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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.

overview_of_health_insurance_in_indonesia

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.

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An Overview about Insurance in Indonesia

insurancepicInsurance can help protect you, your family members and your assets against various contingencies while also providing compensation in case of loss, damage, injury, disability or death. Here, we will take a look at some of the main types of insurance products available in Indonesia:

Life Insurance

This is a type of insurance that pays out a certain sum of money to the insured or their beneficiary(ies) upon the happening of a certain event to the insured. Life Insurance helps cover risks like Premature Death, Illness and Permanent Disability. It can also be used for providing income after retirement.

In Indonesia there are two types of life insurance:

Term Insurance – It offers death benefits. This means that if you die, your nominees will get the sum assured, but if you live past the pre-determined length of the policy, you will not get any benefits.

Permanent Insurance – Permanent life insurance policies are open-ended and also accumulate a cash value that the policyholder can earn dividends from and borrow against or cash-in upon surrendering the policy. Permanent life insurance can be categorized into mainly two types: Whole life insurance and Universal life insurance.

Whole life insurance is meant for satisfying long term goals by offering consumers consistent premiums and guaranteed cash value accumulation whereas, universal life insurance policies focus on giving consumers flexibility in the premium payments, death benefits and a savings element in their policy.

There is also a proposal by insurance companies to come up with micro insurance policies for lower-income people in regencies and municipalities. A number of companies also offer investment-linked insurance plans. A part of the premium is set aside to buy units in an investments fund.

General Insurance

General Insurance protects you from losses and damages other than those covered by Life Insurance. The coverage period for most General Insurance policies is one year and is mostly paid on a one-time basis. General Insurance policies cover a wide range of risks and contingencies; the following are the main categories of General Insurance:

* Motor Insurance
* Fire / House Owner / Householder Insurance
* Personal Accident Insurance
* Medical and Health Insurance
* Travel  Insurance

Health Insurance

Health or Medical Insurance is used for meeting a range of medical treatments covered by your medical insurance policy. There are a number of health insurance products available. Some prominent examples include: Citibank’s New Save in Safe from PT Panin Dai – Ichi Life, PRUhospital Care from Prudential, Health Protection / HospitaLife and Critical Illness Protection from CIGNA, SmartCare Executive / Group Leaver and InternationalExclusive from AXA Indonesia etc.

BPJS Health

The world’s largest state-funded healthcare program, JKN, the national health insurance program administered by the BPJS mandates that every Indonesian citizen and foreigner who has lived in Indonesia for a minimum of six months shall be a member of BPJS in accordance with article 14 of the BPJS Law. Participation by all Indonesians is expected by the latest as of January 1, 2019.Under Presidential Decree No 111, large, medium and small companies must participate as of January 1, 2015 in the national health insurance programme.

Takaful or Islamic Insurance

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 Sun Life Financial.

Guidelines to Buy a Best Insurance Plan in Indonesia

insurance-plansInsurance is a great way to safeguard your life, protect your assets and secure your health. Insurance comes in a range of categories and there are numerous product offerings in each category. Here, we will try and provide you with guidelines to choosing an insurance product in two important categories, health and life:

Life Insurance

Life insurance provides financial payouts in contigencies like death, disability, retirement etc. When you die, get disabled or retire, you / your family members need money to replace the income lost; this is where life insurance comes in. Use the following tips to pick the right life insurance for your requirements:

Assess your needs – Life insurance is certainly required when you have a spouse, kids or ageing parents who depend upon you. Your life insurance should be able to cover funeral/medical expenses, replace lost income, help meet debt payments, mortgages and other bills, provide for children’s education and the like. Compute the amount of money your family might need to stay close to their current level of living while also taking care of their immediate and future financial needs and then plan for adequate insurance.

Decide upon the type of life insurance – There are various types of life insurance available. Term Insurance provides high coverage at a low cost but generally does not return any money. Whole Life and Endowment insurance provide life coverage and return to you the sum assured at the end of the policy term if you are alive and to your nominees otherwise. Unit linked insurance is a combination of protection and investment. Islamic insurance complies with the code of the Shariah.

Shop around – There are a number of life insurance providers. Evaluate both the product and the insurer before choosing one. Factors to evaluate the product – premium costs, amount of premium loading for smokers and those with medical conditions, availability of riders, lifelong coverage or choice of term, returns provided etc. To evaluate the insurer consider customer service and customer friendliness, ease of claims, track record etc.

Check out the fine print – Understand the terms, conditions and riders  involved with the insurance policy you’ve shortlisted. Make sure that your insurance coverage includes special riot provisions and acts of nature like floods, volcanic eruptions and earthquakes if you live in such incident-prone zones.

Health Insurance

Buying a health insurance policy will help you stay prepared for contigencies that require medical treatment. The introduction of the Jaminan Kesehatan Nasional (JKN), Indonesia’s universal healthcare system on the 1st of January 2014, though laudable still faces a number of challenges. And, even with the JKN fully implemented, you may find additional health cover very handy. Here’s how you can go about choosing a health policy:

Consider your needs – Before deciding upon a particular health insurance policy take your existing health needs and budget into consideration. If you or your family members do not have any health problems, a fairly “standard” policy may suffice. If, on the other hand, if you or your family members already have a medical condition or are pre-disposed to such, you could consider a more comprehensive medical policy.

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.

Individual or family? – Do you want to go for individual policies for each of your family members  or for one single policy that covers your entire family? In the case of the former, you may get higher cover, in the case of the latter you could save on costs. And, while you are at it, check for the definition of “family”.

Exclusions – Every healthcare policy comes with 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. Go through the fine print as well and if possible, consult an expert as to how such clauses could impact you.

Shop around – Evaluate the various healthcare products from different insurance service providers; check them out on costs, customer service, ease of claims, hospital network coverage, ease of renewal, facilities offered, types of expenses covered etc.

After you buy the policy – Make sure you meet the premium payments on time; some policies may have payment grace periods, but not all do. Also, check out the process for cashless treatment and for making claims.