Allianz Ayudhya Assurance Pcl.

GROUP INSURANCEEMPLOYEE BENEFITS PLUS
Group Insurance Plan
that cover Employee‘s Benefits

Group Insurance Employee Benefits Plus

Coverage Plan for Group Insurance
For business with 11 - 100 employees
Unit : Baht

Coverage

Benefits

Group Term Life
Insurance

Death Benefit

Plan
1

Plan
2

Plan
3

Plan
4

Plan
5

Plan
6

Plan
7

Plan
8

Plan
9

Plan
10

50,000 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 1,000,000

Death due to accident

1 (Added from Group Term Life

50,000 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 1,000,000

Insurance)
Loss of both hands or both feet or

2 sight of both eyes or combination

50,000 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 1,000,000

of any two

3

Loss of one hand or one foot or sight

30,00060,000 120,000 180,000 240,000 300,000 360,000 420,000 480,000 600,000

37,50075,000 150,000 225,000 300,000 375,000 450,000 525,000 600,000 750,000

32,50065,000 130,000 195,000 260,000 325,000 390,000 455,000 520,000 650,000

25,00050,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 500,000

7 Deafness of one ear

7,500

15,00030,00045,0008 Loss of thumb (two joints)

12,50025,00050,00075,000 100,000 125,000 150,000 175,000 200,000 250,000

5,000

10,00020,00030,00040,00050,00060,00070,00080,000 100,000

10 Loss of index finger (two joints)

4,000

8,000

16,00024,00032,00040,00048,00056,00064,00080,00011 Loss of index finger (one joint)

2,000

4,000

8,000

12,00016,00020,00024,00028,00032,00040,000

2,500

5,000

10,00015,00020,00025,00030,00035,00040,00050,000

2,500

5,000

10,00015,00020,00025,00030,00035,00040,00050,000

500

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

10,000of one eye
Loss of one arm starting from the

4 shoulder or one leg starting from theneck of femur
Loss of one arm starting from the

5 elbow or one leg starting from theknee

6Group Accident
Insurance

9

Deafness of both ears or Loss ofspeechLoss of thumb (one joint) or
index finger (all three joints)

60,00075,00090,000 105,000 120,000 150,000

Loss of other fingers (not less than two

12 joints) other than a thumb or an index
finger

13 Loss of big toe
14

Loss of other toes (not less than one
joint) other than a big toe
Total and Permanent Disability due to15 accident (must continue for a period

50,000 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 1,000,000

not less than 180 days)

16

Group
Permanent
Total Disability
Insurance

Double amount of benefit(Accident in publicity)

The Benefits from No. 1-15 will pay double amount of the benefits if accident happens inpublicity.

17 Extension to cover Murder and Riot

The Benefits from No.1-15 will be extended to the case that the Insured is murdered or
assaulted with intent, or riot in which the Insured does not involve.

Total and Permanent Disability
Benefit from sickness or accident(must continue for a period notless than 180 days)

50,000 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 1,000,000

Premium per employee or spouse or children
per person (per year)

225

450

900

1,350

1,800

2,250

2,700

3,150

3,600

4,500

This information contained herein is provided as illustrative information only. The applicant is advised to study further information regarding an insurance coverage, term andconditions, exclusion and dividends from the policy contract.

Group Insurance Employee Benefits Plus

Unit: Baht

Group Health Insurance:
In-Patient Hospitalization & Surgical Benefits
(IPD)

HS
1

HS
2

HS
3

HS
4

HS
5

HS
6

HS
7

HS
8

HS
9

HS
10

1

Room & Board Fees per day(Max. 45 days)

600

700

1,000

1,200

1,500

2,000

2,500

3,000

4,000

5,000

2

Intensive Care Unit (ICU) Fee (Max. 7 Days)

1,200

1,400

2,000

2,400

3,000

4,000

5,000

6,000

8,000

10,0003

Other Medical Treatment Fees
(Including OPD follow up within 30 days ofdischarging from hospital)

15,00018,00020,00025,00031,00041,00051,00061,00071,000 100,000

4

The Actual Surgery Fees

15,00018,00020,00025,00031,00041,00051,00061,00071,000 100,000

5Specialist Physician’s Counseling Fee(Excluded from item 3 or 4 above)

3,500

4,000

4,500

5,000

6,500

7,500

8,500

9,500

10,000 12,000

6Physician Fee per day (Max. 45 days)

500

600

700

800

1,000

1,500

2,000

2,500

2,700

7

Emergency Treatment Fee Due to
Accident within 72 hours per any Injury(Excluded from Other Medical Treatment Fees)

3,500

4,000

4,500

5,000

6,500

7,500

8,500

9,500

10,000 12,000

8Ambulance service fees(included under Other Medical Treatment Fees)

600

700

1,000

1,200

1,500

2,000

2,500

3,000

4,000

HB Incentive
For the use of Other Medical Benefits

In case the Insured get injury or illness causing the Insured to hospitalize as an
Inpatient according to the Necessary Medical Treatment:- If the Insured uses the rights under Other Medical Benefits in full limit of such
Benefits only, and without any request of benefits from the Company, theCompany shall pay the Additional Daily Hospital Benefits equal to the Daily
Room & Board benefits according to the number of days of Hospitalization
as the Inpatient or- If the Insured uses the rights under Other Medical Benefits in full amount ofsuch Benefits and requests the benefits from the Company only for the benefitsof Room & Board but not exceed the limit, the Company shall pay the Additional
Daily Hospital Benefits equal to the number of days of Hospitalization andmultiple by the benefit of Daily Room & Board and deduct with the benefits of
Daily Room & Board as the Company has paid for the Group Health Coverage Rider,
However, for the above-mentioned payment of benefits, the Company
shall pay the benefits not exceeding the maximum days of Daily Room & Board
benefits per hospitalization.

Premium per employee or spouse or children
per person (per year)

1,100 1,307 1,573 1,913 2,384 3,194 4,003 4,812 5,787 7,647

9

3,200

5,000

This information contained herein is provided as illustrative information only. The applicant is advised to study further information regarding an insurance coverage, term andconditions, exclusion and dividends from the policy contract.

Group Insurance Employee Benefits Plus

Unit: Baht

Group Health Insurance: Out-Patient (OPD)

OPD
1

OPD
2

OPD
3

OPD
4

OPD
5

OPD
6

OPD
7

OPD
8

OPD
9

OPD
10

Out-Patient hospital services(Max. 1 time per day and Max. 30 days per year)

300

400

500

600

700

800

1,000 1,500 2,000

2,500

Premium per employee or spouse or children
per person (per year)

1,222 1,551 1,880 2,162 2,565 2,882 3,600 5,390 7,178

8,910

Unit: Baht

Group Health Insurance: OPD Follow Up

OPDF OPDF OPDF OPDF OPDF OPDF OPDF OPDF OPDF OPDF
1
2
3
4
5
6
7
8
9
10

OPD follow up within 90 days of discharging from
hospital (Max. 1 time per day and Max. 5 times
per Hospitalization) Max. per one time

600

700

1,000 1,200 1,500 2,000 2,500 3,000 4,000

5,000

Premium per employee or spouse or children
per person (per year)

91

106

151

756

181

227

302

378

454

605

Unit: Baht

Group Health Insurance:
Out-Patient Laboratory Test Fee

XRAY XRAY XRAY XRAY XRAY XRAY XRAY XRAY XRAY XRAY
1
2
3
4
5
6
7
8
9
10

Out-Patient Laboratory Test Fee (diagnosis disease
with X-ray, electrocardiography or laboratory tests
for the treatment as an Out-Patient according to
the physician’s recommendation) Max. per policy year

1,500 2,000 2,500 3,000 3,500 4,000 4,500 5,000 5,500

6,000

Premium per employee or spouse or children
per person (per year)

150

600

200

250

300

350

400

450

500

550

Unit: Baht

Group Dental Insurance

Dental Dental Dental Dental Dental Dental Dental Dental Dental Dental
1
2
3
4
5
6
7
8
9
10

Dental Benefits (Max. per policy year)
1) tooth extraction, dental filling and teeth scaling
2) root canal treatment and nerve root treatment
3) Oral cavity examination or X-ray

1,500 2,000 2,500 3,000 3,500 4,000 5,000 6,000 7,000

8,000

Premium per employee or spouse or children
per person (per year)

960

4,480

1,280 1,500 1,680 1,960 2,240 2,800 3,360 3,920

This information contained herein is provided as illustrative information only. The applicant is advised to study further information regarding an insurance coverage, term andconditions, exclusion and dividends from the policy contract.

Group Insurance Employee Benefits Plus

Example of reimbursement Group Health Insurence
In-Patient Hospitalization & Surgical Benefits (IPD) No. 9
HB Incentive for the use of Other Medical Benefits
The Company shall pay the Additional Daily Hospital Benefits equal to the Room & Board benefits according to the number of daysof Hospitalization as the Inpatient. The Company shall pay the benefits not exceeding the maximum days of Room & Board benefits
per Hospitalization or
If the Insured is reimbursed with full amount from the Other Medical Benefits and request the benefits from the Company only for the
benefits of Room & Board but not exceed the limit.
The Company shall pay the Additional Daily Hospital Benefits equal to the remaining amount of Room & Board benefits according
to number of days of Hospitalization as the Inpatient. The Company shall pay the benefits not exceeding the maximum daysof Room & Board benefits per Hospitalization.
Other Medical Benefitsmeans the rights of medical benefits that Insured receive from the social security fund (SSF), the Workmen’s Compensation Fund,
Welfare for medical treatment of the government officer, State Enterprises, Independent Organization, Local Administration Organization,
National Health Security, the Protection for Motor Vehicle Accident Victims Act B.E.2535, Individual or Group Health Insurance (excluding theGroup Health Coverage Rider, which extending Coverage to Additional Daily Hospital Benefits, and/or other Group Health Coverage Riderfor employees, members, or Dependents receiving coverage from the Company).

Example: Plan 7 the benefits of Room & Board Fees per day is 2,500 baht

ActualExpense (B)Room &
Board Fees
per day
benefitsfrom SSF (C)The Company pays the difference after
Other Medical Benefits deduction (not exceed
the benefits of Room & Board Fees per day)  
(D) = (B-C)

HB Incentive per day(E) = (A-D)

2,500

700

700

-

2,500

2

2,500

2,500

700

1,800 (2,500 - 700)700 (2,500 - 1,800)

3

2,500

3,200

700

2,500 (3,200 - 700)
(but not exceed benefits ofRoom & Board Fees per day)

0 (2,500 - 2,500)

ExampleRoom & Board
Fees per day
benefits from
Allianz Ayudhya(A)

1

Registration of Group Insurance
Business Eligibility
A business is comprised of 11-100 full-time employees anddoes not have any Group Insurance Employee Benefit Policy
which still effective with Allianz Ayudhya Assurance Pcl.
n An organization or a business unit registered as a legal entity.
n A business with a location of work in Thailand and eligible
employee having a state of work in Thailand.
n A business requires group insurance program to the full-time
employees.
n Director or business owner or consultants who are not full-time
actively at work are not available.
n

A business with risk exposure not higher than occupation class 3.
All benefits are not available for Cooperative Member,Labor Union, Club Member, Creditor and Debtor consist groupof member or employees who go to work on aboard.
n The Company reserves the right to underwrite on a caseby case basis for an organization that has ever been insured
under the same coverage of Group Insurance Employee
Benefit even though the policy is not effective with
Allianz Ayudhya Assurance Pcl.
nnThis information contained herein is provided as illustrative information only. The applicant is advised to study further information regarding an insurance coverage, term andconditions, exclusion and dividends from the policy contract.

Group Insurance Employee Benefits Plus

Employees EligibilitynAll employees must participate in the group insurance program.

n

If eligible employees are 20 persons or more, all employeesnEligible employee age 15-65 years.

are required to fill the form of “Beneficiary Designation fornMinimum eligible employees who have undergone insurance

Member of Group Insurance” (no health questions).

at 11 persons on the effective date or policy anniversary date,nwhich are excluded the employees’ dependent.
nAll eligible employees are required to be healthy and are notill or under illness, medical treatment, inpatient, or follow up.

If eligible employees are less than 20 persons, all employeesnOnly full-time employees, exclude part-time employees.

are required to answer health questions and/or do medical check-upn

The average age of all employees should not over 45 years old,

according to the Company’s guideline.

which does not include spouse and children.

Eligibility of Dependentn

In case the employer requires extending insurance coveragenThe eligible child must be legitimate child of employee, age notto the employees’ dependents, all employees and theirless than 14 days and not over 18 years old and unmarried,dependents must participate in the group insurance program.

or age not over 25 years old and be a full time student andnPremium rate for spouse or children will be equal to premium rate

unmarried.

n

The eligible spouse are marriage, age is not over 65 years old.

questions and/or do medical check-up according to the

In case the spouse and the insured employee work in the same

Company’s guideline.

of the insured employees.

nAll eligible spouse and children are required to answer healthcompany, the spouse can apply as an employee only.

Classification of Group Insurance and Group Health Insurance Plannn

1 policy can be composed of the insurance plans forplans for employees 5 plans per 1 policy)

Room & Board Fees per day of IPD, and enrollment of

In case chosen the coverage more than 1 plan, theIPD is required.
nGroup Health Insurance: OPD Follow Up is available for plan

For example, if plan 1 is the lowest plan, the next plan

OPDF1-OPDF10 and/or Group Health Insurance: Out-Patientthat can be chosen should not exceed plan 5.

Laboratory Test Fee is available for plan XRAY1- XRAY10Group Health Insurance: In-Patient Hospitalization & Surgicaland/or Group Dental Insurance is available for plan Dental1-

Benefits (IPD), Out-Patient (OPD), OPD Follow Up, Out-Patient

Dental10, but the benefits should not exceed 4 times of Room &Laboratory Test Fee; Group Dental Insurance are the coverage

Board Fees per day of IPD, and enrollment of IPD is required.

that the employer can choose as an additional (added on)nbenefits. However, if the employer would like to enroll for such
benefits, all employees and their all dependents must participate.
nGroup Health Insurance: Out-Patient (OPD) is available
for plan OPD1- OPD10, but the OPD benefit should not exceed

next higher plan should not exceed 4 plan levels.

nnemployees not more than 5 plans (limit insurance

All employees who are in the same or equivalent position
should be insured under the same plan.

n

The spouse and children must enroll under the same plan andGroup Health Insurance: In-Patient Hospitalization & Surgicalsuch plan should not over than the plan of the insured employee.

Benefits (IPD) is available for plan HS1- HS10, and enrollment

For employees who are in the same or equivalent position, theirof Group Term Life Insurance is required.

dependents should be insured under the same plan.

Eligibility of classification plannClassify only one plan under the same plan for all employees.

nClassify by salary.

nClassify by employee position.

nClassify by working period.

This information contained herein is provided as illustrative information only. The applicant is advised to study further information regarding an insurance coverage, term andconditions, exclusion and dividends from the policy contract.

Group Insurance Employee Benefits Plus

Premium payment and Medical Check-up Costn

Employer shall be responsible for all premiums of employeesnand their dependents.
n

In case a required for medical check-up, the insured employees
must absorb the cost by themselves.

Available only annual premium payment mode and thenminimum premium per policy on the effective date or policy

The Company reserves the right to amend the new premium ratebase on actual occupation class of the employer.

anniversary date is 10,000 THB.

Premium Discount Rate (For Employee spouse and children)
Consider from Number of Employees who have undergone
insurance on the effective date or policy anniversary datePremium Discount Rate

11 - 24-

25 - 49

5.0 %

50 - 99

7.5 %

100

10 %

Registration RequirementsnCompleted the “Policyholder Application for Group Insurance”,

nand signed by authorized directors or authorized person withnattorney and the company‘s affidavit.)nnEffective date of the policy will be the next day that theCompleted the “Member Application for Group Insurance”

Company received all required documents and approved foror “Beneficiary Designation for Member of Group Insurance”

the insurance or will be the specified date in the “Policyholder(depends on the case) by the employees and the dependents

Application for Group Insurance” whichever occurs later.

(if applicable). This must be signed and specified the date.
n

All required documents should be submitted 7 days before
effective date.

affixing the company’s seal (must submitted the power of annPayment done before effective date.

nCompleted the “Agreement on the Use of Group Insurance

In case the employee apply for insurance during the policy
year, the effective date for that employee will be the first day

ID Cards”, and signed by authorized directors or authorizedof work or the day after the probation period (according toperson with affixing the company‘s seal.

employer’s regulation) or the specific date   defined in written

Submitted a data sheet containing detailed summary of allby the Company, depends on the case. However, such dateemployees and their dependents with date of birth, position,must be approved by the Company. In case the dependents

effective date of work, ID number, mobile phone number,

apply for insurance and have been approved by the Company,

email (if any), group insurance plan, and classification plan for

the effective date for the dependents will be the sameeach employee/spouse/child according to the Company’s format.

effective date of the employee.

Documentation Requirementsnn

The Policyholder Application for Group Insurance.

n

The Member Application for Group Insurance (for employees
and their dependents (if apply)).

n

The Agreement on the Use of Group Insurance ID Cards.

n

A data sheet containing detailed summary of all employees

A photo copy of commercial registration certificate signed byauthorized person.

n

The power of an attorney (in case submitted the photo copy,
it should be signed by the authorized person).

nPremium amount.

and their dependents as a compact disc or soft file according
to the Company’s format.
This information contained herein is provided as illustrative information only. The applicant is advised to study further information regarding an insurance coverage, term andconditions, exclusion and dividends from the policy contract.

azay.co.th
Study the productin more detailazayfan@AZAYfan

September 2018

Assured by Allianz Ayudhya Assurance Pcl.
1st Floor, Ploenchit Tower, 898 Ploenchit Road, Bangkok 10330
Allianz Ayudhya Customer Care Centre, Tel. 1373, for 24 hours services.