Listening To You

Listening To You

We try to offer the best service at all times but despite our efforts, problems do sometimes occur. When they do, please let us know so that we can put them right as quickly as possible.

Our Customer Services Manager can be contacted on extension 603 or on fax number 0-2632-1133 or email csc@bupa.co.th

If the problem is not settled to your satisfaction please write with full details and any related papers to:

The Managing Director

BUPA Health Insurance

38 Q House Convent Building

9^th Floor, Convent Road,

Silom, Bangrak

Bangkok 10500

Important Events

Important Events

Starting your membership

Your membership starts on the date agreed between the Policyholder and BUPA Health Insurance.

When cover starts for others included in your membership

Membership for each of your dependents (If any) starts on the date as agreed between the Policyholder and BUPA Health Insurance. Their membership may continue for as long as you remain a member of the plan. However, a child dependent will stop being a member on the first renewal date after their 21 st birthday-or on their marriage, whichever happens first.

Renewing your membership

The continuation of your membership is subject to your Policyholder renewing your membership under the agreement.

Ending your membership

The Policyholder can end your membership or that of your dependents at any time by writing to us.

Your membership will automatically end:

· If the agreement between BUPA Health Insurance and the Policyholder is terminated

· If the Policyholder does not renew your membership

· If the Policyholder does not pay premium for you or any other person under the agreement

· Upon the death of the principle member

BUPA Health Insurance can end a person’s membership if there is reasonable evidence that the person concerned has misled, or attempted to mislead us. By this, we mean giving false information or keeping necessary information from us, either intentionally or carelessly, which may influence us when deciding :

· Whether you (or they) may join the plan

· Whether to pay any claim

Terms And Conditions

Terms And Conditions

Please read this in conjunction with your health insurance policy.

1. The Health Insurance Card remains the property of BUPA Health Insurance

2. The Health Insurance Card is not transferable

3. The Health Insurance Card is only valid up until the date shown on the Health Insurance Card or the effective date of deletion or employment termination.

4. The Health Insurance Card is only valid with the member’s photograph or when presented along with an official health insurance card issued by a government agency with the health insurance member’s photo.

5. As soon as the employment is terminated, the membership health insurance card must be returned to us. BUPA Health Insurance

6. will not be responsible for any expenses incurred by the usage of The Health Insurance Card after employment termination.

7. If member lost The Health Insurance Card please submit the request of Health Insurance Card re-issuance together with the police report.

8. The Health Insurance Card facilitates direct settlement of eligible medical expenses only at those hospitals or clinics shown on our hospital and clinic lists.

9. Any eligible expenses will be settled directly in accordance with the Health Insurance benefits shown on the Health Insurance Card. Any ineligible expenses or expenses in excess of the benefits shown on the health insurance card should be settled directly by the health insurance card holder directly with the hospital or clinic.

10. If the health insurance member has a medical condition before the policy commenced, it is recommended that the health insurance member contacts our office prior to the commencement of the treatment to check whether the condition is covered. Presentation of the card does not guarantee reimbursement.

11. In the event of a claim involving a third party, BUPA Health Insurance will settle any eligible medical expenses in excess of those recoverable from the Third party.

12. In the event of the cancellation of the policy, a credit note or the remaining premium will only be reimbursed on receipt of the health insurance card.

How to Make Claim

How to Make Claim

In order to enjoy a high level of service, together with efficient claims settlement, it is important to follow the correct procedures when making your claim. If you are unsure as to whether your condition will be covered by your health insurance plan, please contact one of our advisers before seeing your doctor.

Using your membership card at our network hospitals or clinics

If you are admitted to a hospital which is on our hospital list, tell them that you are a BUPA Health Insurance member and show them your membership card. The hospital will contact us by fax or telephone to recheck your cover and eligibility for benefit. Hospitals which recognize our card will send your bills directly to us for settlement. However, you will be asked to pay for any charges in excess of your benefit levels or any non medical expenses before you leave the hospital.

If you attend a hospital or clinic which is not on our list

If you attend a hospital or clinic not shown on our list you will normally be asked to pay your bills yourself. To obtain reimbursement, you will need to obtain a doctor’s certificate showing diagnosis of condition treated together with an itemized medical expenses bill, original receipt and copy of your membership card. You will also be required to submit the Attending Physician’s Report completed by your treating doctor for the case of hospitalization at non-network hospital. You can either post these to us or bring them to us in person at BUPA Health Insurance, 9^th Floor Q-House Convent Building, 38 Convent Road, Silom, Bangrak, Bangkok 10500 Tel. 0-2234-7755 ext. 835

For claims with no further investigation required will take not more than 7working days. Normally BUPA Health Insurance pays your claim by cheque. However, you may request for “Electronic Money Transfer” for claim reimbursement by filling the form available in this handbook. The completed form must be submitted to BUPA Health Insurance together with the full set of claim reimbursement document.

Remarks : Please note that the supportive documents for claim reimbursement must be submitted within 90 days after discharging from the hospital. After that time we cannot guarantee payment.

Points to remember when making a claim

· We will only pay for treatment you receive while you are a member of your company.

· Payment of your claim will be under the rules and table of benefits of the health insurance plan, subject to any changes agreed with the Policyholder that apply to you at the time you receive the treatment.

· We will only pay for treatment costs and expenses actually incurred by you.

· We will only pay eligible claims if the Policyholder has paid us all the premium due under the agreement.

· We do not have to pay a claim if you or your dependants are breaking any terms or conditions of your membership

· Copy of the receipt will not be accepted for claims reimbursement.

Charges

Please note that we will only pay if the charges are reasonable and customary. By reasonable we mean that the charges are not more than those normally charged by the majority of hospitals or clinics for such treatment or services. By customary we mean that the charges are ones that are normally made by the majority of hospitals or clinics and that they are appropriate to the diagnosis

Excess payments

In the unlikely event that you incur charges in excess of your benefits or the expenses are from ineligible benefits and you do not settle these directly with the hospital or in the event of the treatment for your pre-existing conditions that we are made aware later, we will invoice you separately. Failure to settle these charges within the due date specified in the invoice may result in the cancellation of your membership card.

Recovery

Enjoy your recovery in the knowledge that BUPA Health Insurance will provide prompt settlement of your claim. If you have any questions regarding your claim or your plan please contact one of our advisers who will be pleased to help.

When you need treatment

When you need treatment

Call BUPA Health Insurance first

Before commencing any treatment we recommend that you call any of our advisors at the customer service center tel. 0-2632-1122 or email csc@bupa.co.th. Our fully trained nurses will confirm your level of cover and give you advice on which hospitals and clinics to go to. They are available seven days a week between the hours of 8.00 a.m. to 8.00 p.m. Monday to Friday and 8.00 a.m. to 5.00 p.m. at the weekends and holidays. After office hours, please contact our hotline number at 0-6100-8900

Which hospital can I go ?

You are covered 24 hours and worldwide. However, if you are planning treatment in Canada or in the United States please contact us first. Outside of Thailand you may be expected to pay first and claim later. In the event of an emergency or an accident outside of Thailand you may ask the hospital to contact us and we will then guarantee the charges up to your benefit limits.

In Thailand BUPA Health Insurance membership card is recognized by over 180 hospitals and 60 clinics. With our card you will not be asked for a deposit and all bills for eligible medical treatment within your plan limits will be sent directly to us for settlement. For information about which private hospitals and clinics are closest to your home, please check our hospital and clinic network list.

Where can I get the best Medical care ?

All private hospitals must be licensed by the ministry of Public Health and their doctors must be qualified.

If you are not using a hospital in BUPA Health Insurance network you should check with the hospital that they have the following:-

· 24 hours access to emergency care

· intensive care

· Blood bank

· Doctor on the premises 24 hours a day

· Qualified nursing staff

· Access to EKG equipment and staff trained in resuscitation

What type of accommodation will I have?

The majority of hospitals will have either shared or single accommodation. You may need to check with the hospital how much they will charge and what your policy will cover you for.

Some hospitals charge a room service charge which will not be covered by your health insurance policy.

How do hospitals charge?

Hospitals will normally break down charges into the following areas:-

· Accommodation

· Nursing services

· Hospital general expenses.

· Anesthetist’s fees and anesthesia

· Surgeon’s fees

· Physician’s visits

· Outpatient treatment

Hospital general expenses may include drugs, dressing, X-rays and laboratory tests. Some hospitals may give a more detailed description of these items. The Operating fee is the charge for the use of the operating room and the staff. The surgeon and the anesthetist will also make a charge for performing the operation and for any post operative consultations. Their fees are usually collected by the hospital. The physician’s fee is the charge made by the doctor for visiting you in your hospital room every day.

Ineligible Expenses

Ineligible Expenses

We are also unable to pay for services not related to your medical treatment such as:

· Service charges

· Visitor’s meals

· Telephone, fax, newspaper, TV and video

· Hairdressing and beauty treatments

· Soft drinks

· Rental of medical and non-medical equipment

· Personal sundry items

· Taxi

Additional exclusions for Personal Accident benefit

Additional exclusions for Personal Accident benefit

The loss or injury arising from the following reasons will not be covered under personal

Accident benefit:

1. Infections except pyogenic infections, tetanus, or rabies from a wound or cut suffered as a result of an Accident.
2. Medical treatment or surgical treatment except the necessary treatment for the Injury which is covered under this Health Insurance Policy and occurring within the period of this Health Insurance Policy.
3. Miscarriage and abortion
4. Dental care or root canal treatment unless the treatment is obtained within 7 days from the date of having the Accident.
5. Replacement of or new sets of dentures and crowns.
6. Food poisoning
7. Backache as a result of Herniated Disc, prolapsed Disc, Subluxation or Spondylolisthesis. Degeneration or Spondylosis except if there is a fracture or dislocation of spinal cord as a result of an Accident.

Remark : BUPA Health Insurance will pay for losses arising whilst driving or riding as a passenger on a motorcycle only 50% of the benefit but not more than 200,000 baht or specified otherwise in the policy document.