Falcon Insurance

CONTACT FALCON Health Insurance for Special Tourist Visa (STV)

Health Insurance for Special Tourist Visa (STV) Cover period 90 days
Coverage	Sum Insured (THB)
Coverage	STV Plan 1	STV Plan 2	STV Plan 3
1) In-Patient medical expenses caused by illness or accident (IPD)
- Maximum Coverage per year	400,000	800,000	1,000,000
- Maximum Coverage per each illness or accident	40,000	80,000	100,000
1.1) Room and Board and General Nursing Services
- Daily Room and Board per day	4,000	5,000	6,000
- Daily Charges for Intensive Care Unit per day (Maximum 15 days)	8,000	10,000	12,000
1.2) Other coverage benefits for inpatient medical treatment due to
injury or illness
1.2.1) General medical expenses (Including the expenses incurred by	Actual Cost	Actual Cost	Actual Cost
continuing medical treatment within 30 days after discharged)
1.2.2) Emergency Treatment (within 24 Hours after accident including	Actual Cost	Actual Cost	Actual Cost
follow up within 15 days)
1.2.3) Surgical Treatment	Actual Cost	Actual Cost	Actual Cost
1.2.4) Physician's Daily Hospital	Actual Cost	Actual Cost	Actual Cost
2) Out-Patient medical expenses per day (OPD)	1,500	1,500	2,000
(1 time/day , Maximum 30 times/Year)
3) Loss of life, Dismemberment for Total Permanent Disability caused by	100,000	100,000	100,000
general accident (P.A.1) (Including Murder or assault)
4) Funeral Benefits or Funeral expenses due case of death of injury	10,000	10,000	10,000
or illness
Total Premium for 90 days (Includes tax & duty stamp)
Entry Age (years old)	STV Plan 1	STV Plan 2	STV Plan 3
30 Days – 9	14,662	16,294	19,991
10 – 19	7,470	8,246	10,148
20 – 39	7,745	8,550	10,508
40 – 49	10,185	11,160	13,828
50 – 49	13,309	14,691	18,123
60 – 65	15,973	17,883	21,821
66 – 70	20,178	23,000	27,677
71 – 80 (Renewal Only)	20,178	23,000	27,677

Conditions:
1. Eligibility of Applicant for Special Tourist Visa :
1.1 Applicant must intend to apply for Special Tourist Visa in Thailand.
1.2 Applicant must be 30 Days - 70 years old (can be renewed up to 80 years old subject to satisfactory of claim experience).
1.3 Applicant aged below 15 years old cannot have standalone policy, the company required at least 1 adult policy (father/ mother)
as a compulsory (sum insured for selected plan need to be equal to or less than adult plan).
1.4 The Premium will be adjusted as per age band.
2. This insurance will not pay the benefits for any sickness during the first 30 days from the first policy commencement date of this insurance policy.
3. This insurance will not pay the benefits during the first 120 days from the first commencement date of this insurance policy for
the following diseases : Benign, Malignant tumor, Cancer, Cystic mass, Hemorrhoids, Hernias, Pterygium, Pinguecula, Cataract, Tonsillectomy
or Adenoidectomy, Stones, Varicose Veins, and Endometriosis (In case of renewal policy, this condition will not be applied)
4. Funeral Benefits or any Funeral expenses (only in case of death from illness) can only apply after 180 days from the first policy
inception (In case of renewal policy, this condition will not be applied)

Major Exclusions of Personal Health and Accident Insurance:
This insurance does not cover the cost of treatment or losses arising from injury or illness (including complications thereof) symptoms or
conditions arising from the following :
1. Pre-existing conditions, Congenital abnormalities, growth development abnormalities, and genetic disorders.
2. Any cosmetic surgery or beautification treatment including treatment of acne, freckles, dandruff, weight reduction and weight gain,
hair loss. Reconstructive surgery is also excluded unless injury is sustained as a result of an accident.
3. Services in connection with infertility, pregnancy, childbirth, abortion or miscarriage, or any causes related to pregnancy, sterilization
or investigation of sterilization.
4. AIDS, related or sexually transmitted diseases (STD).
5. Treatment to relieve symptoms commonly associated with aging, menopause or precocious puberty, sexual dysfunction of sex change.

Remarks:
1. The Company reserves the right to reject any application or accept with exclusions (if any), according to underwriting standard of Company.
2. This insurance is based on year-to-year basis (Not an automatic renewal guarantee).
3. This document is not an insurance contract, all conditions shall be referred to definitions General Conditions and Exclusions of the original
Personal Health and Accident Insurance Policy.
4. The English language used in this document is merely a translation of Thai Version.

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