| INTERNATIONAL HEALTHCARE AND PERSONAL ACCIDENT INSURANCE １０００USDプラン SECTION A. - HEALTHCARE INSURANCE The Benefits mentioned in the Table of Benefits are provided to the Insured Person following a Bodily Injury and/or a Sudden Illness as defined herein during the Period of Insurance for actual expenses incurred, subject to a maximum sub-limit specified in the Table of Benefits. |
| Plan | International | |
| 1 | Territorial Scope | Worldwide |
| 2 | Yearly maximum limit per person | US$100,000.00 |
| 3 | Coinsurance (applicable for treatment in USA/Canada on the first US$ 10,000 of covered medical expenses) | 20% |
| IN-PATIENT TREATMENT | ||
| 4 | Room & Board per person per night limit (max. 180 days per year) | US$300.00 |
| 5 | Room and Board per person per night limit - Intensive Care Unit (max. 15 days per year) | US$600.00 |
| 6 | Surgical Charges (while admitted as in-patient) per year limit | US$100,000.00 |
| 7 | Organ Transplantation per year limit | US$100,000.00 |
| 8 | Miscellaneous Hospital Expenses (reimbursement charges for pre-hospitalisation diagnostic tests and for charges incurred during an in-patient stay for medically necessary supplies and services) per year limit | US$20,000.00 |
| 9 | Doctor's visit - not as clinical outpatient (max. 1 visit per day) | Full Refund |
| OUT-PATIENT TREATMENT | ||
| 10 | Specialist Consultation (max. one visit per day) per year limit: o Doctor, specialist consultation o Medication o Clinical test o Surgical procedure |
US$1,000.00 Number of visits: unlimited Amount per visit: unlimited |
| 11 | Post- Hospital treatment (within 30 days of admission and discharge from hospital, subject to prior approval of the Company) per year limit | US$4,000.00 |
| 12 | Home Nursing per year limit | 30 days, 75 USD per day |
| 13 | Emergency Accidental Dental Treatment (for treatment taken within 48 hours following an Accident) | US$15,000.00 |
| 14 | Daycare Surgery (Annual limit for any procedure and treatment where the Insured Person is admitted as a Daycare patient) per year limit | US$12,500.00 |
| 15 | Emergency Accidental Out-patient Services (Annual limit for any procedure and treatment where the Insured Person is admitted as a Daycare patient) | US$15,000.00 |
| ASSISTANCE SERVICE | ||
| 16 | Emergency Medical Transportation | Full Refund |
| 17 | Repatriation in case of Death and incurable condition | US$10,000.00 |
| 17 | Mortem treatment, Coffin and Local Burial | US$1,000.00 |
| 19 | Emergency Compassionate Visit | 1 round trip air ticket (economy class) |
| 20 | Chiropractic, acupuncture and other oriental medical treatment | US$2,000 |
| 21 | Pregnancy complication resulted from accident | US$2,000 |
| 22 | Inoculation: indicated by a Doctor | US$250 |
| Note: The medical expenses insurance herein shall only commence 30 days after the Policy is issued. Nevertheless, this waiting period restriction is not applicable for renewal policies and/or medical expenses claims resulting from Personal Accident. | ||
| SECTION B. - PERSONAL ACCIDENT INSURANCE In case the Insured Person suffers an Accidental Bodily Injury resulting in, within twelve (12) months of the date of Injury, any of the Insured Events set out in the Table of Personal Accident Benefits, the Company will pay the accordingly Benefits stated therein. The Territorial Limit for Personal Accident herein provided is Worldwide Coverage. |
| Sum Assured (in US$) | |
| Age/ | Limit of Indemnity |
| 18 & below | 10,000 |
| 19-64 | 100,000 |
| INSURED EVENTS | THE BENEFITS | |
| Bodily Injury resulting directly in | being a percentage of the Sum Asssured stated in the Schedule | |
| 1. Death | 1 | 100% |
| 2. Permanent Total Disablement | 2 | 100% |
| 3. Permanent and incurable paralysis of all limbs | 3 | 100% |
| 4. Permanent total loss of sight of both eyes | 4 | 100% |
| 5. Permanent total loss of two limbs | 5 | 100% |
| 6. Permanent total loss of one limb | 6 | 80% |
| 7. Permanent total loss of hearing in | 7a. both ears | 80% |
| 7b. one ear | 30% | |
| 8. Permanent total loss of four fingers and thumb of either hand | 8 | 60% |
| 9. Permanent total loss of the lens of one eye | 9 | 50% |
| 10. Permanent total loss of sight of one eyes | 10 | 50% |
| 11. Permanent total loss of four fingers of either hand | 11 | 50% |
| 12. Third degree burns and/or resultant disfigurement which covers more than 40% of the entire external body | 12 | 50% |
| 13. Permanent Disablement not otherwise provided | 13. The Company shall have the absolute discretion to determine and pay such percentage of the sum assured which in the opinion of the Company is not inconsistent with the benefits provided under the insured event 1-12. | |
| 14. Temporary Total Disablement | 14. 0.3% of the sum assured per day The payment of Temporary Total Disablement benefits shall not in any event continue for more than 60 consecutive days and shall not commence until 7 days after the disability occurs. |
| Attained Age | Premium |
| 0 - 18 | 775 |
| 19 - 25 | 893 |
| 26 - 30 | 893 |
| 31 - 35 | 933 |
| 36 - 40 | 1,012 |
| 41 - 45 | 1,130 |
| 46 - 50 | 1,327 |
| 51 - 55 | 1,563 |
| 56 - 60 | 1,878 |
| 61 - 64 | 2,508 |
| Age | USD |
| 1-18 | 24.6 |
| 19-64 | 246 |
| ● The above Premium Schedule is Standard Premium for Occupational Class I |
| ● The Standard Premium multiply by 1.25 for Occupational Class II |
| ● The Standard Premium multiply by 1.5 for Occupational Class III |
| ● The Standard Premium multiply by 2 for Occupational Class IV |
| ● The Premium for person under 18 is unchange |