2nd ghs proposal multi kontrol nusantara
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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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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 $illis Indonesia
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!. E"ECUTIVE SUMMARY!. E"ECUTIVE SUMMARY
W" #$%&' &()" *$ *+,-) 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 /$
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T+(0 0%,/ +,0 ""- /",/"' PT. W(&&(0 I-'$-"0(, *$ ,00(0* PT. M%&*( $-*/$& N%0,-*,/, (-
"
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#. 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
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UNDERWRITINGAVRIST
RELIANCE LIPPOE$is%in& Rene'l
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
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UNDERWRITINGAVRIST
RELIANCE LIPPOE$is%in& Rene'l
IMPLANTPROSTHESESSUCH AS PEN5STENT5 K(WIRE5IOL
9o#ered e.1l"di!5 3OL
9o#ered
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UNDERWRITINGAVRIST
RELIANCE LIPPOE$is%in& Rene'l
=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
RELIANCE LIPPOE$is%in& Rene'l
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
En%i%led R6Bis 3 1ll4
o221/ied ono% 7il8le
Hp5rade to!earest
a#ailablehi5her 1lass
0ith tolera!1e
-)B "p toma.3DR>-,))) "pto dis1har5e
En%i%led R6Bis 3 1ll4
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
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BENEFITSAVRIST
ABDA RELIANCE LIPPOE$is%in& Rene'l
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!
theatre a!da!esthesia
INTERMEDIATEOPERATION PERDISABILITY
2(,))),)))(6,-)),)))(2,))),))),))),)))-,2-),)))$,>-),)))$,))),)))
Do1tors 4ee o!ly
2(,))),)))(6,-)),)))
(2,))),))),))),)))-,2-),)))$,>-),)))$,))),)))
Do1tors 4ee i!1l"di!5 operatio!theatre, a!esthesia
2,&)),)))2$,()),)))(6,/)),)))(2,6)),)))>,$-),)))-,2-),)))&,2)),)))
Do1tors 4eei!1l"di!5operatio!
theatre a!da!esthesia
MINOR OPERATIONPER DISABILITY
(),-)),)))/,2-),)))6,))),)))&,-)),)))2,62-,)))(,/>-,)))(,-)),)))
Do1tors 4ee o!ly
(),-)),)))/,2-),)))6,))),)))&,-)),)))
2,62-,)))(,/>-,)))(,-)),)))
Do1tors 4ee i!1l"di!5 operatio!theatre, a!esthesia
(&,>)),)))((,--),)))/,&)),)))6,$)),)))$,6>-,)))2,62-,)))2,()),)))
Do1tors 4eei!1l"di!5operatio!
theatre a!da!esthesia
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&-,)))(>-,)))(&),)))
No limitatio!o! !"mber o4
daysper disability
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BENEFITSAVRIST
ABDA RELIANCE LIPPOE$is%in& Rene'l
DOCTORDOCTORSPECIALISTSPECIALISTCONSULTATION INCONSULTATION INHOSPITAL5 PER DAYHOSPITAL5 PER DAY
9o#ered "!der3!%ospital Do1tors isit ?e!e7t
/),)))>>),)))-6),)))&2),)))2&-,)))(>-,)))(&),)))
No limitatio!o! !"mber o4
daysper disability
EMERGENCY
OUTPATIENT 6DENTALTREATMENT DUETO ACCIDENTPER DISABILITY
>,))),)))
-,-)),)))&,))),)))$,))),)))(,>-),)))(,2-),)))(,))),)))
PRE 6 POSTHOSPITALI
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BENEFITSAVRIST
ABDA RELIANCE LIPPOE$is%in& Rene'l
HOSPITALI),))),)))-2,-)),)))$),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
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?.#. 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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