Overview of health insurance in Indonesia

What is health insurance?

Health insurance helps cover the risks of medical and surgical treatment for various types of illnesses and accidents. Depending upon the type of coverage you can either pay medical costs from your pocket and get reimbursed by the insurer or have the insurer make payments directly to the medical service provider.

Can you provide a few examples of health insurance packages available in Indonesia?

There are two major types of health insurance packages available; these are:

• Group health insurance

This is a health insurance cover paid for by employers for their employees. A few examples of such packages would be the Group Health Insurance from ACE Jaya Proteksi, Group Health from AXA Indonesia and two packages – Manulife Direct Protection and Manulife Total Protection from Manulife Indonesia.

• Individual health insurance

These are meant for individuals; depending upon the product, such policies can be availed by individuals for themselves and/or their families. We will look at a few examples here:

The New Save in Safe offered by PT Panin Dai-Ichi Life and Citibank provides 24 hours worldwide insurance protection coverage, provides more protection to complement your existing hospital insurance and returns a minimum of 80% of your premiums even though there have been claims paid. Citibank also provides the Ultimate Link Assurance Account (ULAA) Health, a product that provides both health cover and an investment.

Health insurance package from ACE Jaya Proteksi provides coverage not only for medical treatment but also for any financial impact suffered due to hospitalization. It provides for up to 365 days confinement, does not require any medical check-up, provides daily benefits due to accident or illness, has surgical benefit options and covers critical conditions like cancer, heart attack, stroke, kidney failure, end stage liver failure, major burns and paralysis amongst others.

ProHealth from Manulife is a health insurance package that covers medical costs until you reach the age of 99 years. Benefits for the cost of your health care or treatment is provided through medical reimbursement. Coverage includes fees of specialist medical doctor(s), laboratory tests, treatment and other costs related to hospitalization. To enroll you should be between 18 to 55 years of age and the premium payment period is up to 70 years of age.

Takaful or insurance that complies with Islamic Sharia law is also available in Indonesia. Life insurance and investment linked life insurance policies are available. Brilliance Hasanah Sejahtera and Brilliance Hasanah Protection Plus are examples of life insurance Takaful products from PT Sun Life Financial.

What points should you look out for when you want to go in for a health insurance cover?

Plan your needs– Opt for a health policy after considering your existing health needs and budget. A standard cover may be sufficient if you or your family members do not have any health problems. However, if you or your family members already have a medical condition or are pre-disposed to such, you could consider a more comprehensive health cover.

Pre-existing conditions-If you already have a pre-existing medical condition, ensure that you declare this condition and that your healthcare policy provides cover for it. Health policies may also provide cover only after a certain waiting period (2 years, 4 years etc); so check for such conditions before you sign up.

Exclusions-All health insurance products contain exclusions; understand the exclusions that apply to the policy you are looking at and how it could impact you given your current medical condition / requirements.

Compare and shop-Before you go in for a particular health insurance product, compare. Compare it with other similar products from other insurers for costs, ease of claims, hospital network, customer service, facilities offered, types of expenses covered, ease of renewal etc.

Servicing your policy-Finally, do not forget to pay your premiums on time and if your policy requires so, declare any changes in your medical condition.

What about Indonesia’s public healthcare program, Jaminan Kesehatan Nasional?

Indonesia’s government has launched a scheme, Jaminan Kesehatan Nasional (JKN), implemented by the newly-formed social security agency Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS), to provide basic care available to all by 2019.

Under JKN, all citizens are now able to access a wide range of health services provided by public facilities, as well as services from a few private organisations that have opted to join the scheme as providers. JKN care aims to be comprehensive, covering treatment for everyday concerns such as flu through to open-heart surgery, dialysis and chemotherapy.

Under Presidential Decree No 111, large, medium and small companies must participate as of January 1, 2015 in the national health insurance programme. Those in formal employment pay a premium equivalent to 5% of their salary, with 4% payable by employers and 1% payable by employees. Informal workers, the self-employed and investors pay fixed monthly premiums of between Rp 25,500 and Rp 59,500 in a tiered system of first, second and third-rate care depending on the contributions they choose to pay.