Transcript Bupa Health Insurance (Thailand) - International Relations Division
Bupa Health Insurance (Thailand) Public Company Limited
Present to : Khon Kaen University By : Ms.Chanapat / Bupa Khon Kaen Date :18/08/2014
Bupa Private and Confidential Date if required 1
About Bupa
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
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Bupa Thailand
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 Private and Confidential Date if required 4
Service of Bupa
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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Benefits Plan
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.
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IN-PATIENT Benefits
Benefits Description A ) Room an board
including nursing charge (Max. payable per day)
ICU room and board
including nursing charge
Sapphire Plan 1,400
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 plan
300,000
Baht/ disability
E) Personal Accident
cause of accident - lump sump payment in the event of death or dismemberment
20,000
Baht
OUT-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 Allows 1 visit per day.
Maximum 30 visits per year.
To Use Benefits
1. Using your membership card at our network hospitals
Check the list of hospitals which are in Bupa network
Mark Zuckerburg Contract no:
50054733-00213113
Period of cover :
Show your membership card along with your passport 20/08/2014-20/08/2015 * Membership Card Be covered under the benefit plan you bought
Bupa Network in Khon Kaen
No.
Hospital Name 1.
Srinakarin Hospital (KKU) 2.
Khon Kaen Hospital 3.
Ratchapruek Hospital 4.
Khonkaenram Hospital Government Government Private Hospital Private Hospital Direct Settlement (not to pay first) In-patient Out-patient 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.
2. If you attend a hospital or clinic which is not on our list
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.
For claim with no further investigation required will take not more than 10 working days. Bupa pays your claim by cheque or money transfer.
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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.
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Customers Service Center Tel. 02 232 8666
Email : [email protected]
Our Service includes
• Medical consultation.
• Check your benefit entitlement and eligibility.
• How to maximize your health benefit comparing to the expected expense of your treatment.
• Pre-arrangement the treatment at your choice of hospital or specialist ensuring it is suitable to your entitled benefit.
Bupa Cromwell Hospital – Business Update 17
Thank you. Any questions?
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