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 [email protected]
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
Top Related