Elite Series 2019

LMG Health Insurance

1) Worldwide excluding USA - Cover for cost of inpatient and outpatient emergency treatment caused from sudden injury only

- Cover for cost of inpatient emergency treatment caused from sudden illness only

2) Elective treatment outside Thailand will be covered under following conditions:- - Not cover any treatment in USA

- Pre-approval from LMG before receiving treatment

- Costs are based on treatment in Thailand

Area of Coverage

This brochure is not an insurance contract. The terms and conditions are specified in the policy contract.

The applicant should comprehend details of coverages and conditions before applying an insurance.

Effective from 1st July 2019

LMG18072019

Elite Series 2019

* The coverage is according to the insurance plan selected and subjected to terms and conditions specified by LMG.

Customary and reasonable

medical expenses

subject to maximum limit

per disability

Customary and reasonable medical expense*

Customary and reasonable medical expense*

Customary and reasonable medical expense*

Customary and reasonable medical expense*

8,000 16,000

1,000,000 2,000,000

100,000 200,000

30,000 50,000

100,000 150,000

50,000 75,000

200,000 300,000

200,000 200,000

10,000 15,000

80,000 80,000

10,000 10,000

2. Outpatient Treatment2.1 Doctor fees, medication, hospital services charges and laboratory expenses

2.2 Physiotherapy as outpatient as detemined by a registered physician

2.3 Chiropractic and acupunture treatment as prescribed by a registered physician3. Maternity Benefits3.1 Normal labor, vacuum / forcept delivery, planned caesarian section (280 days waiting period)

3.2 In case of miscarriage (90 days waiting period)

3.3 In case of ectopic pregnancy or emergency ceasarian section from life threatening labour

(280 days waiting period)4. Personal Accident BenifitsLoss of life, dismemberment, loss of sight or permanent disability (PA1) by an accident including

murder & assault, and motorcycle accident as a driver or a passenger 5. Funeral BenefitsFuneral Benefits due to injuries or illness ***6. Benefits Addifional 6.1 Dental benefit (Up to 80% of routine dental treatment)

6.2 Vision benefit (Up to 80% of eye examination & perscription lenses)

1. Inpatient Hospital Expenses1.1 Room and Board Including Nursing’s Fee (Maximum limit per day) 1.1.1 Daily charges for standard room & board, including food and nursing’s services

1.1.2 Daily charges for Intensive Care Unit (ICU) / Coronary Care Unit (CCU)

1.2 General Hospital Expenses 1.2.1 Medication and nutrition IV fluid

1.2.2 Blood and blood component

1.2.3 Laboratory and medical equipment expenses

1.2.4 Physiotherapy treatment

1.2.5 Operating room and equipment expenses

1.2.6 Prescribed medications

1.2.7 Local road ambulance service

1.2.8 Emergency treatment within 24 hours after accident

1.2.9 Expenses occured after discharge from the hospital includes OPD follow up and

IPD physiotherapy after discharged (Maximum 30 days)

1.2.10 Small medical procedure or day case surgery

1.2.11 Private nurse fee recommended by the physician immediate after hospitalization (up to 30 days)

1.2.12 Hospice and palliative care

1.2.13 Expenses for organ transplant, bone marrow transplant, hemodyalysis

(Excluding donor's cost) (Maximum limit per year)**

1.2.14 Inpatient Psychiatric Treatment (Maximum limit per year)

1.3 Surgery Expenses or Surgical Fee (Actual Expenses) 1.3.1 Surgeon's fees

1.3.2 Anesthetist fees / Registered anesthetist nurse fees

1.4 Physician care or Specialist Consulting Fee 1.4.1 Physician's daily or hospital visit

1.4.2 Specialist consultation fees (Surgical and non-surgical)

Silver Gold

Silver Gold

20,000,000 80,000,000

5,000,000 20,000,000

Benefit Schedule Coverage DetailsOverall maximum limit per year

Maximum limit per disability

20%

30%

40%

5%

7. Discount Table7.1 Deductible 50,000 per person per year

Deductible 100,000 per person per year

Deductible 200,000 per person per year

7.2 Family discount for 3 family members or more

LMG18072019

Elite Series 2019Annual premium (included 0.4% stamp duty)

Juvenile (Age 15 Days - 5 Years old)

15 Days - 1 Year

2

3

4

5

50,200

49,800

49,000

48,800

47,900

77,200

76,600

75,400

75,100

73,700

61,700

61,400

61,000

60,500

59,700

102,800

102,300

101,700

100,800

99,500

IPD IPD + OPD IPD IPD + OPD15 Days - 1 Year

2

3

4

5

75,300

74,700

73,500

73,200

71,900

115,800

114,900

113,100

112,700

110,600

92,600

92,100

91,500

90,800

89,600

154,200

153,500

152,600

151,200

149,300

IPD IPD + OPD IPD IPD + OPD

IPD IPD + OPD IPD IPD + OPD IPD IPD + OPD IPD IPD + OPD

Premium table for child include at least one parent as the main policy holder. Premium table for standalone child

Age (Year) Silver Gold Age (Year) Silver Gold

Age (Year) Silver Gold Age (Year) Silver Gold

61

62

63

64

65

66

67

68

69

70

69,700

73,900

78,400

83,100

88,000

93,300

98,900

104,900

111,100

117,800

107,300

113,800

120,600

127,800

135,500

143,600

152,300

161,400

171,100

181,300

88,800

94,200

99,800

105,800

112,200

118,900

126,000

133,600

141,600

150,100

136,900

145,200

153,900

163,100

172,900

183,300

194,200

205,900

218,200

231,300

IPD IPD + OPD IPD IPD + OPD71

72

73

74

75

76

77

78

79

80

124,900

132,400

140,300

148,700

157,600

167,100

177,100

187,700

199,000

210,900

192,200

203,700

216,000

228,900

242,600

257,200

272,600

289,000

306,300

324,700

159,100

168,600

178,700

189,500

200,800

212,900

225,600

239,200

253,500

268,700

245,200

259,900

275,500

292,000

309,600

328,100

347,800

368,700

390,800

414,300

IPD IPD + OPD IPD IPD + OPD

Annual premium (included 0.4% stamp duty) (Renewal year only)Age (Year) Silver Age (Year) Silver GoldGold

LMG18072019

Currency : THB

1 - 5

6 - 10

11 - 25

26 - 35

9,500

13,100

14,100

15,100

3,100

3,100

4,100

4,100

Additional BenefitsAge (Year) Dental Vision

36 - 45

46 - 55

56 - 60

61 - 65 [1]

16,100

17,100

19,100

19,100

4,600

4,600

5,100

5,100

Age (Year) Dental Vision

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

31,100

30,600

30,000

29,200

28,500

27,700

27,200

27,000

26,600

26,300

25,900

25,700

25,200

24,800

24,100

24,700

25,000

25,400

25,700

26,500

28,500

29,000

29,200

29,400

29,900

31,800

32,100

32,200

47,900

47,100

46,100

44,900

43,900

42,600

41,900

41,600

40,900

40,500

39,800

39,500

38,700

38,200

37,100

38,000

38,500

39,100

39,600

40,700

43,900

44,600

44,900

45,200

46,000

49,000

49,400

49,500

39,500

39,400

38,600

37,800

36,500

34,800

34,200

33,200

33,000

32,200

31,200

30,700

29,800

29,400

30,200

30,900

31,500

31,900

32,300

33,500

35,800

36,900

37,300

38,200

38,700

40,500

41,500

42,100

60,800

60,600

59,400

58,200

56,100

53,500

52,600

51,100

50,700

49,600

48,000

47,300

45,800

45,300

46,400

47,500

48,400

49,100

49,700

51,600

55,100

56,800

57,400

58,800

59,600

62,300

63,800

64,700

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

33,000

33,600

34,900

35,600

36,400

36,700

37,200

38,600

39,800

40,400

40,800

41,500

42,900

43,700

44,700

45,500

46,500

49,700

50,400

51,200

51,500

53,400

56,400

57,700

59,700

61,800

62,200

50,800

51,700

53,700

54,800

56,000

56,500

57,300

59,400

61,200

62,200

62,800

63,800

66,000

67,300

68,700

69,900

71,600

76,400

77,600

78,800

79,300

82,100

86,800

88,700

91,900

95,100

95,700

42,400

43,400

45,100

45,900

46,100

47,400

48,700

51,100

52,500

54,300

54,600

56,000

57,500

58,200

58,900

59,600

60,300

62,800

63,900

64,600

66,000

67,700

71,800

74,000

77,500

79,700

81,100

65,200

66,800

69,400

70,600

70,900

72,900

75,000

78,600

80,700

83,500

84,000

86,100

88,400

89,500

90,600

91,700

92,800

96,600

98,300

99,400

101,600

104,200

110,400

113,800

119,300

122,600

124,800

LMG Insurance Public Company Limited19th Fl. 2 Jasmine City Building Soi Sukhumvit 23 Sukhumvit Road

Khlongtoey Nua Wattana Bangkok 10110

Tel 02-648-6272 Email LMGAH@lmginsurance.co.th

Elite Series 2019

Coverage Terms and Conditions :

1. Nursing services and hospital daily charges are included in room and board

2. The total maximum number of days for standard room including Intensive Care Unit (ICU) and Coronary Care Unit (CCU) room is 365 days

3. *Customary and reasonable medical expenses subject to maximum limit per disability stated in the benefit schedule

4. **Item 1.2.13 Expenses for Organ transplant, Bone marrow transplant, Hemodyalysis are combined maximum paid amounts for any expense

in item 1 and 2 (maximum limit per year)

5. The condition of expenses relating to treatment for symptoms arising from the same cause including all complications more than 1 period

of treatment:-

- Treatment for same disability within 90 days from last treatment date, the expenses will be considered under the limit of previous

treatment benefits

- Treatment for same disability more than 90 days from last treatment date, the expenses will be considered under the limit of new

treatment benefits

6. Cost of outpatient emergency treatment due to injury within 24 hours of the accident includes follow up treatments within 15 days of the

first treatment. The Company will pay this benefit according to the actual amounts paid but not exceeds the maximum amount per disability or

the maximum benefit stated in the coverage item whichever is smaller

7. ***180 days waiting period for funeral benefits in case of death by sickness

8. Company reserves the right to cover for lab tests, x-rays, diagnostics & pathology test, MRI, PET & CT scan on a case by case basis for customary

and reasonable medical expenses subject to the maximum limit per disability

9. Cover emergency treatment when travelling outside of Thailand; however, the cover must not more than 90 days per trip

1) 24-hr medical assistance services available for insured traveling over 150 kilometers from resident address or cross border. Trip duration

must be no longer than 90 days

2) Worldwide medical evacuation & repatriation up to 30,000,000 THB

3) Repatriation of mortal remains up to 1,000,000 THB

24-hour International Emergency Medical Evacuation / Repatriation / Assistance Services and Hotline +66 2039 5766

Remark : This materials is for information only. A summary of benefits, terms & conditions and exclusions are specified in the policy contract.

The applicant should comprehend details of coverage and conditions before applying an insurance.

General Exclusions

No payment shall be made for any disability, treatment or service arising directly or indirectly due to:

1. Congenital conditions and birth defects, developmental problems, or genetic problems

2. Acquired Immune Deficiency Syndrome (AIDS), venereal disease and sexually transmitted diseases

3. Routine physical examinations or medical check-ups

4. Please refer to the Policy for detailed list of exclusions.

Insurance Terms and conditions for Renewal Year

• Once your application is approved, your policy will be continue renewal up to age 90 irrespective of your health condition or claims record.

We will not apply additional premium loading on your policy alone by your claims experience. Any adjustments to the benefits, terms and premium

will be made on a portfolio pool basis.

• In the renewal years, the insurance policy can be renewed after underwritten and approved by LMG

• Policy renewal at each anniversary is guaranteed at pool level when the benefits and premium rates shall be revised as well

• This plan’s benefits limit are offered on per policy year basis. After renewal, the benefits annual limit will be reset for the policy year

• For the renewal premium, please refer to the Renewal Invitation

• At the renewal year, 5% family discount will be offered if there are 3 or more family members insured together

• Rates are subject to change without prior notice

Insurance Terms and Conditions

• Eligibility - Applicants must satisfy the following :

1. The applicants age must between 15 days to 60 years old.

2. The juvenile age 15 days - 12 years old must submit full medical record

3. The applicant must be Thai resident or reside in Thailand at least 6 months in 12 months period.

4. All applicants must complete an application form and medical questionnaire. In some cases, we may request additional information.

• [1] For Renewal year only

• Insurance policy will be effective after LMG approves the insurance application

• Premium will be adjusted according to the changing age

• Insurance policy does not cover pre-existing conditions and/or any treatment that are not complete at the time the policy commences

• The annual premium includes 0.4% stamp duty

• This insurance plan and premium is valid until 30th June 2020

• Apply for Family policy, all family members must be covered under the same plan as the policyholder. Families must include at least 1 insured adult

LMG18072019