquired Immune Deficiency Syndrome or the disease that causes
instant death, illness, or disability. AIDS shall include HIV (Human
Immuno Deficiency Virus), Encephalopathy Dementia, and the
spreading of viruses.
1.20 Insurance policy year means The period of one year as from the effective date of this insurance
policy or as from the date of insurance policy anniversary in the
following years.
1.21 Terrorism means The action that uses power or violence and/or involves the threat
from the individual or any groups of individual, whether they are
sole actions, substitute actions, or those that are relevant with any
organizations or any governments that are done for the political
results, religions, doctrines, or other similar purposes, including the
need to cause the government and/or the public or any parts of the
public to be in the state of fright.
1.22 Emergency assistance
provider
means The company or juristic person or representative of emergency
assistance provider who is authorized by the company that issues
this insurance policy to provide the emergency assistance while
traveling and other services to the Insured as specified in this
insurance contract.
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Section 2 General Conditions and Provisions
2.1 Insurance Contract
This insurance contract occurs when the Company trusts the statement of the Insured in the request form for
insurance and additional statements (if any) that the Insured has signed as evidence to agree with the insurance according to
the insurance contract. Therefore, the Company has issued this insurance contract.
In case the Insured is already aware but has declared the false statement in the statement according to the first
paragraph or already knows the true statement without notifying the Company in which if the Company was aware of the truth,
it might persuade the Company to demand higher insurance premium or refuse to make the insurance contract, this insurance
contract shall be voided according to Section 865 of Civil and Commercial Code and the Company has the right to annul the
insurance contract.
The Company shall not deny the liability by relying on the statement apart from those that the Insured has
declared in the documents according to the first paragraph.
2.2 Completeness of Contract and Modification of Statement in the Insurance Contract
This insurance policy, including the coverage agreements and the addendums, is combined into the insurance
contract. The modification of any statements in this insurance contract shall receive the consent from the Company and shall
be recorded in the insurance policy or in the addendum for completion.
2.3 Insurance Period
The period of each travel of the Insured that starts and ends within the insurance period.
2.3.1 In case of single trip, the coverage shall begin when the Insured has travelled from the residence for
traveling and it has proceeded continuously until the Insured has travelled back to the residence in Thailand (unless specified
otherwise in this insurance policy).
2.3.2 In case of annual trip to provide the coverage for multiple traveling, each coverage period shall be
identical to Item 2.3.1 and the highest travel period shall not exceed 90 days.
If the travel to Thailand of the Insured is delayed from the normal schedule in which it is the incident that cannot
be expected and is beyond the control of the Insured, the Company shall extend the coverage period of this insurance policy
until the Insured has travelled back to Thailand.
The insurance period shall be extended/determined otherwise, depending on each coverage
agreement/addendum.
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2.4 Notification and Claim for Compensation
The Insured, the beneficiary, or the representative of the said individual as the case may be shall notify the
Company about the loss or the damage without delay. In case of death, notify the Company immediately, unless there are
reasonable causes that it shall not be notified to the Company immediately, but it shall be notified as soon as it shall be done.
In case of the claim for compensation, the Insured, the beneficiary, or the representative of the said individual as
the case may be shall submit the evidence or the documents as specified under the coverage agreement and/or each addendum
and additional documents as required by the Company and as deemed necessary to the Company within the specified period of
time by the expenses of oneself.
The non-submission of documents or evidence within the said period shall not disclaim the right to claim if it
can be shown that there are reasonable causes that the documents or the evidence cannot be submitted within the specified
period of time, but it shall be submitted as soon as it can be done.
2.5 Medical Examination
The Company has the right to check the history of medical treatment and the diagnosis of the Insured as deemed
necessary from this insurance and has the right to perform the biopsy in case of necessity in which it shall not contradict the
law by the expenses of the Company.
In case the Insured does not consent for the Company to check the history of medical treatment and the diagnosis
of the Insured to consider for the compensation payment, the Company shall refuse to provide the coverage to the Insured.
2.6 Compensation Payment
The Company shall pay the compensation within 15 days as from the date that the Company has received the
proof of loss or damage completely and correctly. In the compensation for death, the Company shall make a payment to the
beneficiary. Other compensation shall be paid to the Insured.
In case there are reasonable doubts that the abovementioned claim for compensation of the Company according
to the said insurance policy is not in accordance with the coverage agreements in the insurance policy, the specified period
shall be extended as deemed necessary. However, it shall not exceed 90 days as from the date that the Company has received
the documents completely.
If the Company is not be able to pay the compensation within the specified period of time, the Company shall be
responsible for the interest at the rate of 15 percent per year of the amount paid as from the payment due date.
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2.7 Insurance Premium Payment and Rescission of Insurance Policy
2.7.1 The Insured shall pay the insurance premium immediately or before the starting date of the coverage.
2.7.2 In case of single trip, the rescission of insurance policy after the Company has issued the insurance
policy shall not contain the repayment of insurance premium, except for the case that the VISA of the Insured is not approved
with the evidence from the Embassy in which the Insured shall notify the Company prior to the starting date of the coverage.
2.7.3 In case of annual trip, the Insured or the Company shall be able to use the right to rescind the insurance
policy according to the specified condition as follows:
2.7.3.1 The Company shall rescind this insurance policy by sending the letter of notification for
no less than 15 days in advance by registered mail to the Insured according to the address as lastly notified to the Company. In
this case, the Company shall repay the insurance premium to the Insured by deducting the insurance premium for the period
that the insurance policy is effective by proportion.
2.7.3.2 The Insured shall rescind this insurance policy by notifying the Company in letter and shall
have the right to receive the insurance premium after deducting the insurance premium for the period that the insurance policy
is effective. Then, issue according to the rate of short-term insurance premium according to the table as specified below:
Table of Rate of Short-Term Insurance Premium
Insurance Period (Not Exceeding/Month) Percentage of Full-Year Insurance Premium
1 15
2 25
3 35
4 45
5 55
6 65
7 75
8 80
9 85
10 90
11 95
12 100
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The rescission of this insurance policy according to this condition shall not be done by any parties, but shall be
rescinded for the whole policy only. Any part of the coverage shall not be cancelled during the insurance policy year.
2.8 Arbitration Settlement
In case there are disputes, conflicts, or claims under this insurance policy between the claimant according to the
insurance policy and the Company and if the claimant desires and agrees to settle the dispute by arbitration, the Company
agrees to give consent and make final arbitration decision according to the rules of Office of Insurance Commission regarding
the arbitration.
2.9 Precedent Condition
The Company shall be liable to pay the compensation according to this insurance policy when the Insured or the
representative of the said individual as the case may be has practiced correctly and completely according to the insurance
contract and the conditions of the insurance policy.
2.10 Currency and Expenses that Occur in the Foreign Countries
If the compensation that shall be paid according to this insurance policy is in foreign currency, the Company
shall pay the compensation in Thai Baht by using the foreign exchange rate according to the date as specified in the receipt, the
document for the claim for compensation under the coverage agreements, and/or the addendum
Section 3 General Exclusions
The insurance according to this insurance policy shall not cover the losses or the damages that occur or
continue from the causes or the occurrences in the following period (unless the coverage is specified in the coverage
agreement specifically):
3.1 Suicide, suicide attempt, or self-assault
3.2 War, invasion, malicious action of foreign enemy, or malicious action that is similar to war (whether
there is the declaration or not), or civil war or the war between those who live in the same country, militant, rebellion,
insurrection, strike, commotion, revolution, coup d’etat, martial law declaration, or any incidences that might cause the
declaration or maintain the martial law.
3.3 Terrorism
3.4 Illegal actions of the Insured, confiscation, detention, destruction by customs or other officers, and
the violation of government rules
3.5 Radiation or radioactivity from nuclear or any nuclear wastes that come from the combustion of
nuclear fuel and any processes from the disintegration of nuclear that continuously proceeds by itself
Page 9 of 52
3.6 Explosion of radioinfluence or the components of nuclear or other hazardous objects that come from
the explosion in the nuclear process
3.7 While the Insured are acting as solider, police office, or volunteer and has joined in the war or the
suppression
3.8 Occurs in the country or the territory not included in the coverage as specified in the Policy Schedule
and the addendum (if any)
3.9 Occurs around the oil rig, and natural gas rig in the sea or underground mine
Section 4 Coverage Agreement
Under the requirements, general conditions and provisions, general exclusions, coverage agreements, and
addendums of the insurance policy and in order to repay the insurance premium that the Insured shall pay, the Company agrees
to provide the coverage for the coverage agreements as follows:
3
Page 10 of 52
Coverage Agreement
Accidental Death, Dismemberment, Loss of Sight or Total Permanent Disability
Additional Definition
1 Dismemberment means The amputation of the body from wrists to ankles and shall include
the complete impairment of the said organ with the medical
indicators that it cannot function again.
2 Loss of sight means Complete blindness and unable to heal again.
3. Total permanent disability means The disability that occurs and prevents the working in the regular
career and other careers permanently or the inability to perform the
routine activities for 3 types and above by oneself. Hence, the
practice of daily activity means the ability to perform 6 daily tasks,
which are the medical criteria to assess the patients who cannot
perform the said tasks, which are:
(1) Movement ability, such as the ability to move the chair to the
bed by oneself without receiving assistance from other persons or
equipment
(2) Walking or motion ability, such as the ability to walk or move
from one room to another room by oneself without receiving
assistance from other persons or equipment
(3) Dressing ability, such as the ability to wear or remove clothes by
oneself without receiving assistance from other persons or
equipment
(4) Bathing ability, such as the ability to take a shower, including
going in and going out of the bathroom by oneself without receiving
assistance from other persons or equipment
(5) Eating ability, such as the ability to eat by oneself without
receiving assistance from other persons or equipment
(6) Excretion ability, such as the ability to use the toilet for
excretion, including going in and going out of the toilet by oneself
without receiving assistance from other persons or equipment
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Coverage
This insurance covers the losses or the damages that occur from the physical injury of the Insured. For the
accident that occurs during the period of insurance and causes death, dismemberment, loss of sight, or total permanent disability
within 180 days as from the date that the accident occurs or for the injury that the Insured needs to receive the continuous
treatment as a patient in the hospital or the medical health facility and has passed away due to the injury, the Company shall
pay the compensation as follows:
1. 100% of Sum Insured For loss of life
2. 100% of Sum Insured For total disability permanent with clear medical indications that
the Insured is a person with total permanent disability or in case
there are no medical indications but the person has become a person
with total permanent disability for 12 consecutive months as from
the date that the accident occurs.
3. 100% of Sum Insured For both hands from wrists or both feet from ankles or loss of sight
for both eyes
4. 100% of Sum Insured For one hand from wrist and one foot from ankle
5. 100% of Sum Insured For one hand from wrist and the sight of one eye
6. 100% of Sum Insured For one foot from ankle and the sight of one eye
7. 60% of Sum Insured For one hand from wrist
8. 60% of Sum Insured For one foot from ankle
9. 60% of Sum Insured For the sight of one eye
The Company shall pay the compensation according to this item at the highest amount for each list only.
Throughout the period of insurance, the Company shall pay the compensation for the consequence according to
this coverage agreement in the total amount of not exceeding the amount as specified in the Policy Schedule. If the Company
pays the compensation according to this coverage agreement in the amount that does not reach the limit of the sum insured, the
Company shall maintain the coverage until the end of the insurance period in the amount that is equivalent with the remaining
sum insured.
Additional Conditions and Provisions (Shall be enforced only for the Accidental Death, Dismemberment, Loss of Sight
or Total Permanent Disability)
Claim and Submission of Proof of Damage
The Insured, the beneficiary, or the representative of the said individual as the case may be shall notify and
submit the documents or the evidence to the Company within 30 days as from the date for death, dismemberment, loss of sight,
or total permanent disability at its own expense.
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1. In case of dismemberment, loss of sight, or total permanent disability from accident
1.1 Form for claim for compensation as specified by the Company
1.2 Medical report that confirms the dismemberment, loss of sight, or total permanent disability (if any)
1.3 Copy of passport and/or travel evidence of the Insured
1.4 Copy of identification card of the Insured
1.5 Documents or evidence as required by the Company (if any)
2. In case of death from accident
2.1 Form for claim for compensation as specified by the Company
2.2 Death certificate
2.3 Copy of biopsy report
2.4 Copy of daily police report
2.5 Copy of identification card and house registration with the stamp of “Death” of the Insured
2.6 Copy of passport and/or travel evidence of the Insured
2.7 Copy of identification card and house registration of the beneficiary
2.8 Documents or evidence as required by the Company (if any)
The non-submission of evidence within the said period shall not cause the Company to deny the liability.
Additional Exclusions (Shall be enforced only for the Accidental Death, Dismemberment, Loss of Sight or Total
Permanent Disability)
The insurance according to this coverage agreement shall not cover the injuries, the losses, or the damages
due to or those that continue from the cause or the occurrence in the following periods:
1. Action of the Insured while being under any conditions as follows:
(1) While being under the influence of addictive substances or narcotics and is unable to remain
conscious
(2) While being under the influence of liquor with the alcohol level in the body during the examination
equivalent with the alcohol level in blood from 150 milligram percent and above
(3) While being under the influence of liquor and is unable to remain conscious in case there is no
measurement or in case it is unable to measure the alcohol level
2. Receiving diseases and parasites, except infection, tetanus, or hydrophobia that occurs from accidental
wound
3. Miscarriage, except if the miscarriage is the result from the accident directly
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4. Injury that occurs from the Insured who is racing all types of car and boat; horse; all types of ski,
including jet ski; skate; boxing; parachute (except the parachute to save life); and while getting in or getting out or
while riding in the balloon or glider.
5. When the Insured is getting in or getting out or while riding in the aircraft that is not registered for
carrying the passengers and is not the commercial airline
6. When the Insured is driving or performing the duties as the regular officer in any aircraft
7. When the Insured joins in the fight or plays a part in provoking the quarrel
8. When the Insured causes the crime with the serious offense or while being arrested or trying to avoid
being arrested
Page 14 of 52
Coverage Agreement
Overseas Medical Expenses
Additional Definition
Alternative medicine means The diagnosis, medical treatment, or disease prevention by using
Thai medicine, Thai traditional medicine, Chinese medicine, or
other methods that are not the conventional medicine.
Coverage
While the Insured receives the coverage according to this insurance policy, if the Insured receives the injury or
illness abruptly, suddenly, or unexpectedly in which it occurs while the period of insurance is effective in which it results in
the admission in the hospital, medical health facility, or clinic in the foreign countries, whether as inpatient or outpatient,
The company shall pay the compensation for the necessary and reasonable expenses that occur from the medical
treatment according to the medical requirements and the medical standards in the actual amount paid, but not exceeding the
sum insured as specified in the Policy Schedule to the Insured.
The expenses for the medical treatments that are covered are as follows:
1. Doctor fee, such as medical professional fee for general treatment, medical professional fee for surgery and
operation, medical professional fee for anesthetist, dentist fee, and other professional fee.
2. Medication cost; infusion cost; blood and blood component cost, including expenses in separating, preparing,
and analyzing blood transfusion; laboratory and pathology cost; radioactivity diagnosis fee; diagnosis fee by other special
methods, including doctor fee for result interpretation, cost of usage or service providing, medical utensils and equipment
outside the surgery room, medical consumable supplies (Supplies 1), surgery room, and equipment in the surgery room,
excluding the wage for special nurse while admitted the hospital, medical health facility, or clinic.
3. Cost of ambulance in case of emergency for transferring the Insured to and from the hospital or the medical
health facility with the medical reason according to the medical requirements.
4. Cost of take-home medicine according to the medical requirement, but shall not exceed 14 days
5. Room fee for patient in intensive care or standard size of patient room, including cost of food at the hospital
or medical health facility that is provided for the patient and the daily nursing fee
6. Other expenses that are relevant with the medical treatment, such as nursing service fee, medical service fee,
and medical procedure fee
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Additional Conditions and Provision (Shall be enforced only for the Overseas Medical Expenses)
Claim and Submission of Proof of Damage
The Insured, the beneficiary, or the representative of the said individual as the case may be shall notify and
submit the documents or the evidence to the Company within 30 days as from date of discharge from the hospital or the medical
health facility or the clinic at its own expense.
1. Form for claim for compensation as specified by the Company
2. Medical report that specifies significant symptoms, diagnosis results, and treatments
3. Original copy of receipt that shows the list of expenses or the statement summary sheet with receipt
4. Copy of passport and/or traveling evidence of the Insured
5. Copy of identification card of the Insured
6. Documents or evidence as required by the Company (if any)
The receipt that shows the list of expenses shall be the original copy of the receipt and the Company shall return
the original copy of the receipt that certifies the paid amount for the Insured to claim for the missing amount from other insured.
However, if the Insured receives the compensation from the state welfare or other welfares or from other insurances, the Insured
shall submit the copy of receipt that certifies the amount that is paid from the state welfare or other agencies to claim for the
missing amount from the Company.
The non-submission of evidence within the specified period of time shall not cause the Company to deny the
liability.
Additional Exclusions (Shall be enforced only for the coverage agreement and the Overseas Medical Expenses )
The insurance according to this coverage agreement shall not cover the following expenses:
1. Pre-existing condition
2. Treatment or correction of defects of the body since birth
3. Treatment for recreation or sanitation, recuperation, health check-up, and any other treatments that
are not relevant with the injury or the illness
4. Treatment of diseases or conditions that are relevant with psychosis, stress, and insanity, including the
addiction of addictive substances and genetic disorders
5. AIDS, venereal disease, and sexual transmitted disease
6. Any treatments that are relevant with pregnancy, child birth, miscarriage, pregnancy complications,
infertility problems (including analysis and treatment), sterilization, or birth control
7. Medical treatments that are not the conventional treatment plan, including alternative treatment
8. All types of prosthesis, which are canes, glasses, hearing aid, speech device, and all types of defibrillator
Page 16 of 52
9. Services or surgeries that involve the unnecessary injury or illness that seeks profit or for the fraud
from the insurance policy
10. Treatment for beauty, which are treatment of acne, blemish, freckle, dandruff, weight loss, and hair
growth; treatment to correct the defects of the body; or cosmetic surgery, except it is the plastic surgery that is done
due to the accident for the said organ to function as normal
11. Expenses that are relevant with the dental or gum service, except to relieve the injury from the
accident. It shall not include dental restoration, braces, crown, root canal treatment, tooth cleaning, tooth filling, dental
implant, or denture or the nursing treatment fee for the treatments that are necessary for making natural sound due to
the dental treatment from accident
12. Vaccination or injection of vaccines to prevent the disease, except the injection of vaccines to prevent
hydrophobia after being attacked by animals and vaccine to prevent tetanus after receiving the injury
13. Expenses for the medical treatment by which the doctor is the Insured or is the father, mother, spouse,
or child of the Insured
14. Actions of the Insured while being under any of the conditions as follows:
14.1 While being under the influence of addictive substances or narcotics and is unable to remain
conscious
14.2 While being under the influence of liquor with the alcohol level in the body during the
examination in blood from 150 milligram percent and above
14.3 While being under the influence of liquor and is unable to remain conscious in case there is no
measurement or in case the alcohol level cannot be measured
15. Receiving diseases and parasites, except the infection of diseases or tetanus or hydrophobia that comes
from the accidental wound.
16. When the Insured is racing all types of car or boat; horse; all types of ski, including jet ski; skate;
boxing; parachute; playing or racing paramotor, parachute, and glider; while getting in or getting out or transporting
in the balloon; bungee jumping; diving with air tank and underwater breathing respirator (except parachuting and
diving that needs to use air tank and underwater breathing respirator that are done to save life)
17. Injury that occurs while the Insured is getting in and getting out or while traveling in aircraft that is
not registered to carry the passenger and is not the commercial airline
18. Injury that occurs while the Insured is driving or performing the duties as the regular employee in any
aircrafts
19. Injury that occurs while the Insured is joining in a fight or taking part in the provocation for fighting
20. Injury that occurs while the Insured is doing the serious offense or being arrested or escaping the arrest
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Coverage Agreement
Medical Expenses for case follow-up after return to Thailand
Additional Definition
Alternative medicine means The diagnosis, medical treatment, or disease prevention by using
Thai medicine, Thai traditional medicine, Chinese medicine, or
other methods that are not the conventional medicine.
Coverage
While the Insured receives the coverage according to this insurance policy, if the Insured receives the injury or
illness abruptly, suddenly, and unexpectedly in which it occurs during the period of insurance while traveling in the foreign
receives countries and leads to the ongoing medical care or the follow-up in Thailand, the period to request for medical
treatment is as follows:
1. In case the Insured has never received the medical treatment for the said injury or illness in the foreign countries
before, the Insured shall make the request to receive the medical treatment in Thailand within 24 hours as from the date of
returning to Thailand and the ongoing medical care shall not exceed 30 days.as from the date of receiving the first medical
treatment in Thailand
2. In case the Insured has received the medical treatment since being in the foreign countries, the Insured has the
period of 30 days as from the date of returning to Thailand to receive the ongoing medical care in Thailand.
Hence, the Company shall pay the compensation for the expenses that are necessary and reasonable for the
medical treatment according to the medical requirement and the medical standard for the expenses that occur in Thailand
according to the actual amount paid, but shall not exceed the amount of sum insured as specified in the Policy Schedule.
Additional Conditions and Provisions (Shall be enforced only for the coverage agreement for the Medical Expenses for
case follow-up after return to Thailand)
Claim and Submission of Proof of Damages
The Insured, the beneficiary, and the representative of the said individual as the case may be shall notify and
submit the documents or the evidence to the Company within 30 days as from the date of discharge from the hospital or the
medical health facility, or the clinic at its own expense.
1. Form for claim for compensation as specified by the Company
2. Medical report that specifies the significant symptoms, diagnosis results, and treatments
3. Original copy of receipt that shows the list of expenses or the statement summary sheet with the receipt
4. Copy of passport and/or traveling evidence of the Insured
5. Copy of identification card of the Insured
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6. Documents or evidence as required by the Company (if any)
The receipt that shows the list of expenses shall be the original copy of receipt and the Company shall return the
original copy of receipt that certifies the amount paid for the Insured to claim for the missing amount from other insured.
However, if the Insured has received the compensation from the state welfare or other welfare or other insurances, the Insured
shall submit the copy of receipt that certifies the amount paid from the state welfare or other agencies to claim for the missing
amount from the Company.
The non-submission of evidence within the specified period of time shall not cause the Company to deny the
liability.
Additional Exclusions (Shall be enforced only for the Medical Expenses for case follow-up after return to Thailand)
The insurance according to this coverage agreement shall not cover the following expenses:
1. Pre-existing condition
2. Treatment or correction of defects of the body since birth
3. Treatment for recreation or sanitation, recuperation, health check-up, and any other treatments that
are not relevant with the injury or the illness
4. Treatment of diseases or conditions that are relevant with psychosis, stress, and insanity, including the
addiction of addictive substances and genetic disorders
5. AIDS, venereal disease, and sexual transmitted disease
6. Any treatments that are relevant with pregnancy, child birth, miscarriage, pregnancy complications,
infertility problems (including analysis and treatment), sterilization, or birth control
7. Medical treatments that are not the conventional treatment plan, including alternative treatment
8. All types of prosthesis, which are canes, glasses, hearing aid, speech device, and all types of defibrillator
9. Services or surgeries that involve the unnecessary injury or illness that seeks profit or for the fraud
from the insurance policy
10. Treatment for beauty, which are treatment of acne, blemish, freckle, dandruff, weight loss, and hair
growth; treatment to correct the defects of the body; or cosmetic surgery, except if it is the plastic surgery that is done
due to the accident for the said organ to function as normal
11. Expenses that are relevant with the dental or gum service, except to relieve the injury from the
accident. It shall not include dental restoration, braces, crown, root canal treatment, tooth cleaning, tooth filling, dental
implant, or denture or the nursing treatment fee for the treatments that are necessary for making natural sound due to
the dental treatment from accident
12. Vaccination or injection of vaccines to prevent the disease, except the injection of vaccines to prevent
hydrophobia after being attacked by animals and vaccine to prevent tetanus after receiving the injury
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13. Expenses for the medical treatment by which the doctor is the Insured or is the father, mother, spouse,
or child of the Insured
14. Actions of the Insured while being under any of the conditions as follows:
14.1 While being under the influence of addictive substances or narcotics and is unable to remain
conscious
14.2 While being under the influence of liquor with the alcohol level in the body during the
examination in blood from 150 milligram percent and above
14.3 While being under the influence of liquor and is unable to remain conscious in case there is no
measurement or in case the alcohol level cannot be measured
15. Receiving diseases and parasites, except the infection of diseases or tetanus or hydrophobia that comes
from the accidental wound.
16. When the insured is racing all types of car or boat; horse; all types of ski, including jet ski; skate;
boxing; parachute; playing or racing paramotor, parachute, and glider; while getting in or getting out or traveling in
the balloon; bungee jumping; diving with air tank and underwater breathing respirator (except parachuting and diving
that needs to use air tank and underwater breathing respirator that are done to save life)
17. Injury that occurs while the Insured is getting in and getting out or while traveling in the aircraft that
is not registered to carry the passenger and is not the commercial airline
18. Injury that occurs while the Insured is driving or performing the duties as the regular employee in any
aircrafts
19. Injury that occurs while the Insured is joining in a fight or taking part in the provocation for fighting
20. Injury that occurs while the Insured is doing the serious offense or being arrested or escaping the arrest
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Coverage Agreement
Overseas Daily Hospital Income Benefit
Coverage
While the Insured receives the coverage according to this insurance policy, this insurance shall provide the
coverage in case the Insured needs to be admitted in the hospital or the medical health facility as inpatient during the period of
insurance due to injury or illness that occurs abruptly, suddenly, and unexpectedly according to the medical requirements and
the medical standards.
The Company shall pay the daily compensation to the Insured according to the number of days for the admission
in the hospital or the medical health facility as inpatient in the amount of ............ baht per day or as specified in the Policy
Schedule as from the first date for the admission in the hospital or the medical health facility as inpatient in the foreign countries
by which the compensation shall be paid after being admitted in the hospital. Hence, the Company shall pay the compensation
for a total of up to 30 days per each time of injury or illness as from the first date of receiving the treatment as inpatient in the
hospital or the medical health facility and per each travel or according to the time (if any) that is specified in the Policy Schedule.
If the Insured receives injury or illness abruptly, suddenly, and unexpectedly in which the treatment by surgery
or procedure according to the medical requirements as inpatient is needed, but the Insured does not need to be admitted in the
hospital or the medical health facility due to the medical evolution, the Company shall pay the daily compensation to the Insured
for one day (1 day) for the treatment that occurs by surgery or procedure as follows:
1. ESWL (Extracorporeal Shock Wave Lithotripsy)
2. Coronary Angiogram/ Cardiac Catheterization
3. Extra Capsular Cataract Extraction with Intra Ocular Lens