Terms and Condition on COVID-19 Coverage

(Updated as of 19 May 2022)

Generali Thailand has continuously protected customers during the Covid-19 pandemic

according to the policy contract and coverage condition

The conditions of COVID-19 Claims Coverage: IPD (IPD),     (OPD)

and HB (or HB incentive for Group Insurance)

FAQs - COVID-19 Coverage

What is the criteria of Covid -19 that can be covered under IPD case?

Fall into one of the following indicators

1. Doctor considers to order admit according to medical necessary and standard of Clinical Practice Guidelines (CPG)

 

or

2. อาการเข้าเกณฑ์การส่งต่อเพื่อรักษาแบบ “ผู้ป่วยใน” ในโรงพยาบาล (Hospital) ซึ่งต้องมีอาการ “ข้อใดข้อหนึ่ง” ดังต่อไปนี้

  1. High fever over 39 Celsius degree more than 24 hours
  2. Respiratory rate more than 25 times/min
  3. Oxygen Saturation < 94%
  4. Underlying disease that needs care closely at the doctor's discretion
  5. Child who has breath difficulty, loss of appetite, drowsiness

or

3. Patient with no severe symptom but have one of the following condition or underlying diseases that may contribute to be risky of severe condition

  1. Age >60 years
  2. Chronic Obstructive Pulmonary Disease or other Chronic Pulmonary Disease
  3. Chronic Kidney Disease
  4. Heart disease and/or vascular disease
  5. Cerebrovascular disease
  6. uncontrol Diabetes Mellitus
  7. Obesity (BMI >=30 or weight over 90 kg
  8. Cirrhosis
  9. Immunocompromising and lymphocyte lower that 1,000 cell/mm3
  10. HIV
In case that Covid-19 condition align with IPD criteria in no.1, is fax claim applicable?

In case that Covid1-19 condition align with IPD criteria, fax claim, or reimbursement claim are applicable.

In case that Covid-19 condition does not align with IPD criteria in no.1, is fax claim applicable?

In case that Covid1-19 condition does not align with IPD criteria, fax claim is not applicable. Medical treatment will be covered under OPD benefit (if available).

How can OPD case claim for OPD benefit?

For OPD, insured can use OPD cashless at any hospital network or reimbursement which according to OPD coverage and service condition.

What is the coverage for the case of Home Isolation, Community Isolation or Hotel Isolation?

In case of Home Isolation, Community Isolation or Hotel Isolation will be cover in OPD benefit (if available) only.

What are the required documents for reimbursement?
  • IPD and/or OPD reimbursement

- Filled claim form

- Original receipt

– ใบรับรองแพทย์ (ต้องมีรายละเอียดหรือหลักฐานทางการแพทย์ที่แสดงว่าการรักษาครั้งนั้นเข้าเกณฑ์ความคุ้มครองผู้ป่วยโควิดที่สามารถคุ้มครองได้ ภายใต้การรักษาแบบผู้ป่วยใน)

- Detail of drug and expense (if any)

  • HB (or HB incentive for Group Insurance)

- Filled claim form

- Original or copy receipt

– ใบรับรองแพทย์ (ต้องมีรายละเอียดหรือหลักฐานทางการแพทย์ที่แสดงว่าการรักษาครั้งนั้นเข้าเกณฑ์ความคุ้มครองผู้ป่วยโควิดที่สามารถคุ้มครองได้ ภายใต้การรักษาแบบผู้ป่วยใน)

This condition is applicable for insured who is under Covid-19 treatment from 17 May 2022 onward
(eligible from the first treatment day)

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