Coverage and benefits

Death benefit of AIA Tern 85 (Non-Par)

While the policy is in force and has not been converted to ETI according to the right of policy value as indicated in the policy, The Company shall pay death benefit up to the highest amount among the following:

1. Sum assured as indicated in policy or endorsement (if any)
2. Cash surrender value
3. Total paid premium amount that the Company has received. In addition, in the case that the sum assured amount is reduced while the policy is in force, the total premium will be decreased proportionately to the reduced sum assured.

Important conditions of AIA Term 85 (Non-Par) insurance plan

The Company will not cover the following cases:

1. In case the Insured voids the contract, does not reveal the truth or declares a false statement. However, the Company will not dispute or object to the invalidity of the contract if the Insured is alive for 2 years or more from the contract’s effective date or the latest reinstatement date or the date on which the Company approves the additional sum assured only for an increased portion.
2. The Insured committing suicide within one year from the policy effective date or the latest reinstatement date or the date on which the Company approves the additional sum assured only for an increased portion or is murdered by the beneficiary.
3. The Insured has inaccurately declared their age, and the Company has found out that the actual age is out of the age range on premium rates that the Company is currently using.

Limitation of coverage place liability under the coverage

This rider provides coverage for medical treatment incurred in Thailand.

In case of the medical treatments that are taken place outside of Thailand’s territory, the Company will provide coverage specifically according to the benefits table as follows:

1. Physical injuries from accidents
2. Emergency illnesses in overseas in accordance with the definitions specified in this rider

The first hospitalized date overseas must fall within the first 90 days of travelling outside of Thailand’s territory for each trip. The Company will provide coverage for the necessary and appropriate expenses incurred from the medical treatments in accordance with the medical necessity and standards in each other country. Emergency illnesses overseas refer to:

1. Injury or sudden illness that is life-threatening, for which, if not received timely medical action to correct the respiratory system circulatory system or nervous system, patients have a high chance of dying. or exacerbate the injury or illness of an emergency patient or cause a sudden complication, such as "cardiac arrest", apnea, "shock" from severe blood loss, convulsions continually or convulsions until cyanosis, lethargy, unconsciousness, unconsciousness, severe chest pain from a blocked coronary artery that requires thrombolytic medication, immediate cerebrovascular symptoms that requires fibrinolytic drugs, heavy and persistent bleeding, etc.
2. Injury or illness which is very acute or severe pain that may require urgent medical action. Otherwise, the injury or illness of the emergency patient will be severe or cause complications which can result in death or later disabilities, such as body temperature below 35 degrees Celsius or above 40 degrees Celsius, pulse slower than 40 or faster than 150 beats/minute, systolic blood pressure below 90 mmHg or diastolic greater than 130 mmHg, difficulty breathing or shortness of breath, especially if combined with other clinical features such as unconsciousness, convulsions, paralysis, blindness, sudden deafness, severe blood loss very pale or green, extreme pain or excruciating pain, hands and feet are cold and sweaty, etc., including accidents, especially very large and many wounds, such as major multiple fractures, burns, back injury with or without spinal cord damage, etc.

Important conditions of AIA Health Happy For Kids rider

Waiting period of AIA Health Happy For Kids rider

1. Any illnesses occurring within 30 days following the date on which this rider is issued or reinstated, whichever is later or

2. Any of the following illnesses occurring within 120 days following the date on which this rider is issued or reinstated, whichever is later:

   • All types of Hernia
   • Tonsillectomy or Adenoidectomy
   • Pterygium or Cataract
   • Endometriosis

Pre-existing conditions of AIA Health Happy For Kids

The Company shall not pay any benefit under this rider for chronic disease, injury or illness (including any complication arising therefrom) that is not cured before the contract effective date except:

1. If the Insured has informed the Company and the Company agreed to underwrite the risk without any exclusion, or
2. Chronic disease, injury or illness (including complication) has not shown any symptom and has never been examined or diagnosed by physician or the Insured has never visited or consulted with the physician within 5 years before this rider became effective for the first time and within 3 years after this rider became effective for the first time.

Some exclusions of AIA Health Happy For Kids rider

This rider coverage does not cover an expense from a treatment or any damage that occurred from an injury or an illness (including complications) symptoms or abnormalities from

1. Conditions resulting from congenital disorders or incomplete organ forming system in the body, or genetic disorders or physical development abnormalities, unless this rider has been effective for one year or more and the symptom occurs after the Insured is fully 16 years old.
2. Pregnancy, miscarriage, abortion, delivering a child, complications of pregnancy, infertility issues (including investigation and treatment), sterilization or birth control except choriocarcinoma.
3. Visual sight checkups, LASIK treatment, expenses on apparatus applicable for better visual sight or visual sight malfunction.
4. Treatment or rehabilitation for narcotics, cigarettes, alcoholic drinks or substances affecting mental conditions.
5. Any treatments that are not modern western medicine including alternative medicine.

Requirements and conditions

• Insurable age: 15 days -10 years
• Coverage period^*: Until the age of 85
• Premium payment period^*: Until the age of 84
• Payment mode: Annually / Semi-annually / Quarterly / Monthly

^*AIA Health Happy For Kids has one-year coverage period and one-year premium payment period. The Insured can renew the contract by not exceeding the maximum coverage period of this rider. The Company’s conditions apply to insurance approval.

Premium rates

1. Annual insurance premium for the age of 15 days to 10 years old (depending on gender, age, payment mode and insurance plan)

 

 

 

2. Annual insurance premium for renewal years for the age of 11 to 85 years old (depending on gender, age, payment mode and insurance plan)

 

 

A rider is a one-year and renewable insurance contract. To renew this Rider, the Company reserves the right to change the Insuring Agreement such as adding a Copayment condition according to the rate and criteria as follows.
 

1. 30% copayment rate of the covered expenses shall apply in the case the insured has submit claims cause Simple Diseases from Inpatient benefits at least 3 times or more in a hospital within a policy year, and the claim ratio of insured for such claims under this rider equals or greater than 200%; or
2. 30% copayment rate of the covered expenses shall apply the insured has submit claims from Inpatient benefits at least three 3 times or more in a hospital within a policy year and the claim ratio for such claims of insured under this rider equals or greater than 400%. This provision shall not include treatment expenses for critical illnesses as specifically listed in the document attached hereto (link) and/or major surgery. As mentioned, if the Company applies copayment conditions under this rider according to 1. and 2., the Company will set 50% copayment rate of the covered expenses.

Apart from that, the Company reserves the right to adjust the premium rate during the policy year due to several factors such as age, occupation and claim payment experience, etc. Riders that cover medical expenses may include other factors such as medical inflation rate and medical expenses, or historical claim payments which will be considered in separation of each portfolio and followed to the riders’ conditions which must be approved by the Insurance Commissioner.

Estimated calculation of premium payment mode
 

• Semi-annually = Annual premium rate x 0.51
• Quarterly = Annual premium rate x 0.27
• Monthly = Annual premium rate x 0.09

How to apply

Seek consultation and advice for life insurance planning by contacting Bangkok Bank branches that offer this service, call 1333 or AIA Company Limited Tel. 0 2353 8855, www.aia.co.th