Is it necessary to show the policy holder’s member card when hospitalization is needed?
If you don’t have your member card, you could show your ID card instead. And also mention that you are insured with PLA.
Can I claim for my hospitalization with hospitals outside of PLA network?
You must pay and get reimbursed later while your policy is still active.
When the premium is outstanding in Grace Period, can I use direct billing services at your network hospitals?
You will be covered according to your TOB. This is due to your policy still being active.
You must pay the outstanding premium and then you will be able to use direct billing services.
If the outstanding premium is not paid, you must pay and get reimbursed later.
How can I get the original receipt in order to claim with another insurance company?
PLA will return you the original receipt. You must fill in the form (returning the original receipt) download click and submit altogether with the claims documents as following;
- In case PLA has not covered full payment,PLA will return the original receipt to you with the company stamp stating how much PLA paid in order for your to claim the rest of the medical expenses with another insurance company.
- However, if PLA paid full amount according to the receipt, we won’t be able to return the original receipt but the copy with the company stamp that PLA had paid.
How long it will take to get reimbursement?
When PLA has received the full and complete claims documents, PLA will pay within 15 days for normal process. However, if the process is longer than this, you can contact our Customer Relations Center at;
Line : @philliplife or email : [email protected]
tel 02-022-5800 office hour 8.30 – 17.00 hr.
When the insured has passed away. How does the beneficiary proceed through to the claim process?
The beneficial must inform PLA within 14 days from the day the insured passed away. The Death claims documents are as click.
PLA received the claims documents when the insured is classified as having permanent total disability or passed away. Does the beneficiary have to pay for the due premium when claims are being processed?
Yes, the beneficiary must pay the due premium in order to keep the policy in active status. When the claims process has been finalized and the premium has been waived, PLA will return the premium to the beneficiary later.
Why the beneficiary has to proceed KYC?
According to the Anti-Money Laundering B.E. 2542, PLA has a duty to precede KYC for the beneficiary. The KYC will be proceeded when the beneficiary submits the claims documents directly to PLA staff including PLA all branches.
If I am infected with covid and have to quarantine, home isolation, or community isolation, can I reimburse medical expenses?
You can reimburse if there is a document confirming the infection and the health care provider deems appropriate, the patient can be isolated. This will be considered conditions.
To reimburse medical expenses, there are details as following requirements.
- In case of OPD privilege, pay for medical expenses as actually paid according to the OP limit.
- In case of IPD privilege, pay for medical expenses as an outpatient under the limit “general service fees for medical treatment”.
- In case of both OPD and IPD privileges, pay for medical expenses as OPD type under “general service fees for medical treatment” and OP limit.
However, medical expenses and medical equipment expenses can be reimbursed as actually paid on an outpatient basis but not exceeding the amount. Benefits for expenses incurred from medical treatment and must be ordered by a doctor only, for example:
- Actual medical expenses.
- General medication and andrographis paniculata medication.
- Thermometer expenses (non-digital).
- Face masks and alcohol (provided by hospitals and clinics participating in home isolation or community isolation projects only).
*Not coverage of medication delivery
*Conditions are as specified in the policy and additionally referenced from the OIC document, Registrar Order No. 44/2564.
What does home isolation or community isolation of medical expense documents include?
- What does home isolation or community isolation of medical expense documents include?
- Coronavirus disease 2019 (COVID-19) detection document, which can verify the identity of the person who has been tested for the infection from a laboratory certified by the Department of Medical Sciences by RT-PCR method.
- Medical certificate from a healthcare facility providing evidence that it is a facility capable of providing home isolation or community isolation services.
- Receipt from a medical facility or government agency detailing medical expenses.
- Compensation claim form. Download click.
- Copy of ID card and copy of the insured's identity card.
- Copy of the first page of the bank account showing the name of the insured as the account owner.
If I buy myself an antigen test kit and get a positive result after being tested, and then buy my own medication without the service of home isolation or community isolation, can the expenses be reimbursed?
Unable to reimburse medical expenses. If found to be infected, it is necessary to register according to the conditions for treatment in home isolation or community isolation according to the announcement of the National Health Security Office (NHSO)by registering via https://crmsup.nhso.go.th/.
Get infected and stay at home isolation or community isolation, can I reimburse for the daily income?
You can reimburse according to the following criteria:
- There is a document showing that the insured is a patient diagnosed with Coronavirus 2019 (Covid-19) by a medical care provider.
- There is a medical need to be treated as an inpatient in a hospital, but there is no medical facility to support the insured including with those at risk include people aged 60 years and over, those with a body mass index (BMI) of greater than or equal to 30 kg/m², or weighing more than 90 kg, patients with chronic obstructive pulmonary disease, chronic kidney disease, cardiovascular disease, stroke, and uncontrolled diabetes.
- Compensation will be paid up to 14 days from the date of medical need to be treated as an IPD in a hospital but not supported by a medical facility.
What do I need to request for the form of daily income reimbursement from home isolation or community isolation?
You will need as follows.
- Coronavirus disease 2019 (COVID-19) detection document, which can verify the identity of the person who has been tested for the infection from a laboratory certified by the Department of Medical Sciences by RT-PCR method.
- Medical certificate stating medical need for hospitalization or if there is no medical facility to support the insured but it is medically necessary to be admitted as an IPD, and the doctor must state that the patient is classified as a green, yellow or red patient.
- Compensation claim form. Download click.
- Copy of ID card and copy of the insured's identity card.
- Copy of the first page of the bank account showing the name of the insured as the account owner.