Download Long Stay Visa O-X Brochure

Download Application Form

Remarks : 
1. Eligibility of Applicant under Health Insurance for Long Stay Visa Scheme:
    1.1 Applicant has intention of applying for Long Stay in Thailand Visa.
    1.2 Nationality: (1) Japanese (2) Australia (3) Kingdom of Denmark (4) Republic of Finland (5) Republic of France (6) Federal Republic of Germany (7) Republic of Italy (8) Kingdom The Netherlands (9) The Kingdom of Norway (10) The Kingdom of Sweden (11) Swiss Confederation (12) United Kingdom of Great Britain and Northern Ireland (13) Canada and (14) United States of America 
    1.3 Applicant's age cover between 5 - 75 years old on the date of insuring. (For example, 75 years old and 1 day, do not accept.) The renewal age is not over 80 years old. The company reserves the right to adjust the insurance premium in the renewal year regarding the increasing of age range and risks according to damage history and loss ratio. 
2. Territorial coverage within Thailand.
3. Please attach physician examination report.
    - Applicant's age over 60 years must have the physician examination report in all cases.
    - Applicants who are under 60 years of age, requesting for physician examination report depends on the consideration of the company.
    - List of diseases that need to be examined: CBC, Chemistry (blood), Liver Function, Kidney Function, Heart Exam, Chest Exam (Chest X-ray), Urine Exam, PE Exam (Physical Exam) by doctor
    * In case of having congenital disease or having a special test, please attach the latest special test results (previously checked)
4. Insured under the age of  20 years old must apply with parent. The applicant is under the age of 20 years old, 1 person must apply with father or mother or parent and the applicanct's plan must be provided lower coverage or equivalent to the father or mother or parent or relative who applied simultaneously and have the same insurance period.
5. Insured under the age of 20 years old must have parent a legal guardian signature in the application form and acknowledgement letter for insured's pre-existing condition.
6. The policy can reduce personal income tax in the total sum of all companies not exceeding 15,000.- Baht.
7. Inpatient benefit will be covered for injury or sickness per disability. Including ongoing medical expenses after leaving the hospital (outpatient) within 30 days.
8. The insured can reimburse the previous disease but not less than 90 days after the last treatment date.
9. This insurance will not pay the benefits for any sickness during the first 30 days from the first policy commencement date.
10. Pre-existing conditioned and chronic disease or illness and HIV, AIDS and Virus spreading are not covered under the above plan.
11. Navakij Inpatient Medical Card will be provided for each member.
12. Applicant must send the health application for the company's consideration and premium paid before coverage and issuing the policy. Completed health application will be provided to the company's consideration before coverage.
13. The English language used in this table of benefit is merely a translation of Thai Version.
14. Other terms, conditions and exclusions subject to original Personal Health Insurance (File and use) policy.  
Exclusion:
This insurance does not cover the cost of treatment or losses arising from injury or illness (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 or sex change.
6. Health check ups, convalescent care including rest cures and rehabilitation. Any treatment, drugs or medical supplies  which are not related to the diagnosis; and.  diagnosis which is not related to the injury or illness  or not according to the medical necessity and normal standard.
7. Eye examination and eyesight corrective surgery including lasik and other expenses associated with eyesight correction.   
8. Treatment or surgery relating to dental or gum e.g. denture, crowns and bridges, root treatment, filling, orthodontic, scaling, extraction, except the necessary dental treatment after an accident. However, the coverage does not include the costs for crowns and bridges,  root treatment, orthodontic services.
9. Medical treatment related to alcoholism, cigarette addition, drug or other addicted substance.
10. Medical treatment related to the nervous disorders, mental disorder, anxiety, psychiatric problems, personality disorder, autism, stress, eating disorder.
11. Medical treatment which is in a trial stage or experiment, associated with disease or symptoms of sleep apnea,  sleeping disorder, treatment to stop snoring.
12. Any inoculations or vaccinations, except rabies vaccine needed after an animal attack or tetanus shots needed after  an accident or injury.
13. Treatment which is not considered a modern medicine, including alternative medicine.
14. Any medical treatment given by a medical practitioner who is the parent, spouse or child of the covered person. The covered person who is a registered medical practitioner may not be reimbursed for any self- administered treatment.
15. Suicide or suicide attempt, self inflicted injury or attempt of self-inflicted injury whether being his/her own action or allow others to perform  while insane or not. while insane or not. This also includes the accident to the covered person due to consuming, drinking, or injection of  toxic substance into the body or drug overdose
16. Any loss or injury arising from the action of the covered person whilst under the influence of alcohol, control one’s mind. addictive drugs, narcotic drugs to the extent of being unable to the term “under the influence of alcohol” in case of having a blood test refers to a blood/alcohol level of 150% mg  and over.
17. Injury while the covered person is taking part in a brawl or taking part in inciting a brawl.
18. Injury while the covered person is committing a felony or while the covered person is being arrested, under arrest or escaping the arrest
19. Injury while the covered person is taking part in dangerous sports or activities including racing of all kinds including car, boat and horse racing, racing of water and snow ski-ing, including jet-ski, skating, boxing, parachuting jumping  (except for the purpose of life saving), boarding or traveling in a hot air balloon,  gliding,  bungee jumping, diving with oxygen tank and breathing equipment under water.
20. Injury while the covered person is boarding or traveling in an aircraft which has no license for carrying passengers  or does not operate as a commercial aircraft.
21. Injury while the covered person is piloting or working on board as an employee of an airline.
22. Injury while the covered person serves as a soldier, police, or a volunteer and  participates in war or crime suppression.
23. War (whether declared or not), invasion, acts of foreign enemies, civil war, revolution, insurrection, civil commotion, popular rising against the government, riot, strike.
24. Terrorism
25. Ionising radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel.
26. The radioactive toxic explosive or other hazardous property of any explosive nuclear assembly or nuclear component thereof.
27. This insurance will not pay the benefits for any sickness during the first 30 days from the first policy commencement date.
28. Any benefits during the first 120 days from the first policy commencement date for the following diseases: including Tumors, Benign or malignant tumor or cancer or cystic mass, Hemorrhoids, Hernias, Pterygium, pinguecula, cataract, Tonsillectomy or adenoidectomy, Stones, Varicose Veins and Endometriosis

Other terms, conditions and exclusions subject to original Personal Health Insurance (File and use) policy.
The English language used in this table of benefit is merely a translation of Thai Version.

Download Application Form

Please fill in the form if you are interested in our insurance policy or require further information.
More detail, please contact email: csc@navakij.co.th