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Table of benefits as published by Pacific Cross Health Insurance

This is Pacific Cross Health Insurance's own published table of benefits, reproduced word for word in the insurer's own order and grouping. BrokerFish's comparison uses a standardised vocabulary so plans can be compared like for like; this page is the insurer's exact wording.

Source: Pacific Cross Health Insurance — Lifestyle Series brochure: Standard, Standard Plus & Standard Extra, September 2025 and Pacific Cross Health Insurance — Lifestyle Series brochure: Premier & Premier Plus, September 2025 and Pacific Cross Health Insurance — Lifestyle Series brochure: Maxima & Maxima Plus, September 2025 and Pacific Cross Health Insurance — Lifestyle Series brochure: Ultima & Ultima Plus, September 2025 — showing every published column.

From the insurer's published documents

Standard, Standard Plus & Standard Extra Plans
BENEFITS
The benefit schedule provides a summary of the cover provided per period of insurance, the meanings of the defined terms can be found in the definitions section of the policy terms and conditions. All limits in the benefit schedule are expressed in Thai Baht.
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Maximum benefit amount for in-patient per Confinement	270,000	450,000	780,000
INPATIENT BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Section 1: Room and Board, and Medical Service Fee(s) (Inpatient) per Confinement, maximum 45 days	2,000 per day	3,000 per day	4,000 per day
Intensive Care Inpatient Unit, maximum 15 days	4,000 per day	6,000 per day	8,000 per day
Section 2: Medical Expense(s) for Medical Examination(s) or Medical Treatment, Blood and Blood Component Service Fee(s), Nursing Fee(s), Medicine Fee(s), Parenteral Nutrition Fee(s) and Medical Supplies Fee(s) per Confinement	20,000	50,000	100,000
Subsection 2.1: Medical Expense(s) for Medical Examination(s)	Included in Medical Expenses Benefits on Section 2	Included in Medical Expenses Benefits on Section 2	Included in Medical Expenses Benefits on Section 2
Subsection 2.2: Medical Expense(s) for Medical Treatment, Blood, and Blood Component Service Fee(s), and Nursing Fee(s)
Subsection 2.3: Medicine Fee(s), Parenteral Nutrition Fee(s), and Medical Supplies Fee(s)
Subsection 2.4: Medicine Fee(s) and Medical Supplies 1 for Take Home Medicine, maximum 14 days	2,000	3,000	4,000
Section 3: Physician's Fee(s) per Confinement, maximum 45 days	1,200 per day	1,700 per day	2,200 per day
Section 4: Surgical Treatment (Surgery) and Procedure Fee(s) per Confinement	20,000	50,000	100,000
Subsection 4.1: Operating Theater Fee(s) and Procedure Room Fee(s)	Included in Medical Expenses Benefit on Section 4	Included in Medical Expenses Benefit on Section 4	Included in Medical Expenses Benefit on Section 4
Subsection 4.2: Medicine Fee(s), Parenteral Nutrition Fee(s), Medical Supplies and Equipment for Surgery and Medical Procedures	Included in Medical Expenses Benefit on Section 4	Included in Medical Expenses Benefit on Section 4	Included in Medical Expenses Benefit on Section 4
Subsection 4.3: Physician's Fee(s) for Physicians performing Surgery and Medical Procedures (including Assistant) (Doctor Fee(s))
Subsection 4.4: Physician's Fee(s) for Anesthetist (Doctor Fee(s))
Subsection 4.5: Organ Replacement Surgery, Organ Transplant or Replacement of Liver, Heart, Lung, Kidneys and Bone Marrow including Donor's costs per Confinement	40,000	100,000	200,000
Section 5: Major Surgery that does not require hospitalization (Day Surgery)	20,000	50,000	100,000
INPATIENT BENEFIT LEVEL IN THE EVENT OF NON-ADMISSION AS AN INPATIENT
Section 6: Medical Expense(s) for related direct examination before and after Hospitalization as an Inpatient or Outpatient Treatment Fee(s) which is in consequence of or in connection with Hospitalization as an Inpatient per Confinement
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Subsection 6.1: Medical Expense(s) for related direct examination which occurs within 30 days before and/or after Hospitalization as an Inpatient	Included in Hospital Expenses Benefit on either Section 2 or Section 5	Included in Hospital Expenses Benefit on either Section 2 or Section 5	Included in Hospital Expenses Benefit on either Section 2 or Section 5
Subsection 6.2: Outpatient Treatment Fee(s) after Hospitalization as an Inpatient for each consequential Treatment after such discharge from the Hospital within 30 days (excluding Medical Service Fee(s) for examination)
Section 7: Medical Expense(s) for Treatment of an Injury when using the Outpatient benefit must be undertaken within 24 hours of each Accident for ongoing treatment within 15 days	4,000	6,000	8,000
Section 8: Rehabilitation Medicine Fee(s) after each Hospitalization as an Inpatient per Confinement, for ongoing treatment within 30 days	Included in Medical Expenses Benefit on Section 2	Included in Medical Expenses Benefit on Section 2	Included in Medical Expenses Benefit on Section 2
Section 9: Medical Expense(s) for Treatment of Chronic Renal Failure by Hemodialysis through Vascular Access per Policy Year	20,000	50,000	100,000
Section 10: Medical Expense(s) for Treatment of Tumors or Cancers by Radiotherapy, Interventional Radiology, and Nuclear Medicine per Policy Year	Paid in Full	Paid in Full	Paid in Full
Section 11: Medical Expense(s) for Treatment of Cancer by Chemotherapy per Policy Year	Paid in Full	Paid in Full	Paid in Full
Section 12: Ambulance Fee(s)	1,000	1,000	2,000
Section 13: Medical Expense(s) for Minor Surgery	20,000	50,000	100,000
MEDICAL DEVICES AND PERMANENT ARTIFICIAL ORGAN BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Costs of Medical Devices and Permanent Artificial Organs (5 year Waiting Period)	20,000	50,000	100,000
PRIVATE NURSE BENEFIT
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Private Nurse at Home recommended by physician after hospitalization, Limited up to 30 days	Not Covered	Not Covered	10,000
INPATIENT PSYCHIATRIC BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Psychiatric Treatment as an Inpatient	Not Covered	Not Covered	Not Covered
MATERNITY BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Natural Delivery or Planned Caesarean Section without Indication or Medical Necessity	Not Covered	Not Covered	Not Covered
Caesarean Section
Dilation & Curettage, Miscarriage and Ectopic Pregnancy
PERSONAL ACCIDENT BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Loss of Life, Dismemberment, Loss of Sight, Total Permanent Disability due to Accident (Or.Bor.1). Extended to cover driving or riding on a motorcycle and murder or assault.	100,000	100,000	150,000
Additional rate 145 baht/100,000 Baht, maximum additional coverage	1,000,000	3,000,000	3,000,000
ADDTIONAL BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Dental Treatment, pays up to 80% (co-payment 20%)	Not Covered	Not Covered	Not Covered
Eye Examination, Visual Measurement and General Vision Check, pays up to 80% (co-payment 20%)	Not Covered	Not Covered	Not Covered
OUTPATIENT BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Outpatient Medical Treatment (maximum 1 visit per day / 30 visits per year)	1,000	1,500	2,000
Costs of Medicines and Medical Supplies for Take Home Medicines	Included in Outpatient Medical Treatment	Included in Outpatient Medical Treatment	Included in Outpatient Medical Treatment
Medical Expense(s) for diagnosis directly related to Outpatient Medical Treatment	Included in Outpatient Medical Treatment	Included in Outpatient Medical Treatment	Included in Outpatient Medical Treatment
Cost of Outpatient Physiotherapy, Acupuncture and Chiropractic Treatments (included in Outpatient Benefit, maximum 30 visits per year)	Not Covered	3 visits per year	3 visits per year
INTERNATIONAL ASSISTANCE SERVICES
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Worldwide Emergency Assistance: 24 Hours a Day and 7 Days a Week	Fully Indemnified (Worldwide Evacuation)	Fully Indemnified (Worldwide Evacuation)	Fully Indemnified (Worldwide Evacuation)
Emergency Medical EvacuationThe Emergency Medical Evacuation service shall activate while the Insured Person is travelling more than 150 kilometers away from home for less than 90 consecutive days	Fully Indemnified (Worldwide Evacuation)	Fully Indemnified (Worldwide Evacuation)	Fully Indemnified (Worldwide Evacuation)
Premier & Premier Plus Plans
BENEFITS
The benefit schedule provides a summary of the cover provided per period of insurance, the meanings of the defined terms can be found in the definitions section of the policy terms and conditions. All limits in the benefit schedule are expressed in Thai Baht.
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Maximum benefit amount for in-patient per Confinement				1,200,000	3,000,000
INPATIENT BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Section 1: Room and Board, and Medical Service Fee(s) (Inpatient) per Confinement				5,000 per day (maximum 45 days)	Maximum 6,000 Baht per day
Intensive Care Inpatient Unit				10,000 per day (maximum 15 days)	Maximum 12,000 Baht per day
Section 2: Medical Expense(s) for Medical Examination(s) or Medical Treatment, Blood and Blood Component Service Fee(s), Nursing Fee(s), Medicine Fee(s), Parenteral Nutrition Fee(s) and Medical Supplies Fee(s) per Confinement				200,000	300,000
Subsection 2.1: Medical Expense(s) for Medical Examination(s)				Included in Medical Expenses Benefits on Section 2	Included in Medical Expenses Benefits on Section 2
Subsection 2.2: Medical Expense(s) for Medical Treatment, Blood, and Blood Component Service Fee(s), and Nursing Fee(s)
Subsection 2.3: Medicine Fee(s), Parenteral Nutrition Fee(s), and Medical Supplies Fee(s)
Subsection 2.4: Medicine Fee(s) and Medical Supplies 1 for Take Home Medicine, maximum 14 days				5,000	6,000
Section 3: Physician's Fee(s) (Doctor) per Confinement				2,700 per day (maximum 45 days)	Paid in full
Section 4: Surgical Treatment (Surgery) and Procedure Fee(s) per Confinement				200,000
Subsection 4.1: Operating Theater Fee(s) and Procedure Room Fee(s)				Included in Medical Expenses Benefit on Section 4
Subsection 4.2: Medicine Fee(s), Parenteral Nutrition Fee(s), Medical Supplies and Equipment for Surgery and Medical Procedures				Included in Medical Expenses Benefit on Section 4
Subsection 4.3: Physician's Fee(s) for Physicians performing Surgery and Medical Procedures (including Assistant) (Doctor Fee(s))				Included in Medical Expenses Benefit on Section 4
Subsection 4.4: Physician's Fee(s) for Anesthetist (Doctor Fee (s))				Included in Medical Expenses Benefit on Section 4
Subsection 4.5: Organ Replacement Surgery, Organ Transplant or Replacement of Liver, Heart, Lung, Kidneys and Bone Marrow including Donor's costs per Confinement				400,000
Section 5: Major Surgery that does not require hospitalization (Day Surgery)				200,000
INPATIENT BENEFIT LEVEL IN THE EVENT OF NON-ADMISSION AS AN INPATIENT
Section 6: Medical Expense(s) for related direct examination before and after Hospitalization as an Inpatient or Outpatient Treatment Fee(s) which is in consequence of or in connection with Hospitalization as an Inpatient per Confinement
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Subsection 6.1: Medical Expense(s) for related direct examination which occurs within 30 days before and/or after Hospitalization as an Inpatient				Included in Medical Expenses Benefit either on Section 2 or Section 5	Included in Medical Expenses Benefit either on Section 2 or Section 5
Subsection 6.2: Outpatient Treatment Fee(s) after Hospitalization as an Inpatient for each consequential Treatment after such discharge from the Hospital (excluding Medical Service Fee(s) for examination)				Included in Medical Expenses Benefit on either Section 2 or Section 5 (ongoing treatment within 30 days)	Included in Medical Expenses Benefit on either Section 2 or Section 5 (ongoing treatment within 90 days)
Section 7: Medical Expense(s) for Treatment of an Injury when using the Outpatient benefit must be undertaken within 24 hours of each Accident for ongoing treatment within 15 days				10,000	Paid in full
Section 8: Rehabilitation Medicine Fee(s) after each Hospitalization as an Inpatient per Confinement				Included in Medical Expenses Benefit on Section 2 (ongoing treatment within 30 days)	Included in Medical Expenses Benefit on Section 2 (ongoing treatment within 90 days)
Section 9: Medical Expense(s) for Treatment of Chronic Renal Failure by Hemodialysis through Vascular Access per Policy Year				200,000	300,000
Section 10: Medical Expense(s) for Treatment of Tumors or Cancers by Radiotherapy, Interventional Radiology, and Nuclear Medicine per Policy Year				Paid in Full	Paid in Full
Section 11: Medical Expense(s) for Treatment of Cancer by Chemotherapy per Policy Year				Paid in Full	Paid in Full
Section 12: Ambulance Fee(s)				2,000	2,000
Section 13: Medical Expense(s) for Minor Surgery				200,000	Paid in full
MEDICAL DEVICES AND PERMANENT ARTIFICIAL ORGAN BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Costs of Medical Devices and Permanent Artificial Organs (5 year Waiting Period)				200,000	300,000
PRIVATE NURSE BENEFIT
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Private Nurse at Home recommended by physician after hospitalization, Limited up to 30 days				20,000	Paid in full
INPATIENT PSYCHIATRIC BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Psychiatric Treatment as an Inpatient				Not Covered	30,000 Baht / 100,000 lifetime
MATERNITY BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Natural Delivery or Planned Caesarean Section without Indication or Medical Necessity				Not Covered	30,000
Caesarean Section					60,000
Dilation & Curettage, Miscarriage and Ectopic Pregnancy					25,000
PERSONAL ACCIDENT BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Loss of Life, Dismemberment, Loss of Sight, Total Permanent Disability due to Accident (Or.Bor.1). Extended to cover driving or riding on a motorcycle and murder or assault.				150,000	200,000
Additional rate 145 baht/100,000 Baht, maximum additional coverage				5,000,000	5,000,000
ADDTIONAL BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Dental Treatment, pays up to 80% (co-payment 20%)				15,000 (optional)	15,000 (optional)
Eye Examination, Visual Measurement and General Vision Check, pays up to 80% (co-payment 20%)				3,500 (optional)	3,500 (optional)
OUTPATIENT BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Outpatient Medical Treatment (maximum 1 visit per day / 30 visits per year)				2,500	3,000
Costs of Medicines and Medical Supplies for Take Home Medicines				Included in Outpatient Medical Treatment	Included in Outpatient Medical Treatment
Medical Expense(s) for diagnosis directly related to Outpatient Medical Treatment				Included in Outpatient Medical Treatment	Included in Outpatient Medical Treatment
Cost of Outpatient Physiotherapy, Acupuncture and Chiropractic Treatments (included in Outpatient Benefit, maximum 30 visits per year)				3 visits per year	5 visits per year
INTERNATIONAL ASSISTANCE SERVICES
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Worldwide Emergency Assistance: 24 Hours a Day and 7 Days a Week				Fully Indemnified (Worldwide Evacuation)	Fully Indemnified (Worldwide Evacuation)
Emergency Medical EvacuationThe Emergency Medical Evacuation service shall activate while the Insured Person is travelling more than 150 kilometers away from home for less than 90 consecutive days				Fully Indemnified (Worldwide Evacuation)	Fully Indemnified (Worldwide Evacuation)
Maxima & Maxima Plus Plans
BENEFITS
The benefit schedule provides a summary of the cover provided per period of insurance, the meanings of the defined terms can be found in the definitions section of the policy terms and conditions. All limits in the benefit schedule are expressed in Thai Baht.
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Maximum benefit amount for in-patient per confinement						5,000,000	10,000,000
INPATIENT BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Section 1: Room and Board, and Medical Service Fee(s) (Inpatient) per Confinement						Maximum 8,000 Baht per day	Maximum 10,000 Baht per day
Intensive Care Inpatient Unit						Paid in full	Paid in full
Section 2: Medical Expense(s) for Medical Examination(s) or Medical Treatment, Blood and Blood Component Service Fee(s), Nursing Fee(s), Medicine Fee(s), Parenteral Nutrition Fee(s) and Medical Supplies Fee(s) per Confinement
Subsection 2.1: Medical Expense(s) for Medical Examination(s)
Subsection 2.2: Medical Expense(s) for Medical Treatment, Blood, and Blood Component Service Fee(s), and Nursing Fee(s)
Subsection 2.3: Medicine Fee(s), Parenteral Nutrition Fee(s), and Medical Supplies Fee(s)
Subsection 2.4: Medicine Fee(s) and Medical Supplies 1 for Take Home Medicine, maximum 14 days						8,000	10,000
Section 3: Physician's Fee(s) per Confinement						Paid in full	Paid in full
Section 4: Surgical Treatment (Surgery) and Procedure Fee(s) per Confinement
Subsection 4.1: Operating Theater Fee(s) and Procedure Room Fee(s)
Subsection 4.2: Medicine Fee(s), Parenteral Nutrition Fee(s), Medical Supplies and Equipment for Surgery and Medical Procedures
Subsection 4.3: Physician's Fee(s) for Physicians performing Surgery and Medical Procedures (including Assistant) (Doctor Fee(s))
Subsection 4.4: Physician's Fee(s) for Anesthetist (Doctor Fee(s))
Subsection 4.5: Organ Replacement Surgery, Organ Transplant or Replacement of Liver, Heart, Lung, Kidneys and Bone Marrow including Donor's costs per Confinement
Section 5: Major Surgery that does not require hospitalization (Day Surgery)
INPATIENT BENEFIT LEVEL IN THE EVENT OF NON-ADMISSION AS AN INPATIENT
Section 6: Medical Expense(s) for related direct examination before and after Hospitalization as an Inpatient or Outpatient Treatment Fee(s) which is in consequence of or in connection with Hospitalization as an Inpatient per Confinement
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Subsection 6.1: Medical Expense(s) for related direct examination which occurs within 30 days before and/or after Hospitalization as an Inpatient						Paid in full	Paid in full
Subsection 6.2: Outpatient Treatment Fee(s) after Hospitalization as an Inpatient for each consequential Treatment after such discharge from the Hospital for ongoing treatment within 90 days (excluding Medical Service Fee(s) for examination)						Paid in full (within 90 days)	Paid in full (within 90 days)
Section 7: Medical Expense(s) for Treatment of an Injury when using the Outpatient benefit must be undertaken within 24 hours of each Accident for ongoing treatment within 15 days						Paid in full	Paid in full
Section 8: Rehabilitation Medicine Fee(s) after each Hospitalization as an Inpatient per Confinement, for ongoing treatment within 90 days						Paid in full (within 90 days)	Paid in full (within 90 days)
Section 9: Medical Expense(s) for Treatment of Chronic Renal Failure by Hemodialysis through Vascular Access per Policy Year						1,000,000	1,500,000
Section 10: Medical Expense(s) for Treatment of Tumors or Cancers by Radiotherapy, Interventional Radiology, and Nuclear Medicine per Policy Year						Paid in full	Paid in full
Section 11: Medical Expense(s) for Treatment of Cancer by Chemotherapy per Policy Year
Section 12: Ambulance Fee(s)
Section 13: Medical Expense(s) for Minor Surgery
MEDICAL DEVICES AND PERMANENT ARTIFICIAL ORGAN BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Costs of Medical Devices and Permanent Artificial Organs (5 year Waiting Period)						300,000	300,000
PRIVATE NURSE BENEFIT
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Private Nurse at Home recommended by physician after hospitalization, Limited up to 30 days						Paid in full	Paid in full
INPATIENT PSYCHIATRIC BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Psychiatric Treatment as an Inpatient (per time)						50,000 Baht / 200,000 lifetime	75,000 Baht / 300,000 lifetime
MATERNITY BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Natural Delivery or Planned Caesarean Section without Indication or Medical Necessity						100,000	120,000
Caesarean Section						100,000	120,000
Dilation & Curettage, Miscarriage and Ectopic Pregnancy						40,000	50,000
PERSONAL ACCIDENT BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Loss of Life, Dismemberment, Loss of Sight, Total Permanent Disability due to Accident (Or.Bor.1). Extended to cover driving or riding on a motorcycle and murder or assault.						200,000	400,000
Additional rate 145 baht/100,000 Baht, maximum additional coverage						5,000,000	5,000,000
ADDTIONAL BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Dental Treatment, pays up to 80% (co-payment 20%)						20,000 (Optional)	20,000 (Optional)
Eye Examination, Visual Measurement and General Vision Check, pays up to 80% (co-payment 20%)						6,000 (Optional)	20,000
OUTPATIENT BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Outpatient Medical Treatment (Included in Medical Expense(s) Inpatient Benefits)						Paid in full	Paid in full
Costs of Medicines and Medical Supplies for Take Home Medicines						Included in Outpatient Medical Treatment	Included in Outpatient Medical Treatment
Medical Expense(s) for diagnosis directly related to Outpatient Medical Treatment						Included in Outpatient Medical Treatment	Included in Outpatient Medical Treatment
Cost of Outpatient Physiotherapy, Acupuncture and Chiropractic Treatment (Included in Outpatient Benefits)						5 visits per year	7 visits per year
INTERNATIONAL ASSISTANCE SERVICES
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Worldwide Emergency Assistance: 24 Hours a Day and 7 Days a Week						Fully Indemnified (Worldwide Evacuation)	Fully Indemnified (Worldwide Evacuation)
Emergency Medical EvacuationThe Emergency Medical Evacuation service shall activate while the Insured Person is travelling more than 150 kilometers away from home for less than 90 consecutive days						Fully Indemnified (Worldwide Evacuation)	Fully Indemnified (Worldwide Evacuation)
Ultima & Ultima Plus Plans
BENEFITS
The benefit schedule provides a summary of the cover provided per period of insurance, the meanings of the defined terms can be found in the definitions section of the policy terms and conditions. All limits in the benefit schedule are expressed in Thai Baht.
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Maximum benefit amount for in-patient per Confinement								20,000,000	50,000,000
INPATIENT BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Section 1: Room and Board, and Medical Service Fee(s) (Inpatient) per Confinement								16,000 Baht, Maximum limit per day	18,000 Baht, Maximum limit per day
Intensive Care Inpatient Unit								Paid in full	Paid in full
Section 2: Medical Expense(s) for Medical Examination(s) or Medical Treatment, Blood and Blood Component Service Fee(s), Nursing Fee(s), Medicine Fee(s), Parenteral Nutrition Fee(s) and Medical Supplies Fee(s) per Confinement
Subsection 2.1: Medical Expense(s) for Medical Examination(s)
Subsection 2.2: Medical Expense(s) for Medical Treatment, Blood, and Blood Component Service Fee(s), and Nursing Fee(s)
Subsection 2.3: Medicine Fee(s), Parenteral Nutrition Fee(s), and Medical Supplies Fee(s)
Subsection 2.4: Medicine Fee(s) and Medical Supplies 1 for Take Home Medicine, maximum 14 days								16,000	18,000
Section 3: Physician's Fee(s) per Confinement								Paid in full	Paid in full
Section 4: Surgical Treatment (Surgery) and Procedure Fee(s) per Confinement
Subsection 4.1: Operating Theater Fee(s) and Procedure Room Fee(s)
Subsection 4.2: Medicine Fee(s), Parenteral Nutrition Fee(s), Medical Supplies and Equipment for Surgery and Medical Procedures
Subsection 4.3: Physician's Fee(s) for Physicians performing Surgery and Medical Procedures (including Assistant) (Doctor Fee(s))
Subsection 4.4: Physician's Fee(s) for Anesthetist (Doctor Fee(s))
Subsection 4.5: Organ Replacement Surgery, Organ Transplant or Replacement of Liver, Heart, Lung, Kidneys and Bone Marrow including Donor's costs per Confinement
Section 5: Major Surgery that does not require hospitalization (Day Surgery)
INPATIENT BENEFIT LEVEL IN THE EVENT OF NON-ADMISSION AS AN INPATIENT
Section 6: Medical Expense(s) for related direct examination before and after Hospitalization as an Inpatient or Outpatient Treatment Fee(s) which is in consequence of or in connection with Hospitalization as an Inpatient per Confinement
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Subsection 6.1: Medical Expense(s) for related direct examination which occurs within 30 days before and/or after Hospitalization as an Inpatient								Paid in full	Paid in full
Subsection 6.2: Outpatient Treatment Fee(s) after Hospitalization as an Inpatient for each consequential Treatment after such discharge from the Hospital for ongoing treatment within 90 days (excluding Medical Service Fee(s) for examination)								Paid in full (within 90 days)	Paid in full (within 90 days)
Section 7: Medical Expense(s) for Treatment of an Injury when using the Outpatient benefit must be undertaken within 24 hours of each Accident for ongoing treatment within 15 days								Paid in full	Paid in full
Section 8: Rehabilitation Medicine Fee(s) after each Hospitalization as an Inpatient per Confinement, for ongoing treatment within 90 days								Paid in full (within 90 days)	Paid in full (within 90 days)
Section 9: Medical Expense(s) for Treatment of Chronic Renal Failure by Hemodialysis through Vascular Access per Policy Year								2,000,000	3,000,000
Section 10: Medical Expense(s) for Treatment of Tumors or Cancers by Radiotherapy, Interventional Radiology, and Nuclear Medicine per Policy Year								Paid in Full	Paid in Full
Section 11: Medical Expense(s) for Treatment of Cancer by Chemotherapy per Policy Year
Section 12: Ambulance Fee(s)
Section 13: Medical Expense(s) for Minor Surgery
MEDICAL DEVICES AND PERMANENT ARTIFICIAL ORGAN BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Costs of Medical Devices and Permanent Artificial Organs (5 year Waiting Period)								300,000	Paid in full (cover from 1st year)
PRIVATE NURSE BENEFIT
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Private Nurse at Home recommended by physician after hospitalization, Limited up to 30 days								Paid in Full	Paid in Full
INPATIENT PSYCHIATRIC BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Psychiatric Treatment as an Inpatient (per time)								100,000 Baht / 400,000 lifetime	200,000 Baht / 400,000 lifetime
MATERNITY BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Normal delivery or Planned Caesarean section without indication or medical necessity								150,000	200,000
Caesarean Section								150,000	200,000
Dilation & Curettage, Miscarriage and Ectopic Pregnancy								50,000	60,000
PERSONAL ACCIDENT BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Loss of Life, Dismemberment, Loss of Sight, Total Permanent Disability due to Accident (Or.Bor.1). Extended to cover driving or riding on a motorcycle and murder or assault.								400,000	500,000
Additional rate 145 baht/100,000 Baht, mamimum additional coverage								5,000,000	5,000,000
ADDTIONAL BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Dental Treatment, pays up to 80% (co-payment 20%)								80,000	80,000
Eye Examination, Visual Measurement and General Vision Check, pays up to 80% (co-payment 20%)								20,000	20,000
OUTPATIENT BENEFITS
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Outpatient Medical Treatment (Included in Medical Expense Inpatient Benefits)								Paid in full	Paid in full
Cost of Medicines and Medical Supplies for Take Home Medicines								Included in Outpatient medical treatment	Included in Outpatient medical treatment
Medical Expense(s) for diagnosis directly related to Outpatient Medical Treatment								Included in Outpatient medical treatment	Included in Outpatient medical treatment
Cost of Outpatient Physiotherapy, Acupuncture and Chiropractic Treatment (Included in Outpatient Benefits)								7 visits per year	10 visits per year
INTERNATIONAL ASSISTANCE SERVICES
Benefit	STANDARD	STANDARD PLUS	STANDARD EXTRA	PREMIER	PREMIER PLUS	MAXIMA	MAXIMA PLUS	ULTIMA	ULTIMA PLUS
Worldwide Emergency Assistance: 24 Hours a Day and 7 Days a Week								Fully Indemnified (Worldwide Evacuation)	Fully Indemnified (Worldwide Evacuation)
Emergency Medical EvacuationThe Emergency Medical Evacuation service shall activate while the Insured Person is travelling more than 150 kilometers away from home for less than 90 consecutive days								Fully Indemnified (Worldwide Evacuation)	Fully Indemnified (Worldwide Evacuation)