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2ND PROPOSAL
GROUP HEALTH INSURANCE PROGRAM
FOR
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19 November 2013
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CONFIDENTIALITY
This Proposal contains information which is confidential to both
PT. Multi Kontrol Nusantara Indonesia and PT. Willis Indonesia.
Accordingly, we trust you will understand this Proposal is given to
PT. Multi Kontrol Nusantara and their officers and employees in confidence
and may not be reproduced in any form or communicated to any other
person, firm or company without the prior approval of PT. Willis Indonesia.
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TABLE
OF
CONTENTS
1. EXECUTIVE SUMMARY........................................................................................
4
SUMMARY........................................................................................4
2. INSURANCE GENERAL UNDERWRITING AND SERVICES COMPARISON...................................
6
COMPARISON...................................6
3. INSURANCE BENEFIT COMPARISON.......................................................................
11
COMPARISON.......................................................................11
4. ASO BENEFITS................................................................................................
15
BENEFITS................................................................................................15
5. PARTICIPANTS LIST..........................................................................................
18
LIST..........................................................................................18
6. PREMIUM COMPARISON.....................................................................................
19
COMPARISON.....................................................................................19
7. TOTAL NUMBER OF PLUS POINTS.........................................................................
20
POINTS.........................................................................20
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1. EXECUTIVE SUMMARY
We would like to thank PT. Multi Kontrol Nusantara for this opportunity to submit our Proposal for the
upcoming renewal of your Group Hospitalization & Surgical Insurance program.
This proposal is designed based on your current Inpatient benefit program, which copy of benefit table,
was provided to PT. Willis Indonesia on 7 November 2013.
The purpose to approach other Insurers is to have improvement on the level of service and betterment
coverage for upcoming medical program. We have been able to approach your existing insurer,
PT. Avrist Assurance and below are some extra benefits for the upcoming Renewal Program
-
Cashless facility within AVRIST Provider with Show Card procedure for Inpatient benefits IMPROVED!
Child is covered as of birth up to 25 years old IMPROVED!
No pre-existing conditions for the upcoming member IMPROVED!
Reinstatement Benefit becomes 14 days IMPROVED!
Prescribed Food Supplement during hospitalization is covered IMPROVED!
Room and Board (R&B) tolerance if entitled R&B is not available or fully occupied is accessible
IMPROVED!
Please see the difference which identified in pink in this proposal compared to your proposal previously
received directly from your existing Insurer.
Total Insured persons are 557 (five hundred sixty seven) participants based on summary data provided to
us on 7 November 2012.
MARKET APPROACH
We have invited the following insurance companies for comparison to ensure your insurance cover
maintains its high level quality and benefits at an affordable price, they are as follows:
1.
2.
3.
PT. Asuransi Bina Dana Arta Tbk.; a Local National Insurance Company
PT. Asuransi Reliance Indonesia; a Local National Insurance Company
PT. Lippo General Insurance Tbk; a Local National Insurance Company
CONCLUSION
Having compared in every single details, please find the conclusion below:
LIPPO provides the most comprehensive benefits with higher premium compared to your
existing Insurer.
AVRIST as your current Insurer provides more betterment terms and conditions for your next
renewal policy compared with your existing terms and conditions.
In terms of Premium, AVRIST provides the most competitive premium compared to other quoting
Insurer.
Furthermore, please see our Insurance Underwriting and Benefit & Service Comparisons on Chapter 2
and 3 for your further review. Coverage that is clearly better (plus points) is identified in yellow.
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This summary has been prepared by PT. Willis Indonesia to assist PT. Multi Kontrol Nusantara in
evaluating the benefits provided by the quoting Insurers. We highlight only the key items from the terms
& conditions applied by each Insurer. For complete details of plan benefits, conditions, limitations and
exclusions, PT. Multi Kontrol Nusantara should refer to the policy wording, copy of which will be
provided upon request.
We hope you will find our proposal to be satisfactory and look forward to have a meeting with you to
discuss in more details.
Jakarta, 19 November 2013
Employee Benefits Team
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2. INSURANCE GENERAL
UNDERWRITING AND SERVICES
COMPARISON
Coverage that is clearly better is identified in yellow.
AVRIST
UNDERWRITING
RELIANCE
Existing
INSURER PROFILE
POLICY CURRENCY
PRE-EXISTING
CONDITION(S)
CASHLESS
FACILITY AT
HOSPITAL/
CLINICS
NETWORKS
EMPLOYEES AGE
RESTRICTION
(with standard
premium)
LIPPO
Renewal
A Local national insurance
company
IDR
Waived for
existing
member only
Available,
using
Admedika
system for all
benefits
Waived for
existing &
upcoming
member
Available
Inpatient using
Avrist Provider
(Show Card
system)
Outpatient,
Dental and
Maternity
(ASO) using
Admedika
system
Available with
Showcard
system within
Reliance
Provider for all
benefits.
Available with
Showcard
system within
Lippo Provider
for all benefits.
Employee is
covered up to
65 years old
(> 55 yrs. old
cover with an
extra
premium)
Employee is
covered up to
65 years old
AVRIST
UNDERWRITING
RELIANCE
Existing
CHILDRENS AGE
RESTRICTION
(with child
premium)
LIPPO
Renewal
Child is
covered from 0
day
up to 21 years
old,
(subject to fulltime students,
unmarried,
unemployed)
Child is
covered as of
birth up to 25
years old
(subject to fulltime students
and unmarried
and unemployed)
Child is
covered from 0
day (for baby
born less than
37 weeks or
weight is less
than 2500
grams is
covered from
15 days) up to
23 years old
(subject to fulltime students
& unmarried
Child is
covered from 0
day
up to 21 years
old,
(subject to fulltime students,
unmarried,
unemployed)
Covered
HAEMODIALYSIS
CHEMOTHERAPY
ENDOMETROSIS
(Not related to
Infertility/Fertility
and non-hormonal
cases)
HEART SURGERY
CIRCUMCISSION
(Related to
medical indication
only)
Covered
Only for
Surgical
Covered
Covered
Covered
Covered
For child which
age up to max
5 years old
Covered
AVRIST
UNDERWRITING
Existing
IMPLANT
PROSTHESES
SUCH AS PEN,
STENT,
K-WIRE,
IOL
FOOD
SUPLLEMENT &
VITAMIN
(Curative Treatment,
Related to diagnose
and recommended
by Doctor)
Covered
Vitamins Only
RELIANCE
LIPPO
Covered
Except hearing
aid, organ and
marrow
transplantation
Covered
including IOL
Covered
vitamins and
food
supplement as
long as
medically
necessary (not
for preventive
purposes) and
it is not MLM
products
Covered
vitamins and
food
supplement as
long as
medically
necessary and
registered in
the updated
MIMS,
recommended
by the treating
doctor and
related with
the diagnose
Renewal
Covered
vitamins and
food
supplement as
long as
medically
necessary and
it is not MLM
products
VALIDITY OF
CLAIM
REIMBURSEMENT
SUBMISSION
90 Days
CLAIM
REIMBURSEMENT
SETTLEMENT
14 Working Days
(Subject to
Claim Documents
received in
Complete)
PREMIUM
CALCULATION FOR
ADDITION &
DELETION
MEMBER
Prorate Basis
Not Available
50% x (60%
premium
claim paid) loss in the last
year for policy
period greater
than 1 year
Treatment will
be covered up
to max. 15
days from the
date of expiry
policy or if the
limits has been
reached
(whichever is
earlier)
PROFIT SHARING
(Subject to Renew
for Another 12
Months & Available 3
Months After
Renewal
Confirmation)
CONTINUITY OF
HOSPITALIZATION
IF THE POLICY
DISCONTINUE (As
long as the benefit
limits are still
available)
[77% (60% x
premium)
claim paid]
outstanding
excess claim
subject to
claim ratio
<60%
Treatment will
be covered up
to max. 7 days
from the date
of expiry
policy or if the
limits has been
reached
(whichever is
earlier)
AVRIST
UNDERWRITING
RELIANCE
Existing
QUARTERLY
PREMIUM
PAYMENT
WITHOUT
SURCHARGE/
LOADING PREMIUM
ALL TYPE OF
EXCESS CLAIM
WITHIN PROVIDER
NETWORK
COVERED BY
INSURER FIRST
AND INVOICE TO
THE COMPANY
LATER
LIPPO
Renewal
No, Semi
Annually
Yes
Yes
No information
on max. excess
Yes
Max. IDR 5 million
GEOGRAPHICAL
LIMITS
Yes
Max.
IDR 15 million
INPATIENT (INSURED)
INPATIENT
TYPE OF PRODUCT
INPATIENT
REINSTATEMENT
BENEFIT
SEMI ICU/
INTERMEDIATE/
ISOLATION ROOM
INPATIENT
MINIMUM HOUR(S)
(as long as the
Hospital Charged for
the Room & Board)
Inner Limit
30 days
14 days
6 hours
14 Days
8 hours
6 hours
30 days before
and 30 days
after
hospitalization
31 days before
and 90 days
after
hospitalization
Covered
10
AVRIST
UNDERWRITING
RELIANCE
Existing
Renewal
No tolerance
Entitled R&B
is fully
occupied or
not available
Upgrade to
nearest
available
higher class
with tolerance
20% or max.
up to
IDR 50,000
(whichever is
lesser) up to
maximum 2
(two) days
Entitled R&B
is fully
occupied or
not available
Upgrade to
nearest
available
higher class
with tolerance
50% up to
max.
IDR75,000 up
to discharge
LIPPO
Entitled R&B
is fully
occupied or
not available
Upgrade to one
level available
higher class for
maximum of 3
(three) days
ASO PROGRAM
TYPE OF BENEFITS
COVER UNDER ASO
ABILITY TO
FOLLOW ASO
BENEFITS
PROGRAM AS
REQUESTED BY
THE COMPANY
ASO DEPOSIT
REQUEST
IDR 300,000,000
per 3 (three) months
IDR 88,000
IDR 80,000
IDR
300,000,000
If the deposit
was already
used up 50% of
the initial fund,
the policy
holder must
reload the
deposit up to
the initial
deposit.
If the deposit
already used
up 75% and
has not been
reloaded,
cashless
facility will be
closed
IDR
500,000,000
If the deposit
was already
used up 50% of
the initial fund,
the policy
holder must
reload the
deposit within
14 days from
the invoice
date.
If the deposit
already used
up 75% and
has not been
reloaded,
cashless facility
will be closed
IDR 100,000
IDR 135,000
11
AVRIST
UNDERWRITING
TOTAL PLUS
POINTS
Existing
Renewal
9 (nine)
plus points
16 (sixteen)
plus points
RELIANCE
LIPPO
10 (ten)
plus points
15 (fifteen)
plus points
12
3. INSURANCE BENEFIT
COMPARISON
3.1. HOSPITALISATION & SURGICAL BENEFIT
Benefits expressed in IDR and coverage that is clearly better is identified in yellow.
BENEFITS
DAILY HOSPITAL
ROOM & BOARD
(R&B) per day
INTENSIVE CARE
UNIT (ICU) PER DAY
MISCELLANEOUS
HOSPITAL
EXPENSES PER
DISABILITY
PRIVATE NURSE,
PER DAY
AVRIST
ABDA
Existing
RELIANCE
LIPPO
Renewal
1,400,000
1,100,000
800,000
600,000
350,000
250,000
200,000
Max. 70 days per disability
2,800,000
2,200,000
1,600,000
1,200,000
700,000
500,000
400,000
Max. 20 days including 70 days
for each disability
49,000,000
38,500,000
28,000,000
21,000,000
12,250,000
8,750,000
7,000,000
(Including private nurse,
operation theatre, anesthesia,
laboratory diagnostic, medicines
& infusion, etc)
1,400,000
1,100,000
800,000
600,000
350,000
250,000
200,000
No limitation on number of days per disability
2,800,000
2,200,000
1,600,000
1,200,000
700,000
500,000
400,000
No limitation
on number of
days per
disability
2,800,000
2,200,000
1,600,000
1,200,000
700,000
500,000
400,000
Max. 20 days
per disability
2,800,000
2,200,000
1,600,000
1,200,000
700,000
500,000
400,000
No limitation on
number of days
per disability
49,000,000
38,500,000
28,000,000
21,000,000
12,250,000
8,750,000
7,000,000
(Including medicines, laboratory diagnostic,
administration, etc /excl. operation theatre,
anesthesia)
Not covered
2,800,000
2,200,000
1,600,000
1,200,000
700,000
500,000
400,000
Max.30 days
per disability
980,000
770,000
560,000
420,000
245,000
175,000
140,000
No limitation on
number of days
per disability
13
BENEFITS
AVRIST
ABDA
Existing
RELIANCE
COMPLEX
OPERATION PER
DISABILITY
63,000,000
49,500,000
36,000,000
27,000,000
15,750,000
11,250,000
10,000,000
Doctors fee only
63,000,000
49,500,000
36,000,000
27,000,000
15,750,000
11,250,000
10,000,000
Doctors fee including operation
theatre and anesthesia
MAJOR OPERATION
PER DISABILITY
42,000,000
33,000,000
24,000,000
18,000,000
10,500,000
7,500,000
6,000,000
Doctors fee only
42,000,000
33,000,000
24,000,000
18,000,000
10,500,000
7,500,000
6,000,000
Doctors fee including operation
theatre, anesthesia
INTERMEDIATE
OPERATION PER
DISABILITY
21,000,000
16,500,000
12,000,000
9,000,000
5,250,000
3,750,000
3,000,000
Doctors fee only
21,000,000
16,500,000
12,000,000
9,000,000
5,250,000
3,750,000
3,000,000
Doctors fee including operation
theatre, anesthesia
MINOR OPERATION
PER DISABILITY
10,500,000
8,250,000
6,000,000
4,500,000
2,625,000
1,875,000
1,500,000
Doctors fee only
10,500,000
8,250,000
6,000,000
4,500,000
2,625,000
1,875,000
1,500,000
Doctors fee including operation
theatre, anesthesia
980,000
770,000
560,000
420,000
245,000
175,000
140,000
Max. 70 days per disability,
including Specialist Doctor
980,000
770,000
560,000
420,000
245,000
175,000
140,000
No limitation on number of days
per disability, including Specialist
Doctor
IN-HOSPITAL
DOCTOR VISIT,
PER DAY
LIPPO
Renewal
88,200,000
69,300,000
50,400,000
37,800,000
22,050,000
15,750,000
14,000,000
Doctors fee
including
operation
theatre and
anesthesia
58,800,000
46,200,000
33,600,000
25,200,000
14,700,000
10,500,000
8,400,000
Doctors fee
including
operation
theatre and
anesthesia
29,400,000
23,100,000
16,800,000
12,600,000
7,350,000
5,250,000
4,200,000
Doctors fee
including
operation
theatre and
anesthesia
14,700,000
11,550,000
8,400,000
6,300,000
3,675,000
2,625,000
2,100,000
Doctors fee
including
operation
theatre and
anesthesia
980,000
770,000
560,000
420,000
245,000
175,000
140,000
No limitation
on number of
days
per disability
14
BENEFITS
DOCTOR
SPECIALIST
CONSULTATION IN
HOSPITAL, PER DAY
AVRIST
ABDA
Existing
LIPPO
980,000
770,000
560,000
420,000
245,000
175,000
140,000
No limitation
on number of
days
per disability
7,000,000
5,500,000
4,000,000
3,000,000
1,750,000
1,250,000
1,000,000
EMERGENCY
OUTPATIENT &
DENTAL
TREATMENT DUE
TO ACCIDENT
PER DISABILITY
RELIANCE
Renewal
Specialist Consultation
2,800,000
2,200,000
1,600,000
1,200,000
700,000
500,000
400,000
31 days before & 90 days after
Hospitalization
Diagnostic Tests
2,800,000
2,200,000
1,600,000
1,200,000
700,000
500,000
400,000
31 days before & 90 days after
Hospitalization
5,600,000
4,400,000
3,200,000
2,400,000
1,400,000
1,000,000
800,000
30 days before
and 30 days
after
Hospitalization
Not covered
13,125,000
10,312,500
7,500,000
5,625,000
3,281,250
2,343,750
1,875,000
Limit per policy
period
5,600,000
4,400,000
3,200,000
2,400,000
1,400,000
1,000,000
800,000
31 days before
& 90 days after
Hospitalization
Covered under
Surgical benefit
limit
15
BENEFITS
HOSPITALIZATION
DUE TO
COMPLICATION OF
PREGNANCY
CHEMOTHERAPY &
HAEMODIALYSIS
PER POLICY
PERIOD
AVRIST
ABDA
Existing
Not Covered
98,000,000
77,000,000
56,000,000
42,000,000
24,500,000
17,500,000
14,000,000
DEATH BENEFIT
10,000,000
All Plans
Employee Only
10,000,000
All Plans
For All
Members
(Employee &
Dependents)
ACCIDENTAL
DEATH &
DISABLEMENT
10,000,000
All Plans
Employee Only
Not Available
RELIANCE
LIPPO
122,500,000
96,250,000
70,000,000
52,500,000
30,625,000
21,875,000
17,500,000
Not Covered
122,500,000
96,250,000
70,000,000
52,500,000
30,625,000
21,875,000
17,500,000
Covered under
Inpatient
benefit
Renewal
10,000,000
Only for plan
1,400,000
10,000,000
Only for plan
1,400,000
10,000,000
All Plans
For All
Members
(Employee &
Dependents)
10,000,000
All Plans
For All
Members
(Employee &
Dependents)
Unlimited
6 (six)
plus points
5 (five)
plus points
18 (eighteen)
plus points
16
4. ASO BENEFITS
4.1. OUTPATIENT BENEFIT
Benefits expressed in IDR and cover under ASO Program.
BENEFITS
PLAN 1
PLAN 2
PLAN 3
PLAN 4
PLAN 5
GENERAL
PRACTITIONER
CONSULTATION
PER VISIT PER DAY
As Charge
No limitation on number of visit per day
DOCTORS
SPECIALIST
CONSULTATION
PER VISIT PER DAY
As Charge
No limitation on number of visit per day
DIAGNOSTIC
LABORATORY
SERVICES per
POLICY YEAR
As Charge
PRESCRIBED
MEDICINES PER
POLICY YEAR
As Charge
PHYSIOTERAPY,
PER YEAR
As Charge
One visit per day
ADMINISTRATION
FEE
As Charge
IMMUNIZATION
As Charge
FAMILY PLANNING
As Charge
REIMBURSEMENT
PERCENTAGE
85%
OVERALL LIMIT
PER POLICY YEAR
Unlimited
PLAN 6
PLAN 7
17
BENEFITS
PLAN 1
PLAN 2
PLAN 3
PLAN 4
PREVENTIVE
TREATMENT,
PER YEAR
As Charge
BASIC DENTAL
TREATMENT,
PER YEAR
As Charge
COMPLEX DENTAL
TREATMENT,
PER YEAR
As Charge
GUM TREATMENT,
PER YEAR
As Charge
REHABILITATIVE
TREATMENT, PER
TOOTH
As Charge
REIMBURSEMENT
PERCENTAGE
85%
OVERALL LIMIT
PER POLICY YEAR
Unlimited
PLAN 5
PLAN 6
PLAN 7
BENEFITS
PLAN 1
PLAN 2
PLAN 3
PLAN 4
PLAN 5
PLAN 6
PLAN 7
1,400,000
1,100,000
800,000
600,000
350,000
250,000
200,000
NORMAL DELIVERY
CAESARIAN
DELIVERY
MISCARRIAGE
REIMBURSEMENT
PERCENTAGE
As Charge
85%
19
5. PARTICIPANTS LIST
As of data received 7 November 2013
Band
EMPLOYEE
SPOUSE
CHILD
Total
12
28
28
44
100
Plan 5 RB 350
41
38
75
163
Plan 6 RB 250
64
18
52
89
223
Plan 7 RB 200
18
13
14
50
157
31
136
232
557
Male
Female
Male
Female
Plan 1 RB 1,400
Plan 2 RB 1,100
Plan 3 RB 800
Plan 4 RB 600
Total
20
6. PREMIUM COMPARISON
We would like to inform you that the premium below is an estimation premium based on
summary data given dated 7 November 2013 with 557 participants.
Premium mentioned below are indicative premium from the insurer. Insurer will recalculate the
actual premium subject to receive data at the beginning of the coverage and the benefit
chosen by the Company.
This quotation is valid until 30 days from proposal date.
ANNUAL PREMIUM
(in IDR)
INPATIENT
ASO FEE
TOTAL
AVRIST
1st
2nd
485,231,520
504,374,400
ABDA
RELIANCE
LIPPO
698,646,32
5
975,235,700
714,970,00
0
(15 Months)
9,776,000
9,776,000
49,192,000*
44,720,000
55,700,000
55,700,000
75,195,000
544,199,520
558,870,400
754,346,32
5
1,030,935,70
0
790,165,00
0
(15 Months)
* Notes:
On the 1st quotation that you received directly from AVRIST, AVRIST has not included the
dependents for calculating the ASO Fee
The above premiums are excluding policy cost and the initial ASO Deposit
The above est. premiums to be recalculated upon receiving confirmation of insurance benefit
being purchased and the final number of participants to be covered.
The above est. premiums are calculated based on Male, Female and Child except AVRIST
based on Employee only, Employee & Spouse, Employee & Children and Employee & Family.
The above est. premiums are calculated with Quarterly payment method, except for Lippo
with Semi Annually.
21
AVRIST
ABDA
RELIANCE
LIPPO
16
10
10
15
18
12
19
16
15
33
1st
2nd
General
Underwriting
& Services
Inpatient
Combined
22