data plan kesehatan

8/18/2019 data plan kesehatan

1/31

Premium per person in USDAge Range Primary Plan Standard Plan

Child 731 98818-39 1.362 1.85140-49 1.819 2.46950-55 2.395 3.24856-59 Available For renewal 2.628 3.57460-64 Available for renewal 3.187 4.322Maternit !ene"t o#tional $%A 2.358ADDITIONAL PREMIUM FOR ACCIDENT EMER!ENC" TREATMENT IN US

Age Range Primary Plan Standard PlanChild 351 47418-39 654 88840-49 873 1.18550-55 1.150 1.55956-59 Available For renewal 1.261 1.716

60-64 Available for renewal 1.530 2.075

$ote & '(' b)#a 1 * +ri,art Medi +lan '(' !)#a 2 * tandard +lan dan '(' !)#a+erhit)n an #re,i e )ai ),)r di tabel

/ han a ,en )al #lan tabel warna hi a) tan#a additional #re,i), for a i


2/31

E$e%uti&e Plan1.3492.5253.3564.4134.8555.8822.358

#CANADAE$e%uti&e Plan

5671.0611.4101.8532.039

2.470

3 * / e )tive +lan

ent /,er en reat,ent in : A%Canada


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!LO'AL (EALT( INDONESIA

Age)ona * )ona +

Classi% Supreme Elite Classi% Supreme Elite0-5 2.913 4.017 4.770 1.360 1.874 2.2246-7 2.913 4.017 4.770 1.360 1.874 2.22418-24 3.696 5.032 5.883 1.725 2.346 2.74225-29 4.591 6.259 7.159 2.141 2.917 3.33530-34 4.934 6.625 7.811 2.300 3.087 3.63835-39 5.259 7.233 8.359 2.451 3.369 3.89340-44 5.954 8.089 9.442 2.775 3.768 4.38845-49 6.791 9.357 10.554 3.164 4.357 4.91450-54 7.601 10.439 12.064 3.541 4.861 5.61755-59 9.455 12.443 14.529 4.403 5.793 6.76360-64 11.934 15.920 19.413 5.556 7.410 9.03565-69; 16.956 22.976 27.050 7.892 10.692 12.587

70; 19.241 26.295 30.998 8.955 12.235 14.42371; 19.524 26.717 31.500 9.086 12.432 14.65672; 19.808 27.132 31.996 9.218 12.625 14.88773; 20.113 27.505 32.686 9.360 12.799 15.20874; 20.427 27.871 33.376 9.506 12.968 15.52975; 22.270 30.085 37.493 10.364 13.998 17.44476; 22.576 30.442 38.175 10.506 14.164 17.76177; 22.881 30.807 38.873 10.648 14.334 18.08678; 23.214 31.293 39.320 10.802 14.560 18.29479; 23.527 31.770 39.775 10.948 14.782 18.505

80nl?ental 1.864 ?ental 872

$ote & 'ndi@a i =ate a a.

$> / & / han a ,en )al ona 4 #lan la i #erhit)n an ),)r e )ai den an tabel w


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rna hi a).


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Ta,el -aminan Polis Simas Se.at

-enis -aminan Plan D Plan E'agian I

!ia a Ba,ar Men ina# #erhari %d 365 hari 500.000 600.000

!ia a Ba,ar 'C: %'CC: #erhari %d 60 hari 1.000.000 1.2000.000!ia a Ane@a +erawatan =),ah a@it A Char ed A Char ed

A Char ed A Char ed

!ia a B)n )n an ?o@ter ?i =),ah a@it A Char ed A Char ed!ia a B)n )n an ?o@ter Ahli ?i =),ah a@it A Char ed A Char ed

A Char ed A Char ed

!ia a Bon )lta i an )tan %d 60 (ari etelah e#a =awat A Char ed A Char ed

A Char ed A Char ed!ia a =awat alan ?ar)rat A@ibat Be ela@aa n A Char ed A Char ed!ia a =awat alan ?ar)rat Di i A@ibat Be ela@aan A Char ed A Char ed!ia a >#era i %!edah +la ti@ A@ibat Be ela@aan 4.000.000 5.000.000!ata Ma@ i,), #en antian #er-tah)n 400.000.000 500.000.000

'agian II

200.000.000 250.000.000

Premi Perta.un untu4 -aminan Di seluru. Dunia TERMASU5 -epUsia 7 Ta.un 8

Plan D Plan EPemegang Polis Atau Pasangannya Ana4 %d 19 0-19; 1.189.000 1.455.000

20-29 20-24 1.715.000 2.107.000

30-39 2.000.000 2.451.00040-49 2.277.000 2.782.00050-59 3.068.000 3.737.00060-65 3.682.000 4.461.000

Premi Perta.un untu4 -aminan Si Seluru. Dunia 5e%ualUsia 7 Ta.un 8

!ia a >#era i%+e,bedahan er,a )@ !ia a +e,bi) andan !ia a Ba,ar !edah +re +o t !edah 31 (ari

ebel),% e )dah

!ia a +e,eri@ aan ab e ?ia no ti@ 7 (ari ebel),+erawatan 'na# ?i =),ah a@it

!ia a ran #orta i Mobil A,b)lan e Men) ) =),ah a@it ?ala, Beadaan ?ar)rat

ran #lanta i >r an )b)h ant)n (ati +ar) -+ar) Din aldan ), ), t)lan bata Ma@ i,), #en antian #ertah)n


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Pemegang Polis Atau Pasangannya Ana4 Plan D Plan E%d 19 0-19; 1.010.000 1.237.000

20-29 20-24 1.458.000 1.791.00030-39 1.700.000 2.084.00040-49;; 1.936.000 2.365.00050-59 2.607.000 3.177.00060-65;; 3.143.000 3.792.000

Catatan &; Mini,), : ia Ana@ & 30 hari ;;; Ma@ i,), : ia +e erta dewa a )nt)@ $ew !) ni &49 ah)n;;; Ma@ i,), : ia +e erta dewa a )nt)@ =enewal &65 ah)n

Bh) ) )nt)@ #oli renewal abel +re,i diata berla@) efe@tif #er 01 $ove,ber 2012

$> / & / han a ,en )al +lan ! 'n : ? dan #lan in '?= a,inan di el)r)h d)nia


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E$e%uti&e / E0e%ti&e per 1*/12/31*3

Plan F Plan ! Plan ( Plan I Plan -

700.000 800.000 900.000 1.000.000 1.500.000

1.400.000 1.600.000 1.800.000 2.000.000 3.000.000A Char ed A Char ed A Char ed A Char ed A Char ed

A Char ed A Char ed A Char ed A Char ed A Char ed

A Char ed A Char ed A Char ed A Char ed A Char edA Char ed A Char ed A Char ed A Char ed A Char ed



A Char ed A Char ed A Char ed A Char ed A Char edA Char ed A Char ed A Char ed A Char ed A Char edA Char ed A Char ed A Char ed A Char ed A Char ed6.000.000 7.000.000 8.000.000 9.000.000 14.000.000

600.000.000 700.000.000 800.000.000 900.000.000 1.400.000.000

300.000.000 350.000.000 400.000.000 450.000.000 700.000.000

ng6USA Canada

PLan F Plan ! Plan ( Plan I Plan -1.914.000 2.472.000 3.090.000 3.818.000 6.808.0002.769.000 3.564.000 4.445.000 5.578.000 10.825.000

3.222.000 4.158.000 5.194.000 6.485.000 12.215.0003.659.000 4.740.000 5.936.000 7.343.000 13.549.0004.907.000 6.389.000 8.018.000 9.863.000 16.948.0005.879.000 7.682.000 9.681.000 11.715.000 19.829.000

9 -epang6USA Canada


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PLan F Plan ! Plan ( Plan I Plan -1.627.000 2.101.000 2.627.000 3.245.000 5.787.0002.353.000 3.030.000 3.778.000 4.742.000 9.201.0002.739.000 3.534.000 4.415.000 5.513.000 10.382.0003.111.000 40.29.000 5.046.000 6.242.000 11.517.0004.171.000 5.431.000 6.815.000 8.383.000 14.406.0004.997.000 6.530.000 8.229.000 9.958.000 16.855.000

er,a )@ A,eri@a e#an dan Canada den an ,en )na@an tabel warna hi


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in US:

Plan 5 Plan A Plan '

2.000.000 200 300

4.000.000 400 600A Char ed A Char ed A Char ed

A Char ed A Char ed A Char ed

A Char ed A Char ed A Char edA Char ed A Char ed A Char ed



A Char ed A Char ed A Char edA Char ed A Char ed A Char edA Char ed A Char ed A Char ed19.000.000 1.800 2.800

1.900.000.000 180.000 280.000

950.000.000 90.000 140.000

Plan 5 Plan A Plan '10.879.000 1.085 2.53618.064.000 1.801 3.896

19.916.000 1.936 4.16621.727.000 2.167 4.44225.524.000 2.545 4.74429.434.000 2.935 5.339


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Plan 5 Plan A Plan '9.247.000 922 2.156

15.355.000 1.531 3.31116.929.000 1.689 3.54118.468.000 1.841 3.77521.696.000 2.164 4.03225.019.000 2.495 4.538

a)


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SELURU( DUNIA / TANPA RESI5O SENDIRI7 dalam US DOLLAR 8

Usia Plan A Plan ' Plan C Usia Plan A Plan ' Plan C0 4.061 2.540 1.7221 4.061 2.540 1.722 41 9.789 6.578 4.164

2 4.061 2.540 1.722 42 9.976 6.793 4.2983 4.061 2.540 1.722 43 10.163 7.008 4.4324 4.061 2.540 1.722 44 10.350 7.224 4.5665 4.061 2.540 1.722 45 10.537 7.440 4.7016 4.061 2.540 1.722 46 10.724 7.655 4.8367 4.061 2.540 1.722 47 10.911 7.871 4.9698 4.061 2.540 1.722 48 11.098 8.086 5.1049 4.061 2.540 1.722 49 11.285 8.302 5.238

10 4.061 2.540 1.722 50 11.472 8.517 5.37211 4.259 2.585 1.819 51 11.659 8.733 5.50712 4.457 2.630 1.915 52 11.846 8.948 5.64113 4.655 2.674 2.012 53 12.040 9.106 5.90714 4.853 2.719 2.108 54 12.235 9.264 6.17415 5.051 2.764 2.205 55 12.429 9.422 6.44116 5.250 2.808 2.302 56 12.622 9.580 6.70717 5.448 2.853 2.398 57 12.817 9.738 6.97418 5.646 2.898 2.494 58 13.650 10.457 7.52919 5.843 3.057 2.542 59 14.621 11.250 8.10020 6.041 3.216 2.590 60 15.544 12.101 8.71221 6.238 3.376 2.637 61 16.655 13.011 9.36822 6.436 3.535 2.685 62 17.847 13.990 10.07323 6.634 3.693 2.733 63 19.122 15.038 10.82724 6.831 3.852 2.780 64 20.489 16.163 11.63625 7.028 4.011 2.828 65 21.951 17.366 12.50426 7.225 4.171 2.876 66 23.520 18.656 13.43327 7.423 4.330 2.923 67 25.198 20.039 14.42928 7.621 4.489 2.971 68 26.995 21.552 15.49529 7.818 4.648 3.019 69 28.921 23.109 16.63830 7.971 4.781 3.095 70 30.367 24.341 17.52631 8.123 4.915 3.171 71 31.955 25.636 18.45732 8.277 5.049 3.247 72 33.623 26.995 19.43633 8.430 5.182 3.322 73 35.373 28.442 20.46434 8.582 5.316 3.398 74 37.210 29.918 21.54135 8.736 5.449 3.475 75 39.138 31.490 22.67336 8.888 5.582 3.550 76 41.161 33.139 23.86037 9.041 5.716 3.626 77 43.283 34.870 25.10738 9.228 5.932 3.761 78 45.510 36.688 26.41539 9.415 6.147 3.895 79 47.846 38.593 27.78740 9.602 6.363 4.029 80 50.297 40.593 29.227


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$> / & +re,i * e )ai tabel ),)r i@a in in ada re i@o endiri 500 1500 5000 a@an , / ,en )al +lan C a ia >nl tabel warna (i a)


13/31

SELURU( DUNIA 5ECUALI AMERI5A SERI5 Tanpa Resi4o Sendiri / 7 dalam US DOLLA

Usia Plan A Plan ' Plan C Usia Plan A Plan '0 1.906 1.411 8071 1.906 1.411 807 41 5.344 3.653

2 1.906 1.411 807 42 5.423 3.7753 1.906 1.411 807 43 5.503 3.8964 1.906 1.411 807 44 5.582 4.0185 1.906 1.411 807 45 5.662 4.1396 1.906 1.411 807 46 5.741 4.2617 1.906 1.411 807 47 5.820 4.3828 1.906 1.411 807 48 5.899 4.5049 1.906 1.411 807 49 5.979 4.625

10 1.906 1.411 807 50 6.058 4.74811 2.060 1.436 852 51 6.137 4.86912 2.213 1.461 898 52 6.217 4.99113 2.367 1.486 944 53 6.307 5.06414 2.521 1.510 990 54 6.397 5.13715 2.675 1.536 1.035 55 6.488 5.21116 2.828 1.560 1.080 56 6.579 5.28417 2.982 1.585 1.126 57 6.668 5.35818 3.136 1.610 1.172 58 7.086 5.72219 3.244 1.695 1.193 59 7.598 6.15820 3.352 1.781 1.216 60 8.087 6.62421 3.461 1.866 1.238 61 8.674 7.12522 3.569 1.951 1.261 62 9.305 7.66323 3.678 2.037 1.282 63 9.979 8.23824 3.786 2.122 1.305 64 10.703 8.85625 3.893 2.208 1.327 65 11.478 9.51726 4.002 2.293 1.349 66 12.309 10.22727 4.110 2.379 1.371 67 13.199 10.98728 4.219 2.464 1.393 68 14.152 11.80129 4.327 2.550 1.416 69 15.174 12.67430 4.415 2.627 1.451 70 15.947 13.35231 4.502 2.704 1.487 71 16.793 14.06432 4.590 2.781 1.523 72 17.683 14.81233 4.677 2.858 1.559 73 18.617 15.59634 4.764 2.936 1.594 74 19.598 16.42235 4.852 3.012 1.631 75 20.628 17.28636 4.939 3.090 1.666 76 21.709 18.19437 5.027 3.166 1.702 77 22.844 19.14738 5.107 3.288 1.764 78 24.035 20.14839 5.186 3.409 1.827 79 25.284 21.19740 5.264 3.531 1.890 80 26.596 22.298


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enda#at@an di @on 5E 12 5E dan 25 E


15/31

T ASIA Tanpa Resi4o Sendiri 8 7 dalam US DOLLAR 8Plan C Usia Plan A Plan ' Plan C Usia Plan A

0 1.715 1.269 7471.952 1 1.715 1.269 747 41 4.810

2.015 2 1.715 1.269 747 42 4.8812.078 3 1.715 1.269 747 43 4.9532.140 4 1.715 1.269 747 44 5.0242.203 5 1.715 1.269 747 45 5.0952.265 6 1.715 1.269 747 46 5.1662.328 7 1.715 1.269 747 47 5.2382.391 8 1.715 1.269 747 48 5.3092.454 9 1.715 1.269 747 49 5.3802.517 10 1.715 1.269 747 50 5.4522.579 11 1.853 1.292 789 51 5.5232.642 12 1.992 1.314 831 52 5.5942.766 13 2.131 1.336 873 53 5.6762.892 14 2.269 1.359 915 54 5.7573.016 15 2.407 1.381 957 55 5.8393.141 16 2.546 1.404 999 56 5.9213.265 17 2.684 1.426 1.042 57 6.0023.559 18 2.823 1.449 1.084 58 6.3783.838 19 2.921 1.531 1.105 59 6.8384.138 20 3.018 1.613 1.125 60 7.2794.462 21 3.115 1.695 1.145 61 7.8074.807 22 3.212 1.777 1.165 62 8.3745.179 23 3.310 1.859 1.186 63 8.9815.579 24 3.407 1.941 1.207 64 9.6326.007 25 3.505 2.023 1.227 65 10.3306.468 26 3.602 2.105 1.248 66 11.0786.961 27 3.699 2.187 1.268 67 11.8797.491 28 3.797 2.269 1.289 68 12.7378.059 29 3.894 2.351 1.309 69 13.6568.505 30 3.973 2.423 1.342 70 14.3518.973 31 4.051 2.495 1.376 71 15.1149.464 32 4.131 2.567 1.408 72 15.9159.982 33 4.209 2.640 1.442 73 16.756

10.525 34 4.289 2.712 1.475 74 17.63811.096 35 4.367 2.784 1.508 75 18.56511.696 36 4.446 2.857 1.541 76 19.53812.326 37 4.525 2.929 1.575 77 20.56012.988 38 4.596 3.041 1.633 78 21.63213.683 39 4.667 3.154 1.691 79 22.75614.413 40 4.739 3.266 1.749 80 23.937


16/31


17/31

Plan ' Plan C

3.379 1.807

3.492 1.8643.604 1.9223.717 1.9803.829 2.0383.941 2.0964.054 2.1544.166 2.2124.279 2.2704.392 2.3284.504 2.3864.616 2.4444.684 2.5594.752 2.6754.821 2.7904.888 2.9064.956 3.0215.306 3.2595.707 3.5146.137 3.7886.599 4.0827.093 4.3987.623 4.7378.192 5.1018.801 5.4929.453 5.910

10.151 6.36010.901 6.84311.703 7.36012.325 7.76512.979 8.19113.664 5.63814.384 9.10815.139 9.60315.933 10.12216.764 10.66717.637 11.23918.554 11.84119.516 12.47320.524 13.136


18/31


19/31

Ma;or Medi%alNil E$%ess

ge Band nnual nnual nnual0 - 17 82518 - 20 991

21 - 24 1 10925 - 29 1 20230 - 34 1 29135 - 39 1 41740 - 44 1 63145 - 49 1 83150 - 54 2 61355 - 59 3 36760 - 64 4 62665 - 69; 7 130

70 - 74; 8 11075 - 79; 9 34080 / & / han a ,en )al +lan Ma or Medi al #erhit)n an #re


20/31

*6111 E$%ess


21/31

Smart(ealt. / MA=I >IOL

Ta,el Man?aat Ra@at Inap / Rupia

Ra@at Inap

Man?aat Untu4 setiap 5elas 7 dalam Rp 8Ba,arBa,ar 'C:B)n )n an ?o@ter an ,erawatBon )lta i ?o@ter #e iali

Pem,eda.an!edah Bo,#le@

!edah !e ar!edah edan!edah Be il!ia a ain- ain =awat 'na#

+erawatan ebel), dan etelah =awat 'na#+erawatan +ribadi ?i r),ahA,b)lan=awat alan dan =awat Di i ?ar)rat @arena Be ela@aan

ant)nan Be,atian

Ma4simum Man?aat dalaCatatan=awat 'na# da#at ,en )na@an Fa ilita =),ah a@it a

TA'EL MANFAAT RA AT INAP RA A

RA AT INAP7 ,ila di tam,a.4an Ra@at -alan 8

Man?aat Untu4 Setiap 5elas 7dalam Rp 8Ba,arBa,ar 'C:B)n )n an ?o@ter an ,erawatBon )lta i ?o@ter #e iali

Pem,eda.an!edah Bo,#le@!edah !e ar


22/31

!edah edan!edah Be il!ia a ain- ain =awat 'na#+erawatan +ribadi ?i r),ahA,b)lan

ant)nan Be,atian

RA AT -ALAN BMan?aat Untu4 Setiap 5elas 7 Dalam Rp 8Bon )lta i ?o@ter :,),Bon )lta i ?o@ter #e iali ;;>bat- >batan+e,eri@ aan ?ia no ti@Fi iotera#i

ilaya. Pertanggungan

; Bo A )ran i;; ?a#at lan )n ,eneri,a #erawatan dari do@ter #e iali

Catatan 9- =awat 'na# da#at ,en )na@an Fa ilita =),ah a@it arin- =awat alan han a berla@) den an i te, =ei,b)r e,ent

TA'EL MANFAAT 5E(AMILAN6PER

5E(AMILAN 6PERSALINAN NIFASMan?aat untu4 setiap 4elas 7dalam Rp 8Melahir@an $or,al%Abnor,al

a,bahan :nt)@ Melahir@an Abnor,alMelahir@an den an #e,bedahan@e ) )ran an le al

ebel), dan e )dah Melahir@anCatatan 9- Manfaat Melahir@an $or,al Melahir@an Abnor,al Melahir@an

=),ah a@it arin an Allian -Ad,edi@a Fa ilita Ca hle - Bh) ) Manfaat ebel), e )dah Melahir@an !erla@) de

TA'EL RA AT !I!I /Rupia.

RA AT !I!I BMan?aat Untu4 Setiap 5elas 7 dalam Rp 8+en e ahan


23/31

+erawatan Di i ?a ar+erawatan Di i Bo,#le@Di i +al )B8 31 %o /S.areCatatan 9!erla@) den an =ei,b)r ,ent

TA'EL MANFAAT SANTUNAN (ARIAN /SANTUNAN (ARIAN

Man?aat untu4 setiap 4elas 7 dalam Rp 8ant)nan (arian

Catatan 9!erla@) den an i te, =ei,b)r e,ent

$> / & et han a ,en )al +lan D dan #erhit)n an #re,i e


24/31

T * 7 IDR 8

PLAN !

'atasan Ma4simum IIP


25/31

#er #eriode rawat ina# 54 000 000#er #eriode rawat ina# 30 000 000#er #eriode rawat ina# 12 500 000#er hari ,a@ 180 hari #er tah)n 375 000#er #eriode rawat ina# 500 000

8 500 000

'atasan Ma4simum IOP


26/31

#er tah)n 3 375 000#er tah)n 3 750 000#er tah)n 3 750 000

Rupia.Plan !DC


27/31


28/31

an Fa ilita


29/31


30/31

INTERNATIONAL (EALT( AND (OSPITAL PLA

A!E 'RAC5ETS 1/2 *1/3<Plans @it.out Dedu%ti,le(o #ital +lan 0 4 620Mod)le 1 $on -(o #itali ation !ene"t 0 3 002Mod)le 2 Medi ine A##lian e 0 1 002Plans a&aila,le @it. USD +11 dedu%ti,le(o #ital +lan 0 3 298Mod)le 1 $on -(o #itali ation !ene"t 0 2 223Mod)le 2 Medi ine A##lian e 0 733Plans a&aila,le @it. USD *6 11 Dedu%ti,le(o #ital +lan 0 2 292Mod)le 1 $on -(o #itali ation !ene"t 0 1 014Mod)le 2 Medi ine A##lian e 0 104Plans a&aila,le @it. USD


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3 /++ +

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