Your Benefits in Detail

A. Hospitalization
1. Room and Board
Hospital Room and Board (Non-intensive Care Unit)
BUPA Health Insurance will reimburse the cost of accommodation inclusive of nursing care, catering services and the service charge, up to the maximum amount allowed per day but not exceeding the total benefits allowed per disability.

Hospital Room and Board (Intensive Care Unit)
As above but one night in ICU is equal to two nights in a non ICU accommodation

2. Hospital General Expenses
Hospital General Expenses
BUPA Health Insurance will reimburse up to stated maximum amount for each disability the cost of the following :

• Use of the operating room, laboratory tests, medicine, physical therapy, x-rays, dressings and blood administration
• Anesthesia and its administration
  Follow up treatments after the hospitalization
• We will only pay for up to 14 days discharge medication
• We will pay for the outpatient expenses for follow up treatment within 30 days of discharge from hospital and also any further hospitalization in the same disability. The company will pay this benefit according to the amount actually paid or the balance remaining for that disability in the hospital general expenses schedule, whichever is smaller.
  The cover of CT, MRI, Echocardiogram and Exercise Stress Test
• CT, MRI, Echocardiogram and Exeercise Stress Tests will only be paid under the inpatient benefit if it is in association with a condition which is medically necessary. Member is strictly required to contact us at tel. 0-2632-1144 or email csc@bupa.co.th before receiving the tests. The need for further hospitalization will be paid under the Inpatient benefits. If there is only the need for ongoing drug therapy or lab tests, it will be paid under the Outpatient benefit if member is entitled.
  Specialist's Consultation Fees (Included in Hospital General Expenses)
  The specialist's consultation fees where no surgery is performed, pays the actual amount incurred but not more than 10% of the maximum benefit per disability. Sample case : During your hospitalization for peptic ulcer treatment you have the acute ear problem. The ear practitioner is the called to look after you. in this case, the ear practitioner is regarded as the specialist.

3. Surgical Fees

• Surgical Procedure
  BUPA Health Insurance will reimburse the actual amount charged by the surgeon or the percentage of the benefit allowed in the surgical schedule (whichever is smaller) for any one operation or procedure performed. The surgical schedule reflects the complexity of the operation or procedure performed. You are advised to check the surgical's fees before you agree to surgery.
  If the surgical operation performed is not listed in the schedule of surgical procedures, we will determine the maximum surgical benefit for such operation. A surgical operation of equivalent gravity and severity listed in the schedule will be used as a basis for settlement.
  If more than one operation is performed through the same incision, payment will be made for the operation providing the largest benefit.
• Day Case and Outpatient Surgery
  Any surgery performed as a day case or outpatient basis i.e. mole excision, cauterization, upper GI endoscopy pterygium excision, breast mass excision will be eligible for benefit under the inpatient benefit headings. If you do not have outpatient cover it is not necessary to be admitted to qualify for benefit.
• Specialist's Consultation Fee
  The Specialist's consultation fee in case of surgery should not exceed 10% of the maximum payable under this heading.
  

4. Inpatient Physician Care
BUPA Health Insurance will reimburse the fee charged by a physician for care required in connection with the treatment of injury or sickness up to the maximum amount allowed per day and the maximum number of visits for each disability.

5. Emergency Accident Treatment (OPD)
(Included in Hospital General Expenses)
BUPA Health Insurance will pay for services in connection with emergency treatment or surgery carried out in a hospital due to injury within 24 hours of the accident and subject to the maximum limit allowed which includes:

• Initial consultation
• Use of the minor surgery room, laboratory tests, medicine, x-rays and blood administration.
  The maximum amount payable also includes fifteen days follow up treatment after the date of the accident.
  
  Note : Membership card for this emergency accident treatment (OPD) will be accepted only for the first treatment within 24 hours of the accident only. Member is required to pay for the cost of the follow up treatment within 15 days first and submit the relevant document for further claims reimbursement
  

6. Ambulance (Included in Hospital General Expenses)
BUPA Health Insurance will also pay for the appropriate use of an ambulance up to the maximum per
disability stated in the policy.

B. Outpatient Care (Optional)
The outpatient benefit allows one visit per day and a maximum of 30 visits per year or specified otherwise in your policy document. BUPA Health Insurance will reimburse actual expenses up to the stated maximum daily amount for the cost of the followings :

• Doctor consultation
• Medicine
• Laboratory tests
• X-rays
  In the case of minor surgery performed on an outpatient basis, a surgical fee will be paid in accordance with the surgical schedule.

Note : In the unlikely event that you need to see the doctor twice or more per day causing by
different disease i.e. you see the doctor in the morning due to diarrhea and see the doctor again in the afternoon for ear treatment. In this case, BUPA Health Insurance will consider the maximum limit per day instead of the number of visit per day

If you are entitled to other optional benefits i.e. maternity, major medical or dental it is recommended that you check the details of the conditions from your human resources department or the coordinator of you health insurance