‘Caring is Giving’ Thaivivat Insurance PCL.

Coverage	Sum Insured
Coverage	HLSV01	HLSV02	HLSV03
Overall maximum limit per year	400,000	600,000	800,000
IPD Room & Board incl. nursing service
- Room and board including nursing & service charges (Max per day)	4,000	6,000	8,000
- ICU room and board including nursing and service charges (Max per day)	8,000	12,000	16,000
Hospital general expenses / Disability
- Hospital general expenses / Disability, Incl. follow-up OPD treatments up to max 30 days after discharge	Actual Cost
- Emergency OPD treatment for Accident, incl. follow up treatments up to max 15 days	Actual Cost
Surgical fee per disability
- Surgical fee per disability (Including surgeon's consultations)	Actual Cost
In Patient Physicain's fee for doctor visits
- In-patient Physician's fees for doctor visits (Max 1 visit per day)	Actual Cost
Personal Accident
- Lump Sum payment in the event of death or dismemberment including murder, assault, driving and being passenger on motorcycle	100,000	100,000	100,000
Additional Cover
- Out patient Cover Max 1 Visit per day	2,000 40,000 per year	3,000 60,000 per year	4,000 80,000 per year
- Transportation Cost for IPD case only (Max 30 times per year)	1,000	1,000	1,000

Age	Annual Premium Incl. SBT & Stamp Duty
Age	HLSV01	HLSV02	HLSV03
15 Days - 5 Years	36,000	60,200	100,600
6 - 10 Years	21,000	35,100	58,600
11 - 20 Years	17,000	28,400	47,400
21 - 35 Years	29,000	46,400	74,200
36 - 40 Years	29,000	46,400	74,200
41 - 50 Years	36,000	57,600	92,200
51 - 60 Years	46,000	73,600	117,800
61 - 70 Years	59,000	88,500
71 - 75 Years	81,000
76 -100 Years (Renewal Only)	120,000

Download Health Application Form

Remarks :

Eligibility requirements for the Thaivivat Health Insurance for Long Stay Visa Plans:

1.1 Nationality:

Japan	Australia	Denmark	Finland
France	Germany	Italy	The Netherlands
Norway	Sweden	Switzerland	United Kingdom (incl. Northern Ireland)
Canada	United States of America

1.2 Main applicant must be between 50 - 75 years of age at first entry, and can then renew for life.
1.3 Applicant's dependents can be aged 15 days - 75 years of age at first entry, and can renew as long as main applicant renews.

This insurance will not pay the benefits for any sickness during the first 30 days from the first policy commencement date.
This Insurance will not pay any benefits during the first 120 days from the first policy commencement date for the following diseases:
1. 3.1 Benign or malignant tumor or cancer or cystic mass
2. 3.2 Hemorrhoids
3. 3.3 Hernias
4. 3.4 Pterygium, pinguecula, cataract
5. 3.5 Tonsillectomy or adenoidectomy
6. 3.6 Stones
7. 3.7 Varicose Veins
8. 3.8 Endometriosis
Pre-existing condition(s), chronic disease(s) or /and HIV, AIDS are not covered under this policy, unless pre-existing/chronic condition has been explicitly accepted in writing at time of application.
Applicant must send the filled out and signed health application form together with a copy of passport for the company's consideration, and premium must be paid before coverage can commence.
The English language used in this table of benefits is merely a translation of the Thai Version.
Other terms, conditions and exclusions subject to the original Health and Personal Accident Insurance Policy wordings.

For more information, please contact:
Thaivivat Insurance PCL.
Thaivivat Insurance Building, 71 Din Daeng Road, Samsen Nai, Phaya Thai, Bangkok 10400
Telephone: +662-695-0800 or 1231 Ext.4901 Fax. +662-695-0808
Email: dutsadee_wan@thaivivat.co.th