The Company shall pay the benefit for the necessary and reasonable expenses which arise from medical treatment based on medical necessity and medical standard according to the actual expenses but not exceeding the benefit specified in the coverage schedule.
Pre-existing conditions which are:
Chronic disease, illness (including its complications) or injury which has not been cured before the effective date or the latest renewal date of the rider, whichever is the latest; unless
- The insured has declared to the Company and the Company has approved to accept risk without exclusions of such coverage; or
- This rider has been effective for at least 3 years consecutively where such chronic disease, injury or illness (including its complications) is asymptomatic and has not been treated or diagnosed by a physician, or has not been seen or consulted by a physician within 5 years before the first rider effective date.
Conditions existing during the waiting period which are:
- Any illnesses which exist within 30 days counting from the effective date or the latest date of renewal of the rider, whichever is the latest; or
- Illnesses due to the following diseases which exist within 120 days counting from the effective date or the latest date of renewal of the rider, whichever is the latest.
- Tumors, cysts, or all types of malignancy/cancer
- All types of hernia
- Tonsillectomy or adenoidectomy
- Varicose vein
- Pterygium or cataract
- All types of stone
- Child delivery in a hospital or a medical center, and pre- and post-natal complications within 280 days counting from the effective date or the latest renewal date of the rider, whichever is the latest
- Cervical dilation and curettage in a hospital or a medical center in case of miscarriage within 90 days counting from the effective date or the latest renewal date of the rider, whichever is the latest.
- Annual health checkup within 1 year counting from the effective date or the latest renewal date of the rider, whichever is the latest.
• Exclusions of Elite Health Rider from a total of 26 clauses
For example, the rider shall not cover medical expenses or damages from injury or illness (including its complications), conditions, or abnormality that arises from any of the following causes.
1. Chronic disease, illness or injury that has not been cured prior to the insurance contract formation date, treatment for congenital disorder, or delay developmental or genetic disorder
2. Cosmetic surgery or any other treatments for skin beauty purposes, pimple, blemish, and freckles treatment, dandruff and hair fall treatment, or weight control, or elective surgeries, unless it is a skin grafting arising from accident that the rider covers, etc.
- This rider shall be attached to new policy only.
– Underwriting is subject to the Company’s rules.
– Conditions and exclusions are as stated in the insurance policy.
– Insurable age is 18 – 80 years old.
– Coverage period is 1 year. Premium payment period is 1 year. The insured can renew until the age of 84; however, it must not exceed coverage period of the life insurance policy that this rider is attached to.
– Terms of Service of Best Doctor and MTL Global Connect are as specified by the Company. In this regard, the insured can use the service until the Company changes.
– Premium of this rider is entitled to personal income tax deduction according to the Notification of the Director-General of the Revenue Department on Income Tax No. 315.
Warning: Buyer should have an understanding in the details of coverage and conditions every time before making a decision to purchase insurance.