Download Group Insurance - Webster University Thailand

Group Insurance
Webster University Thailand offers additional health and accident insurance to employees according to an
arranged plan and insurance coverage scheme on an annual basis. The extent of cover and type of
benefits provided under the scheme is determined by job position. Further Insurance Scheme Details and
Plan Coverage are available from the HR Department.
Level of Employee
Plan
Schemes
1. Director and above
Plan 1
2. Manager and Head of Academic Department
Plan 2
3. Assistant Manager, Faculty Member and Academic Coordinator
Plan 3
4. Member of Staff
Plan 4
/
Note: Legal spouses of fulltime employees / Faculty members (contract A) can apply for the same plan
and scheme benefits at no cost. However, Life and Accident insurance are excluded. Children of
employees can also join the same plan but the employee is responsible for paying the insurance premium.
Faculty members (contract B) are eligible to apply for the scheme benefits. However, such an employee’s
spouse and children are excluded from applying.
Main contact: in the first instance, please contact your account executive:
Account Executive: Prathan Chuchokaew
E-Mail: [email protected]
Telephone: 02-305-4641
Mobile No: 092-937-0019
In case of special needs, complaints, or other issues, please contact:
Manager:
Yukontorn Viriyaburana
E-Mail: [email protected]
Telephone: 02-305-4661
Existing Insurer
Krungthai AXA Life Insurance Public Co., Ltd.
Insurance Benefits:
Type of Benefits
Employees
Spouse
Children
1. Life Benefit
Covered
Nil
Nil
2. Accident Death & Dismemberment Benefit
Covered
Nil
Nil
3. Group Total Permanent Disability Insurance
Covered
Nil
Nil
4. Health Insurance
Covered
Covered
Nil
4.1 In-Patient (IPD)
Covered
Covered
Nil
4.2 Major Medical
Covered
Covered
Nil
4.3 Out-Patient (OPD)
Covered
Covered
Nil
4.4 Dental Insurance
(For Plan 1 & 2)
(For Plan 1 & 2)
Nil
Eligible Members
•
All regular full-time employees of the Policyholder, from the first date of their employment
Employees of a minimum age of 15 years and a maximum age of 65 years.
Scope of Insurance
•
Coverage is 24 Hours per day, everyday of the year.
•
Coverage is worldwide.
Group Health Insurance
General Coverage: The employee is insured in respect of any illness, surgery, or injury arising from an
accident.
IPD Coverage: The employees is covered if hospitalized and registered as an In-Patient, in accordance
with a physician’s recommendation, for at least 6 hours consecutively.
Group Health Insurance Program: IPD Coverage
1. Daily Room and Board
•
Standard Room and Board
•
Intensive Care Unit
2. General Hospital Expense
•
Other medical service charges which do not constitute room and board and nursing
•
Operating room, diagnosis, medication, blood transfusion and physical therapy charges,
excluding room and board charges
•
Physician’s charges for anesthesia and its administration
•
Ambulance service charge as medically necessary for transportation to or from hospital
•
Follow-up treatment as an outpatient, commencing from the date of hospital discharge
3. Surgical Fee: Coverage for actual surgical charges for each surgery, or according to the surgical
schedule, but not exceeding the maximum benefit as defined in the IPD health insurance plan.
4. In-Hospital Doctor’s Visit Fee: Coverage for in-hospital doctor’s visit equal to the actual expenses,
up to the limitation on the sum and number of days as outlined in the relevant plan per each
separate sickness or injury.
5. Emergency Accident Treatment as an Outpatient: Coverage for emergency accident treatment
and medical treatment carried out within 24 hours of the accident, plus up to 31 days OPD
follow-up, but not exceeding the maximum benefit as specified in the benefit schedule.
6. Specialist’s Consultation Fee: Coverage includes specialist consultancy fees when the doctor incharge has the opinion that the case needs to be referred to a specialist consultant for said
treatment. The amount covered is actual cost, but not more than the maximum fee for specialist
consultancy as specified in the schedule of benefits, per the Supplemental Contract for each
hospital admission.
Major Medical Coverage
The company shall pay medical service fees at the actual amount Co-Insurance 80 % -of occurred for the
amount that is over the amount that the insurance covers as specified in the table of coverage of this
endorsement. However, It is subject to the requirement on excess (If any) or co-insurance (If any) .
Therefore, the company shall pay the benefit to the insured as indicated.
Example
Major Medical Benefit
Detials of IPD
Benefit
Actual Expense
Basic Plan
Room & Board
2,000.00
15,000.00
ค่าห้องและค่าอาหาร
General Expense
25,000.00
40,000.00
ค่าใช้จ่ายท
ั ่ วไป
Surgery Fee
25,000.00
45,000.00
ค่าธรรมเนียมผ่าตัด
Doctor visit / Per day
1,500.00
10,000.00
ค่าแพทย์เยี่ยมต่อวัน
Total Expense
110,000.00
ค่าใช้จ่ายท
ั ้ งหมด
Date of admission : 01.01.2015 - 06.01.2015
Total : 5 days
Exceed amount Co-Insurance 80 %
10,000.00
5,000.00
25,000.00
15,000.00
12,000.00
25,000.00
20,000.00
16,000.00
7,500.00
2,500.00
2,000.00
67,500.00
42,500.00
34,000.00
The above table shows the details of benefits that exceed the IPD coverage. Hence, the major benefits
will be covered the exceed amount 80 % as the above table.
Group Health Insurance Program: OPD Coverage
The coverage includes medical fees when the insured employee is treated as an out-patient, in the case
that the insured has become ill or injured and needs to be treated by a doctor at a hospital, medical
treatment institute, or clinic. The coverage includes actual expenses incurred for such treatment up to but
not exceeding the maximum benefit per event and maximum number of times per year per policy as
specified in the table of coverage.
Exclusion:
1 Medicine which has been bought without prescription.
2. Eye examinations, new glasses, contact lenses, hearing equipment, gingivitis treatment, dental
treatment.
3. Malfunction / dysfunction – including constipation, indigestion, flatulence, and loss of appetite.
Dental Coverage (Exclusive for Plan 1 & 2)
The coverage includes dental benefits in the event that the insured employee becomes ill or injured and
needs to be treated by a dentist at a hospital, medical treatment Institute, or clinic. The coverage
includes remuneration of the actual expenses incurred for such treatment. However, such payment shall
not exceed the benefit amount specified in the table of coverage. For an insured employee who has
participated in this scheme for a period less than one full policy year, the maximum benefit will be
calculated according to the proportion of the period that he/she joined the scheme.
Dental Benefit
1. Oral examination or dental scaling and polishing. (Maximum 2 times / Year).
2. Dental diagnosis – X-ray and laboratory test.
3. Filling, tooth extraction, tooth impaction surgery, and endodontic dentistry. In cases where the insured
is under 12 years old, topical fluoride is included.
Exclusion
1. Teeth Whitening
2. Treatment of a diastema
3. Tooth discoloration treatment
4. Orthodontic treatment – all kinds
5. Oral examination or treatment which is not related to diagnosis or otherwise specified in the scheme of
benefits
6. Teeth examination or treatment as a purpose of cosmetic dentistry
7. Use or change of denture teeth
Using the insurance card
Guide on treatment at the AXA Hospital Network and using the insurance card
Treatment in other hospitals that are not in the AXA network
Group Health Insurance Program: Exclusion
1. Congenital disease or development of a genetic disorder.
2. Cosmetic surgery or treatment, or surgery to solve skin problems such as, pimples, blemishes, spots,
dandruff, falling hair, weight control, or other similar surgery, except reconstructive surgery for wounds
caused from accidents which would normally be covered by the scheme.
3. Pregnancy, miscarriage, abortion, labor, pregnancy complication, infertility (including the procedure of
diagnosis and treatment), sterilization and birth control.
4. Treatment or the use of drugs or any substances used for the purpose of anti-aging, hormone
replacement therapy for menopause, sexual dysfunction, sexual deviation, sex change, or reassignment
surgery, except for reconstructive surgery for a wound caused by an accident which is covered under the
scheme.
5. General health examination, a request from the insured to be admitted to hospital (medical treatment
institute), or a request to carry out surgery, recuperation, rest for recovery after treatment or just rest.
Any diagnosis that is not relevant to the admission to the hospital (medical treatment institute) or clinic.
6. Special nursing service, treatment and diagnosis to find cause that is not medically necessary or
against medical standards.
7. Vision correction, vision improvement, and Lasik treatment, including all related devices and
equipment, except in necessary cases where the injury is caused by an accident.
8. Treatment for drug addiction; cigarette or alcohol related conditions; substance abuse, psychotropic
drug use; or any disease or condition resulting from the use of drugs.
9.Treatment for diseases or symptoms related to the mind, mental disorders, behavioral disorders, or
personality disorders, including Attention Deficit Hyperactivity Disorder (ADHD), autism, stress, eating
disorders, or anxiety.
10.Treatment that is in the process of clinical trials; treatment for obstructive sleep apnea; treatment for
sleep disorders or snoring.
11. Suicide; attempted suicide; self-harm; and attempted self-harm, including attempted self-harm when
carried out by other persons at the request of the insured employee, whether he/she is insane or not.
This also includes accidents happening to the insured employee from his/her eating, drinking, injecting
drugs or poisonous substances into the body, or overdoses of any kind.
12. Injury that occurs as a result of the insured employee’s acts while he/she is drunk on alcohol, or
otherwise unable to control him/herself due to the use of addictive substance or drugs. The phrase
“drunk on alcohol” is defined as the amount of alcohol in the blood being measured by a blood alcohol
test at a level of 150 mg/dL or higher.
13. Injury that occurs while the beneficiary commits a serious crime, or is arrested, or whilst fleeing.
Injury that occurs while the beneficiary is performing his/her duties as military, police, or volunteer work
or operating in a war or in the suppression of unrest.
14. Injury that occurs as a result of war, invasion, terrorism or any actions that lead to war or
antagonism (even though there is no announcement of war), civil war, mutiny, rebellion, insurgence,
strikes, disturbances, revolution, coups, martial law, or any events that lead to the imposition of martial
law.
15. Injury, illness or any condition arising from the release of radioactivity, nuclear energy or other
nuclear fall out resulting from nuclear combustion or other nuclear procedures.
16. Injury, illness or any condition resulting from exposure to radioactivity, nuclear components, or other
dangerous nuclear materials.
For more information, please contact the HR department for details of the individual Insurance Plan