2nd GHS Proposal Multi Kontrol Nusantara

8/11/2019 2nd GHS Proposal Multi Kontrol Nusantara

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CONFIDENTIALCONFIDENTIAL

22NDND

PROPOSALPROPOSALGROUP HEALTH INSURANCE PROGRAMGROUP HEALTH INSURANCE PROGRAM

FORFOR

PT. MULTI KONTROLPT. MULTI KONTROLNUSANTARANUSANTARA

Prepared by:EMPLOYEE BENEFITS DIVISION

PT. Willis Indonesi26thFloor, Wisma Keiai

Jl Je!d S"dirma! Ka# $%& Ja'arta ()22)*el +62 2( 22& -$)) % Fa. +62 2( 22& -$/

Website: 0000illis1om0000illis1om

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http://www.willis.com/http://www.willis.com/http://www.willis.com/


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3/22

CONFIDENTIALITY

This Proposal contains information which is condential to bothPT !"lti #ontrol N"santara Indonesia and PT $illis Indonesia

Accordin%l&' we tr"st &o" will "nderstand this Proposal is %i(en toPT !"lti #ontrol N"santara and their o)cers and emplo&ees in condence

and ma& not be reprod"ced in an& form or comm"nicated to an& otherperson' rm or compan& witho"t the prior appro(al of PT $illis Indonesia

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5/22

!. E"ECUTIVE SUMMARY!. E"ECUTIVE SUMMARY

W" #$%&' &()" *$ *+,-) PT. M%&*( $-*/$& N%0,-*,/, $/ *+(0 $$/*%-(* *$ 0%(* $%/ P/$$0,& $/ *+"%$(-7 /"-"#,& $ $%/ G/$% $0(*,&(,*($- : S%/7(,& I-0%/,-" /$7/,.

T+(0 /$$0,& (0 '"0(7-"' ,0"' $- $%/ %//"-* I-,*("-* "-"(* /$7/,; #+(+ $ $ "-"(* *,&";#,0 /$


6/22

T+(0 0%,/ +,0 ""- /",/"' PT. W(&&(0 I-'$-"0(, *$ ,00(0* PT. M%&*( $-*/$& N%0,-*,/, (-

"


7/22

#. INSURANCE GENERAL#. INSURANCE GENERALUNDERWRITING AND SERVICESUNDERWRITING AND SERVICESCOMPARISONCOMPARISON

Co(era%e that is clearl& better is identied in &ellow

UNDERWRITINGAVRIST

RELIANCE LIPPOE$is%in& Rene'l

INSURER PROFILEA oi!t #e!t"re i!s"ra!1e

1ompa!yA Lo1al !atio!al i!s"ra!1e

1ompa!y

POLICY CURRENCY 3DR

PRE(E"ISTINGCONDITION)S*

Wai#ed 4ore.isti!5

member o!ly

Wai#ed 4ore.isti!5 "p1omi!5member

Wai#ed 4or e.isti!5 "p1omi!5members

CASHLESSFACILITY ATHOSPITAL+CLINICSNETWORKS

A#ailable,"si!5Admedi'a

system 4or allbe!e7ts

A#ailable3!patie!t "si!5A#rist Pro#ider

8Sho0 9ard

system

O"tpatie!t,De!tal a!d;ater!ity

8ASO "si!5Admedi'a

system

A#ailable 0ithSho01ardsystem 0ithi!

Relia!1ePro#ider 4or all

be!e7ts

A#ailable 0ithSho01ard

system 0ithi!Lippo Pro#ider4or all be!e7ts

EMPLOYEE,S AGERESTRICTION)'i%- s%ndd/e0i10*

;a.im"m a5e 4or


8/22

UNDERWRITINGAVRIST


CHILDREN,S AGERESTRICTION)'i%- 2-ild/e0i10*

9hild is1o#ered 4rom )

day"p to 2( years

old,8s"be1t to 4"ll%time st"de!ts,

"!married,"!employed

9hild is1o#ered as o4birth "p to 2-

years old8s"be1t to 4"ll%time st"de!tsa!d "!married

a!d "!%employed

9hild is1o#ered 4rom )day 84or babybor! less tha!$> 0ee's or

0ei5ht is lesstha! 2-))5rams is

1o#ered 4rom(- days "p to2$ years old

8s"be1t to 4"ll%

time st"de!ts "!married

9hild 0ith a5e2$%2- years

old s"be1tedto ad"lt

premi"m

9hild is1o#ered 4rom )

day"p to 2( years

old,8s"be1t to 4"ll%time st"de!ts,

"!married,"!employed

FULL ANNUALLIMIT FORADDITION MEMBER

F"ll ?e!e7t apply 4or 3!patie!t be!e7t

AUTOMATICADDITION ANDDELETIONMEMBERS

Able to ba1'dated the e@e1ti#e date 0ithi! $) days 4rom reporti!5date

ORGANTRANSPLANTATION)E$2l1din& %-e Cos%o3 O&n*

9o#ered

HAEMODIALYSIS 9o#ered "!der 3!patie!t be!e7t terms

CHEMOTHERAPY 9o#ered "!der 3!patie!t be!e7ts terms

ENDOMETROSIS

)No% el%ed %oIn3e%ili%4+Fe%ili%4nd non(-o0onl2ses*

9o#ered 9o#eredO!ly 4orS"r5i1al

HEART SURGERY 9o#ered

CIRCUMCISSION)Rel%ed %o0edi2l indi2%iononl4*

9o#ered

9o#eredFor 1hild 0hi1ha5e "p to ma.

- years old

9o#ered

8


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UNDERWRITINGAVRIST


IMPLANTPROSTHESESSUCH AS PEN5STENT5 K(WIRE5IOL

9o#ered e.1l"di!5 3OL

9o#ered


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UNDERWRITINGAVRIST


=UARTERLYPREMIUMPAYMENTWITHOUTSURCHARGE+LOADING PREMIUM

GesNo, SemiA!!"ally

ALL TYPE OFE"CESS CLAIMWITHIN PROVIDERNETWORKCOVERED BYINSURER FIRSTAND INVOICE TO

THE COMPANYLATER

Ges;a. 3DR - millio!

GesNo i!4ormatio!o! ma. e.1ess

Ges;a.

3DR (- millio!

GEOGRAPHICALLIMITS

World0ide, $6- days, 2& ho"rs

INPATIENT )INSURED*

INPATIENTTYPE OF PRODUCT

3!!er Limit

INPATIENT

REINSTATEMENTBENEFIT

$) days (& days (& Days

SEMI ICU+INTERMEDIATE+ISOLATION ROOM

9o#ered "!der 39H be!e7t limit

INPATIENTMINIMUM HOUR)S*)s lon& s %-eHos/i%l C-&ed 3o%-e Roo0 6 Bod*

6 ho"rs / ho"rs 6 ho"rs

ONE DAY SURGERY 9o#ered

PRE AND POSTHOSPITALI


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UNDERWRITINGAVRIST


ROOM 6 BOARD)R6B* TOLERANCE

No tolera!1e

En%i%led R6Bis 3 1ll4

o221/ied ono% 7il8le

Hp5rade to!earest

a#ailablehi5her 1lass

0ith tolera!1e2)B or ma.

"p to

3DR -),)))80hi1he#er islesser "p toma.im"m 28t0o days


o221/ied ono% 7il8le

Hp5rade to!earest

a#ailablehi5her 1lass

0ith tolera!1e

-)B "p toma.3DR>-,))) "pto dis1har5e


o221/ied ono% 7il8leHp5rade to o!ele#el a#ailablehi5her 1lass 4orma.im"m o4 $

8three days

ASO PROGRAM

TYPE OF BENEFITSTYPE OF BENEFITSCOVER UNDER ASOCOVER UNDER ASO

O"tpatie!t, De!tal a!d ;ater!ity

ABILITY TOABILITY TO

FOLLOW ASOFOLLOW ASOBENEFITSBENEFITSPROGRAM ASPROGRAM ASRE=UESTED BYRE=UESTED BYTHE COMPANYTHE COMPANY

Ges, 4or all be!e7ts

ASO DEPOSITASO DEPOSITRE=UESTRE=UEST 3DR $)),))),)))per $ 8three mo!ths

3DR$)),))),)))34 the deposit0as already

"sed "p -)B o4the i!itial 4"!d,

the poli1yholder m"streload the

deposit "p tothe i!itialdeposit

34 the depositalready "sed"p >-B a!dhas !ot bee!

reloaded,1ashless

4a1ility 0ill be1losed

3DR-)),))),)))34 the deposit0as already

"sed "p -)B o4the i!itial 4"!d,

the poli1yholder m"streload the

deposit 0ithi!(& days 4romthe i!#oi1e

date34 the depositalready "sed"p >-B a!dhas !ot bee!

reloaded,1ashless 4a1ility0ill be 1losed

ASO FEE PERASO FEE PERPERSON PER YEARPERSON PER YEAR

3DR //,))) 3DR /),))) 3DR ()),))) 3DR ($-,)))

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:. INSURANCE BENEFIT:. INSURANCE BENEFIT

COMPARISONCOMPARISON

:.!. HOSPITALISATION 6 SURGICAL BENEFIT:.!. HOSPITALISATION 6 SURGICAL BENEFIT

*enets e+pressed in ID, and co(era%e that is clearl& better is identied in &ellow

BENEFITSAVRIST

ABDA RELIANCE LIPPOE$is%in& Rene'l

DAILY HOSPITALROOM 6 BOARD)R6B* /e d4

(,&)),)))(,()),)))/)),)))6)),)))$-),)))2-),)))2)),)))

;a. >) days per disability

(,&)),)))(,()),)))/)),)))6)),)))$-),)))2-),)))2)),)))

No limitatio! o! !"mber o4 days per disability

INTENSIVE CAREUNIT )ICU* PER DAY

2,/)),)))2,2)),)))(,6)),)))(,2)),)))>)),)))-)),)))&)),)))

;a. 2) days i!1l"di!5 >) days4or ea1h disability

2,/)),)))2,2)),)))(,6)),)))(,2)),)))>)),)))

-)),)))&)),)))

No limitatio!o! !"mber o4

days perdisability

2,/)),)))2,2)),)))(,6)),)))(,2)),)))

>)),)))-)),)))&)),)))

;a. 2) daysper disability

2,/)),)))2,2)),)))(,6)),)))(,2)),)))>)),)))-)),)))&)),)))

No limitatio! o!!"mber o4 days

per disability

MISCELLANEOUSHOSPITALE"PENSES PER

DISABILITY

&,))),)))$/,-)),)))2/,))),)))2(,))),)))(2,2-),)))/,>-),)))>,))),)))

83!1l"di!5 pri#ate !"rse,operatio! theatre, a!esthesia,

laboratory dia5!osti1, medi1i!es i!4"sio!, et1

&,))),)))$/,-)),)))2/,))),)))2(,))),)))(2,2-),)))/,>-),)))

>,))),)))83!1l"di!5 medi1i!es, laboratory dia5!osti1,admi!istratio!, et1 e.1l operatio! theatre,

a!esthesia

PRIVATE NURSE5PER DAY

9o#ered "!der ;is1ella!eo"sospital e.pe!ses

Not 1o#ered

2,/)),)))2,2)),)))(,6)),)))(,2)),)))>)),)))-)),)))&)),)))

;a.$) daysper disability

/),)))>>),)))-6),)))&2),)))2&-,)))(>-,)))(&),)))

No limitatio! o!

!"mber o4 daysper disability

13


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BENEFITSAVRIST


COMPLE"OPERATION PERDISABILITY

6$,))),)))&,-)),)))$6,))),)))2>,))),)))(-,>-),)))((,2-),)))(),))),)))

Do1tors 4ee o!ly

6$,))),)))&,-)),)))$6,))),)))2>,))),)))(-,>-),)))((,2-),)))(),))),)))

Do1tors 4ee i!1l"di!5 operatio!theatre a!d a!esthesia

//,2)),)))6,$)),)))-),&)),)))$>,/)),)))22,)-),)))(-,>-),)))(&,))),)))Do1tors 4ee

i!1l"di!5operatio!

theatre a!da!esthesia

MA>OR OPERATIONPER DISABILITY

&2,))),)))$$,))),)))2&,))),)))(/,))),)))(),-)),)))>,-)),)))6,))),)))

Do1tors 4ee o!ly

&2,))),)))$$,))),)))2&,))),)))(/,))),)))(),-)),)))>,-)),)))6,))),)))

Do1tors 4ee i!1l"di!5 operatio!theatre, a!esthesia

-/,/)),)))

&6,2)),)))$$,6)),)))2-,2)),)))(&,>)),)))(),-)),)))/,&)),)))

Do1tors 4eei!1l"di!5operatio!


INTERMEDIATEOPERATION PERDISABILITY

2(,))),)))(6,-)),)))(2,))),))),))),)))-,2-),)))$,>-),)))$,))),)))

Do1tors 4ee o!ly

2(,))),)))(6,-)),)))

(2,))),))),))),)))-,2-),)))$,>-),)))$,))),)))


2,&)),)))2$,()),)))(6,/)),)))(2,6)),)))>,$-),)))-,2-),)))&,2)),)))



MINOR OPERATIONPER DISABILITY

(),-)),)))/,2-),)))6,))),)))&,-)),)))2,62-,)))(,/>-,)))(,-)),)))

Do1tors 4ee o!ly

(),-)),)))/,2-),)))6,))),)))&,-)),)))

2,62-,)))(,/>-,)))(,-)),)))


(&,>)),)))((,--),)))/,&)),)))6,$)),)))$,6>-,)))2,62-,)))2,()),)))



IN(HOSPITALDOCTOR VISIT5PER DAY

/),)))>>),)))-6),)))&2),)))2&-,)))(>-,)))(&),)))

;a. >) days per disability,i!1l"di!5 Spe1ialist Do1tor

/),)))>>),)))-6),)))&2),)))2&-,)))(>-,)))(&),)))

No limitatio! o! !"mber o4 daysper disability, i!1l"di!5 Spe1ialist

Do1tor

/),)))>>),)))-6),)))&2),)))2&-,)))(>-,)))(&),)))


daysper disability

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15/22

BENEFITSAVRIST


DOCTORDOCTORSPECIALISTSPECIALISTCONSULTATION INCONSULTATION INHOSPITAL5 PER DAYHOSPITAL5 PER DAY

9o#ered "!der3!%ospital Do1tors isit ?e!e7t

/),)))>>),)))-6),)))&2),)))2&-,)))(>-,)))(&),)))


daysper disability

EMERGENCY

OUTPATIENT 6DENTALTREATMENT DUETO ACCIDENTPER DISABILITY

>,))),)))

-,-)),)))&,))),)))$,))),)))(,>-),)))(,2-),)))(,))),)))

PRE 6 POSTHOSPITALI


16/22

BENEFITSAVRIST


HOSPITALI),))),)))-2,-)),)))$),62-,)))2(,/>-,)))(>,-)),)))

Not 9o#ered

CHEMOTHERAPY 6HAEMODIALYSISPER POLICYPERIOD

9o#ered "!der 3!patie!t be!e7t

/,))),)))>>,))),)))-6,))),)))&2,))),)))

2&,-)),)))(>,-)),)))(&,))),)))

(22,-)),)))6,2-),)))>),))),)))-2,-)),)))

$),62-,)))2(,/>-,)))(>,-)),)))

9o#ered "!der3!patie!t

be!e7t

DEATH BENEFIT(),))),)))All Pla!s


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?. ASO BENEFITS?. ASO BENEFITS

?.!. OUTPATIENT BENEFIT?.!. OUTPATIENT BENEFIT

*enets e+pressed in ID, and co(er "nder A-O Pro%ram

BENEFITS PLAN ! PLAN # PLAN : PLAN ? PLAN @ PLAN PLAN

GENERALPRACTITIONER

CONSULTATIONPER VISIT PER DAY

As 9har5e

No limitatio! o! !"mber o4 #isit per day

DOCTOR,SSPECIALISTCONSULTATIONPER VISIT PER DAY

As 9har5eNo limitatio! o! !"mber o4 #isit per day

DIAGNOSTICLABORATORYSERVICES /ePOLICY YEAR

As 9har5e

PRESCRIBEDMEDICINES PERPOLICY YEAR

As 9har5e

PHYSIOTERAPY5PER YEAR

As 9har5eO!e #isit per day

ADMINISTRATIONFEE

As 9har5e

IMMUNI


18/22

?.#. DENTAL BENEFIT?.#. DENTAL BENEFIT

*enets e+pressed in ID, and co(er "nder A-O Pro%ram

BENEFITS PLAN ! PLAN # PLAN : PLAN ? PLAN @ PLAN PLAN

PREVENTIVETREATMENT5PER YEAR

As 9har5e

BASIC DENTALTREATMENT5PER YEAR

As 9har5e

COMPLE" DENTALTREATMENT5PER YEAR

As 9har5e

GUM TREATMENT5PER YEAR

As 9har5e

REHABILITATIVETREATMENT5 PERTOOTH

As 9har5e

REIMBURSEMENT

PERCENTAGE /-B

OVERALL LIMITPER POLICY YEAR

Unli0i%ed

?.:. MATERNITY BENEFIT?.:. MATERNITY BENEFIT

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. PREMIUM COMPARISON. PREMIUM COMPARISON

We 0o"ld li'e to i!4orm yo" that the premi"m belo0 is a! estimatio! premi"m based o!s"mmary data 5i#e! dated > No#ember 2)($0ith --> parti1ipa!ts

Premi"m me!tio!ed belo0 are i!di1ati#e premi"m 4rom the i!s"rer 3!s"rer 0ill re1al1"late thea1t"al premi"m s"be1t to re1ei#e data at the be5i!!i!5 o4 the 1o#era5e a!d the be!e7t1hose! by the 9ompa!y

*his M"otatio! is #alid "!til $) days 4rom proposal date

ANNUAL PREMIUM

)in IDR*

AVRIST

ABDA RELIANCE LIPPO!s% #nd

INPATIENT ?@5#:!5@# @?5:?5?

5?5:#@

@5#:@58(- ;o!ths

!?55

GROUP TERM LIFE 55 55

ASO FEE ?5!#5 ??5#5 @@55 @@55 @5!@5

TOTAL @??5!5@# @@55?@?5:?5:#

@!5:5:@5

8(- ;o!ths

5!@5

** Notes:Notes:

% O! the (O! the (ststM"otatio! that yo" re1ei#ed dire1tly 4rom AR3S*, AR3S* has !ot i!1l"ded theM"otatio! that yo" re1ei#ed dire1tly 4rom AR3S*, AR3S* has !ot i!1l"ded thedepe!de!ts 4or 1al1"lati!5 the ASO Feedepe!de!ts 4or 1al1"lati!5 the ASO Fee

% *he abo#e premi"ms are e.1l"di!5 poli1y 1ost a!d the i!itial ASO Deposit*he abo#e premi"ms are e.1l"di!5 poli1y 1ost a!d the i!itial ASO Deposit%% *he abo#e est premi"ms to be re1al1"lated "po! re1ei#i!5 1o!7rmatio! o4 i!s"ra!1e be!e7t*he abo#e est premi"ms to be re1al1"lated "po! re1ei#i!5 1o!7rmatio! o4 i!s"ra!1e be!e7t

bei!5 p"r1hased a!d the 7!al !"mber o4 parti1ipa!ts to be 1o#eredbei!5 p"r1hased a!d the 7!al !"mber o4 parti1ipa!ts to be 1o#ered%% *he abo#e est premi"ms are 1al1"lated based o! ;ale, Female a!d 9hild e.1ept AR3S**he abo#e est premi"ms are 1al1"lated based o! ;ale, Female a!d 9hild e.1ept AR3S*based o!


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. TOTAL NUMBER OF PLUS POINTS. TOTAL NUMBER OF PLUS POINTS

Co(era%e that is clearl& better is identied in &ellow

YELLOWHIGHLIGHTED

AVRISTABDA RELIANCE LIPPO

!s% #nd

GenelGenelUnde'i%in&Unde'i%in&

6 Se7i2es6 Se7i2es !! !! !! !@!@

In/%ien%In/%ien% :: :: @@ !!

Co08inedCo08ined !#!# !! !! !@!@ ::::

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2nd GHS Proposal Multi Kontrol Nusantara

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