Coverage and benefits

Optional coverage and benefits (You can choose your coverage and apply for more)

Notes:

• AIA reserves the right to consider and adjust the premium rates and/or terms & conditions of insurance at any policy anniversary date by sending a written notice to the employer at least 31 days prior to the policy anniversary date.
• AIA reserves the right to increase the premium rates subject to AIA guidelines for ex-clients with a past record of policy renewal lapsed due to premium increased
• The applicant is advised to study details of product information/prospectus. After receiving the policy contract and/or Group Member Certificate, it is advised to study the terms and conditions of coverage in the policy contract and/or Group Member Certificate.
• Terms and conditions will be specified in policy contract and/or Group Member Certificate issued to policyholder and/or applicant.
• This material is prepared for the purpose of reference only. For any discrepancies or differences created in translation, the Thai original will prevail.

Group 40 critical illnesses and sickness death benefits Cover for 40 critical illnesses

Coverage benefits

• Death benefit
  • To cover death from sickness, not accidental death (additional coverage from Group Term Life).

• Living benefit
  • To cover sickness from 40 critical illnesses during the lifetime.

Notes:

• Payment of both death benefit and living benefit altogether shall be no more than 100% of the maximum sum assured as stipulated in the schedule of this supplementary contract.
• Benefits shall not be covered for any critical illness or sickness which first occurred prior to the effective date of Insured Member or within 60 days following to the effective of Insured Member.

1. Group of cancers and tumors

1. Invasive Cancer
2. Benign Brain Tumor

2. Group of cardiovascular, respiratory, and circulatory diseases

1. Acute Heart Attack
2. Coronary Artery By-pass Surgery
3. Cardiomyopathy
4. Open Heart Surgery for the Heart Valve
5. Primary Pulmonary Arterial Hypertension
6. Severe Chronic Obstructive Pulmonary Disease / End-stage Lung Disease
7. Aplastic Anemia
8. Surgery to Aorta

3. Groups of diseases involving important organs and systems

1. Chronic Kidney Failure
2. Fulminant Viral Hepatitis
3. Chronic Liver Disease / End-stage Liver Disease / Liver Failure
4. Lupus Nephritis from Systemic Lupus Erythematosus
5. Chronic Relapsing Pancreatitis
6. Severe Ulcerative Colitis or Crohn’s Disease
7. Severe Rheumatoid Arthritis
8. Major Organs Transplantation or Bone Marrow Transplantation
9. Elephantiasis

4. Group of serious injuries and disabilities

1. Blindness
2. Major burn
3. Major Head Trauma
4. Loss of Independent Living
5. Total and Permanent Disability - TPD
6. Loss of Speech
7. Coma
8. Multiple Root Avulsions of Brachial Plexus

5. Group of cerebrovascular diseases, neuromuscular diseases, and sepsis

1. Major Stroke
2. Multiple Sclerosis
3. Bacterial Meningitis
4. Cerebral Aneurysm Requiring Brain Surgery
5. Viral Encephalitis
6. Motor Neuron Disease
7. Alzheimer’s Disease
8. Parkinson’s Disease
9. Apallic Syndrome or Vegetative State
10. Muscular Dystrophy
11. Poliomyelitis
12. Necrotizing Fasciitis and Gangrene
13. Paralysis

Group 40 critical illnesses and sickness death benefit termination

• After the full (100%) sum assured as specified in the schedule of this supplementary contract have been paid to the Insured Member, his/her coverage under 40 GCIR shall be terminated.
• The coverage of basic policy and other benefits are still in effect, such as group life insurance, accident insurance, health insurance.

Underwriting guidelines

Eligibility

• A business group consisting of 50-100 full-time employees for the first year, and 15 -150 for the renewal year, which does not currently hold the same type of group employee benefits with AIA.
• All benefits are available to full-time employees aged 15 years and above and not more than 65 years who are actively at work on the effective date of the group insurance.
• The average age of all employees should not exceed 45 years old.

Participation requirements

• All employees in a company must participate in the group insurance program (on compulsory basis).
• All eligible employees are required to complete the Employee Enrolment Form (Green Card).
• The effective date of the group insurance is the following day after all required documents are obtained and insurability is approved.
• In the case that a new employee requests to participate in the group insurance program during the policy year, the effective date is the first day of his being actively at work or after his probation period (defined as waiting period in the Employer Application Form).

Eligibility of dependents

• All medical benefits and 40 GCIR are available to spouses aged below 65 years and child(ren) at least 2 weeks old and not over 18 years of age and unmarried. Child(ren) can be extended from 18 to 23 years old if still a full-time student and unmarried.
• The eligible dependents must enrol under the same plan as the Insured Employee (for medical coverage and 40 GCIR only).
• In case that the employer requires to extend medical insurance coverage and 40 GCIR to the employee’s dependents, all eligible dependents of all married employees must be insured.
• All eligible dependents are required to complete the Dependent Enrolment Form (White Card).

Occupation class

• All benefits are available to the business with risk exposure not higher than occupation class 2.

Example of occupation class 1: Banks; insurance companies and similar activities; manufacturers of watches, musical instruments or sporting goods; designing or drawing in the office; hotels; and sales and ticketing clerk in the office.

Example of occupation class 2: Actors (excluding stunts); filmmakers; publication of advertisements; places to sell and repair cars; sales and installation of air conditioners; travel agents; tour guides; golf course caddies; and restaurants.

Premium

• Mode of payment is on an annual basis.
• The premiums of all eligible employees and their dependents must be paid by the employer.

Classification of plan

• All eligible employees who are in the same or equivalent position will be insured under the same plan.
• The benefits of the upper position must be higher or equal than the benefits of the lower position.
• One policy can consist of not more than 3 different plans.
• Compulsory coverage for a basic plan is Group Life, Group AD&D, Group TPDI and Medical Benefit (in-patient).
• The difference between the insurance plans should not exceed 3 plan levels. For example, in case that plan 1 is chosen as the lowest plan, the higher plan must not exceed plan 4.
• Supplementary Major Medical (SMM) benefits is optional for the employer to choose and apply for some plans. All eligible employees must participate in the coverage.
• Clinical benefits, dental benefits, out-patient X-ray & lab test benefits, and 40 GCIR are optional for the employer. In case that the employer decides to opt for coverage of clinical benefits and/or dental benefits and/or out-patient X-ray & lab test benefits and/or 40 GCIR, all eligible employees must participate in the coverage.
• Crossing of plans for different benefits is allowed for clinical benefits and/or dental benefits and/or out-patient X-ray and lab test benefits only.
• One policy can choose only one option of clinical benefits (with or without influenza vaccinations & health check-ups).
• 40 GCIR plans must be insured under the same plan(s) as the basic plan(s).
• Maternity benefits shall provide coverage to all female employees and female spouses only (in case coverage is extended to dependents).
• Changes in plans, benefit and amount of insurance shall become effective on each policy anniversary.

Package conversion at policy anniversary date

• In case the number of employees is fewer than 15, it must be converted to Be Together Group S.
• In case the number of employees is more than 150, it must be converted to a Non-Package for which AIA will provide a group insurance proposal. The premium rates will be considered based on the past claims experiences for renewal confirmation.
• The conditions of taking over and waiving pre-existing conditions can be applied for the existing members.

Waiting period

• 40 GCIR Benefit shall NOT be payable for any critical illness other than a diagnosis of critical illness as defined in the contract nor shall it cover any critical illness, the symptoms of which first occurred prior to the effective date of the Insured Member and within 60 days following the effective date of each Insured Member joining.

Exclusions

• Examples of Group Life insurance exclusions

  • The Insured Member voluntarily committed suicide within 1 year after the effective date.
  • The beneficiary intentionally killed the Insured Member.

• Examples of accidental death & dismemberment exclusions

  • War (whether declared or not), revolution or any warlike operations.
  • Participating in riot and civil commotion strikes or terrorist activities.

• Examples of total & permanent disability benefits exclusions

  • While the Insured Member serves as soldier, police, or volunteer and participates in war or crime suppression.
  • While the Insured Member is committing a felony or while the Insured Member is being arrested, under arrest, or escaping the arrest.

• Examples of medical benefits (in-patient) exclusions

  • Pre-existing conditions for which the Insured Member received medical treatment, diagnosis, consultation or prescribed drugs during the 90 days preceding the effective date of his/her coverage, unless the Insured Member affected by these conditions has been insured under supplementary contracts for 12 consecutive months.
  • Pregnancy, miscarriage, abortion or childbirth or complications from pregnancy; infertility (including investigations and treatments) sterilization and birth control.
  • Cosmetic or plastic surgery or any elective surgery or treatment or surgery for congenital anomalies.

Other exclusions will be as specified in the group insurance policy.

• Examples of clinical benefits (out-patient) exclusions

  • Drugs purchased without doctor’s prescription.
  • Eye refractions, fitting of glasses, contact lenses or hearing aids, gingivitis, oral care.

• Examples of dental benefits exclusions

  • Dental appliances such as braces, space maintainers, mouth guards, gutta-percha, implant, night guards.
  • Charges for any dental procedures which are not included in the schedule such as prophylaxis, sealants, fluoride treatments.

• Examples of Group Critical Illness Rider Benefits (40 GCIR) exclusions

  • Benefits shall not be payable for any critical illness if it can be established that the Insured Member sought advice or treatment for symptoms which, in the opinion of the Company, had contributed directly or indirectly to the critical illness prior to the effective date of each Insured Member under this supplementary contract.
  • No benefit shall be payable under this supplementary contract where in the Company’s opinion the critical illness is directly or indirectly due to Acquired Immunodeficiency Syndrome (AIDS) or infection by any Human Immunodeficiency Virus (HIV).

• Examples of out-patient X-ray & lab test benefits exclusions

  • X-ray examinations or laboratory tests unless recommended by a registered medical practitioner for the diagnosis of a Sickness or Injury.
  • An examination made in a hospital if the Insured Member is entitled to any other benefits with respect to such examination under the supplementary contract to which this endorsement is attached.

• Examples of Supplementary Major Medical (SMM) exclusions
  • Benefits shall not cover any Hospital confinement, surgical operation or out-patient treatment caused directly or indirectly, wholly, or partly, by Acquired Immuno-Deficiency Syndrome (AIDS) or any Human Immunodeficiency Virus (HIV).

• Examples of maternity benefits exclusions
  • Benefits shall not be payable if the pregnancy commences before the insurance of the Insured Member becomes effective.

Companies and/or juristic organizations that have never had Group Insurance or have had Group Insurance Policy with other insurance companies and desire to create coverage plans other than the above package must submit information and preliminary documents as specified by AIA Company Limited for consideration and offer of Group Insurance in the form of tailormade or non-package policies.

Documentation requirements

• The Group Insurance Master Application Form (for the employer) is completed and signed by an authorized person on behalf of the employer and stamped (if any).

• Company affidavit issued by the Department of the Business Development cannot be more than 6 months. If it is a copy, it must be signed by an authorized person or someone with the power of attorney appointed as an authorized person on behalf of the employer.

• A copy of the ID card of the signatory (in case of submitting the power of attorney, must attach a copy of the authorized person’s ID card) which has been certified and signed.

• List of all employees including their dependents (if applicable), which is a detailed file with the employee’s ID card number including their dependents (if applicable) in AIA format.

• The Employee Enrolment Form (Green Card) completed by employees.

• The Dependent Enrolment Form (White Card) (If applicable) completed by employees.

• Representation for the policyholder letter of representation for obtaining consent of the Insured Members/ dependents

• Evidence of premium payment (premium must be paid before the effective date of the policy):

  • Payment method, pay via Bill Payment by cash/cheque/TR

    • Pay by cheque, payable to “AIA Company Limited”
    • Transfer to Bangkok Bank account, account name: “AIA Company Limited”.

How to apply

For life insurance consultation, please contact a branch of Bangkok Bank with this service, call 1333
AIA Company Limited Tel. 0 2353 8855 or visit www.aia.co.th