Medical Insurance

CAPITAL TAIYO MEDICAL INSURANCE

OBJECTIVE

Capital Taiyo Medical Insurance is a type of Coverage includes hospitalization, outpatient treatment, ophthalmology outpatient treatment, dental outpatient treatment, death, and total permanent disability during the insurance period.

Age Limitation

6 months and 75 years old (If the insured is between 6 months and 18 years old, a parent/guardian’s permit is required.)

Policy Term

1 Year

Number of Units and Insurable Sum Assured

The number of units for basic coverage ranges from 1 to 25 units.

The number of units for option (1) ranges from 1 unit to the number of units for basic coverage.

However, for option (2), the insurable sum can be selected freely within the range of 1,000,000 Kyats to 100,000,000 Kyats.

Premium Payment

For group contracts, premiums can be paid monthly, quarterly, semi-annual, or annual.

For individual contracts, premiums can be paid semi-annual or annual.

Grace Period for the premium payment installment

The grace period for installment payment shall be until the end of the month 1 months following the premium due date. If the insurance premium is not paid within the grace period, the contract will expire.

Type of Medical Insurance Package	Coverage	Payment Condition	Payment Amount
1. Basic Cover Hospitalization (Basic Cover)	hospitalization	The hospitalization is directly caused by an injury or illness that occurred after the start date of liability.	1.The cumulative payment limit for hospitalization is 50,000 Kyats × Number of outpatient days × Number of units. 2. A maximum of 90 days of hospitalization will be covered.
2. Option 1 Outpatient	Outpatient Treatment	The outpatient treatment is directly caused by an injury or illness that occurred after the start date of liability.	1.The cumulative payment limit for outpatient is 50,000 Kyats × Number of outpatient days × Number of units. 2. The limit is 200,000 Kyats (4 outpatient visits) per unit. The cost directly incurred for the outpatient.
	Ophthalmology Outpatient Treatment	The ophthalmology outpatient treatment is directly caused by an injury or illness that occurred after the start date of liability.	The limit is 50,000 Kyats (1 ophthalmology outpatient visit) per unit.The cost directly incurred for the ophthalmology outpatient.
	Dental Outpatient Treatment	The dental outpatient treatment is directly caused by an injury or illness that occurred after the start date of liability.	The limit is 50,000 Kyats (1 dental outpatient visit) per unit. The cost directly incurred for the dental outpatient.
Option-2 Death & TPD	Death	If the insured person dies during the insurance period, the insured amount shall be paid.	If the insured person dies during the insurance period, the insured amount shall be paid.
Option-2 Death & TPD	Total permanent disability	Please refer to Table 1 for the payment conditions applicable to Total Permanent Disability.	The insured amount shall be paid.

Table No.1
No	Content
1.	Complete blindness in both eyes.
2.	Complete amputation or complete dysfunction of both hands above the wrist.
3.	Complete amputation or complete dysfunction of both feet above the ankle.
4.	Complete blindness in one eye and complete amputation or complete dysfunction of one arm above the wrist.
5.	Complete blindness in one eye and complete amputation or complete dysfunction of one leg above the ankle.
6.	To receive the total permanent disability benefit, the total permanent disability condition must continue for at least 90 days, and a certificate of total permanent disability issued by the specialist in charge of treatment is required. However, if necessary, a certificate of total permanent disability issued by two doctors selected by the insurance company must also be attached.
7.	The payment amount is the same amount as the death benefit.
8.	If the insured person becomes severely disabled and there is no prospect of recovery, this contract will terminate.

The cost directly incurred refer to the expenses paid to the hospital, including medical treatment fees (such as doctor consultation fees, examination fees, surgery fees, medication costs, and costs for medical consumables necessary for treatment such as syringes), accommodation fees, and meal charges.

Premium Pricing (Group)

Contract	Category	Age	Monthly	Quarterly	Semi Annual	Annual
Group	Hospitalization (Basic Cover)	6 Months~5 Years	6,000	17,400	33,600	65,400
		6 Years~30 Years	3,000	8,700	16,800	32,700
		31 Years~40 Years	3,600	10,400	20,200	39,200
		41 Years~50 Years	4,500	13,100	25,200	49,100
		51 Years~60 Years	7,500	21,800	42,000	81,800
		61 Years~75 Years	15,900	46,100	89,000	173,300
	Outpatient (Option 1)		12,800	37,100	71,700	139,500

Premium SI 1,000,000

Contract	Category	Monthly	Quarterly	Semi Annual	Annual
Group	Death (Option 2)	700	2,100	4,100	8,000

Premium Pricing (Individual)

Contract	Category	Age	Monthly	Quarterly	Semi Annual	Annual
Individual	Hospitalization (Basic Cover)	6 Months~5 Years	-	-	35,300	68,700
		6 Years~30 Years	-	-	17,600	34,300
		31 Years~40 Years	-	-	21,200	41,200
		41 Years~50 Years	-	-	26,500	51,500
		51 Years~60 Years	-	-	44,100	85,800
		61 Years~75 Years	-	-	93,500	182,000
	Outpatient (Option 1)		-	-	75,300	146,500

Premium SI 1,000,000

Contract	Category	Monthly	Quarterly	Semi Annual	Annual
Individual	Death (Option 2)	-	-	4,300	8,400

(A) Suicide, attempted suicide, or self-inflicted injury

(B) Intentional act or gross negligence by the policyholder

(D) Intentional act or gross negligence by the beneficiary

(E) Use of narcotics or dangerous drugs

(F) AIDS/HIV

(G) War, riots, rebellion, and similar events (However, if the insured is involved in such events against their will, insurance benefits may be paid. The insurance amount may be reduced depending on the impact, at the company's discretion.)

(H) Pre-existing conditions that the insured had at the time of enrollment (regardless of whether the insured was aware of them)

(I) Pre-existing conditions that are strongly suspected to have existed at the time of enrollment (regardless of whether the insured was aware of them)

(J) Childbirth, cesarean section, or surgery related to childbirth. However, hospitalization due to complications (such as toxemia of pregnancy, pregnancy-induced hypertension, gestational diabetes) associated with pregnancy after enrollment and normal pregnancy at the time of enrollment are covered.

(K) Psychosis, mental disorder

(L) Hospitalization for health check-ups or rest purposes

(M) Hospitalization and surgery for the purpose of having children

(N) Dental treatment for purposes other than accidental injury. However, if option (1) is selected, dental treatment is covered as dental outpatient treatment, paid once.

(O) Eye examinations, vision deviations, eye treatments, or vision improvement for purposes other than accidental injury. However, if option (1) is selected, eye treatment is covered as ophthalmology outpatient treatment, paid once.

(P) Cosmetic purposes

(Q) Installation of hearing aids

(R) Physical defects or infirmities

(S) Fraudulent claims

However, even if the above exclusions apply, the company may refund the equivalent amount of the premiums already paid at its discretion.

Gross Negligence

Gross negligence includes the following example cases and the occurrence of the incident can easily be prevented by behaving normally.

Accidents caused by driving under the influence.

Accidents are caused by fishing on the coast of the sea or swimming in the sea when a storm is brewing.