/ Small Business Enterprise Plan

/ Bupa Health Insurance Table of Benefits

/ BENEFITS ( )
/ DESCRIPTION INPATIENT BENEFIT LIMIT (BAHT)
1/
2 /
3 /
4 /
5 /
6 /

7 / / INPATIENT AND DAY BENEFITS

Plan 1
Plan 2
Plan 3
Plan 4
Plan 5
Plan 6
Plan 7
8 / Plan 8
/ ROOM AND BOARD
/ Room and board including nursing service 1,000 1,200 1,500 1,700 2,000 2,500 3,000 4,000
(Maximum payable per day) / ICU room and board
including nursing 2,000 2,400 3,000 3,400 4,000 5,000 6,000 8,000 and service charges (Maximum payable per day)
/ HOSPTAL GENERAL EXPENSES
, , , , 15,000 18,000 20,000 25,000 30,000
40,000 50,000 60,000 , ( ) / Hospital
general expenses including drugs, dressing, X-ray, laboratory tests, physical therapy and use of operating theatre
and emergency treatment. (Maximum payable per disability)
( 24 ) 4,000 4,000 5,000 5,000 6,000 7,000 8,000
9,000 15 (
) / Emergency treatment - first visit within 24 hours of emergency and fifteen
days follow up (Included in hospital general expenses)
- 3,000 3,000 4,000 4,000 5,000 6,000 7,000
8,000 ( ) / Specialist's
consultation fees in connection with an operation or no operation - maximum per disability. (ncluded in surgical fee or
hospital general expenses). -
1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 ( ) /
Ambulance - maximum payable per disability. (ncluded in hospital general expenses)
/ SURGICAL FEE ( ) / Surgical fee per
disability 25,000 30,000 35,000 40,000 45,000 55,000 65,000 70,000 (pays percentage of benefit in accordance with
complexity of the procedure as per policy schedule.) / PHYSICIAN'S FEE
( 1 /) / n-patient 500 600 700 800 900 1,200
1,300 1,500 physician's fees for doctor visits (one visit per day) / PERSONAL
ACCIDENT (.2) ,
/ Personal 100,000 150,000 200,000 250,000 300,000 400,000 500,000 600,000
Accident - lump sum payment in the event of death or dismemberment
/ OPTIONAL BENEFIT
/ MAJOR MEDICAL
80%
( )
/ Major medical pays 80% of eligible
medical expenses in excess of the basic inpatient benefits (excluding room and board) up to the maximum shown
below / Overall maximum
inpatient 100,000 150,000 200,000 250,000 300,000 400,000 500,000 600,000 benefit payable per disability under
the plan
/ OUTPATENT (PER VST)
, , 400 500 600 700 800 1,000 1,200 1,500
( 1 30 ) / ncludes doctor
consultation, drugs, X-ray and laboratory test (maximum benefit per visit/ 1 visit per day / maximum of 30 visits per
year) / ADDITIONAL PA COVER (.2)
,
( 50%) / Personal Accident - additional lump sum payment in the
event of death or dismemberment (cover motorcycle accident 50%) PA 200 200,000 PA 400 400,000
S-PD-20 REV.1


/ Remarks
/ Conditions for Health nsurance 1.
5-25 / For group sizes
5-25 persons. 2. 15-60
40 /
Full time employees age 15 - 60 years and average age of all employees should not exceed 40 years. 3.

2 / Business type is not higher than class 2. 4.

/ All employees in company must participate in the group insurance program
and who are in the same or equivalent position will be insured under the same plan. 5.

/ Dependent must enroll under lower or the same plan as the
insured employee. 6. 1 3 / One policy
can consist of not more than 3 different plans. 7.
3 / The difference between the insurance plans should not exceed 3 plans levels.
/ Health Insurance
/ This table of benefits should be read in conjunction with your policy
documentation. -


90 / Inpatient expenses are payable for any one disability. This
means expenses relating to treatment for a condition or symptoms arising from the same cause including all
complications. If the same disability should reoccur 90 days must elapse from the last treatment date for that disability
to be considered a new disability. -
MR, CT Scans ECGs



/ Expensive tests such as MRI, CT Scans and Stress ECGs will normally be paid under
the outpatient benefit unless such tests have been authorized in advance. If pre-authorized they will be reimbursed
under the Hospital General Expenses benefit heading. -
(Small Business Enterprise) 65

/ Small Business Enterprise
members are covered up to and including the age of 65 year only. Thereafter they have the option of transferring to
Personal Care membership. -
5
/ f you have more than one policy with Bupa Health nsurance, the maximum amount insured for any one
disability is 5 million baht. / Personal Accident -

1,000,000 / If
you have more than one Bupa policy the cumulative maximum amount of the sum insured is 1 million baht. -

20,000,000
/ The cumulative maximum amount of the sum insured of all employees and dependents are 20,000,000 baht.
/ Major Exclusions
/ Health nsurance



/ Although you will be
covered for the major costs of treatment, there are certain things that Bupa has to excluded. Full details of these can
be found in your policy document. Some of the conditions which we cannot pay for are shown below: -
,
/ Pre-existing conditions, Treatment for congenital abnormalities. -
/ Treatment which is
not recommended by a doctor. -
/ Pregnancy delivery and miscarriage. Birth
control and treatment of infertility. - / Hormone replacement therapy. -
.
/ Expenses recoverable from a third party including Workmen Compensation Act and
Victim's Act. - ,
, , /
Treatment arising from a self inflicted injury, suicide attempt, alcoholism, drug abuse or sexually transmitted diseases.
-
/ Routine and annual
health checks, eye sight examination, eye sight laser treatment such as LASIK, dental and cosmetic treatment (Acne,
Melasma etc.) - / HV/ ADS and HV related illnesses. -
/ Appliances
such as spectacles, lenses, hearing aids or wheelchairs. -
/ Alternative treatment such as Acupuncture, macrobiotic. -
/ Transplant surgery and supportive treatment of renal failure. -
/ njury due to the
dangerous sports. / Personal Accident
, ,

/ Bupa will cover you for loss of life, loss
of sight, hearing and speech and dismemberment arising from injury due to external causes. However you will not be
covered for losses arising from the following: - / Dangerous sports. -


/ Flying in a non-commercial aircraft or
whilst serving as a crew member in any aircraft. -
/ Being under the influence of drugs or alcohol. -
/ Suicide or self inflicted injury. -

50%
200,000 / For losses arising whilst driving or riding as a passenger on a motorcycle only 50% of the benefit will
be paid and not more than 200,000 baht. - / Bacterial
infections. - / Miscarriage resulting from an
accident. - ,
, / Taking part in a brawl, Criminal acts War,
Radioactivity.
S-PD-20 REV.1