Você está na página 1de 22

CONFIDENTIAL

2ND PROPOSAL
GROUP HEALTH INSURANCE PROGRAM
FOR

PT. MULTI KONTROL


NUSANTARA
Prepared by:
EMPLOYEE BENEFITS DIVISION
PT. Willis Indonesia
26th Floor, Wisma Keiai
Jl. Jend. Sudirman Kav. 3-4 Jakarta 10220
Tel. +62 21 2924 5300 - Fax. +62 21 2924 5398
Website: www.willis.com

--------------------------------------------------------------------------------------------------------------------------------

19 November 2013

--------------------------------------------------------------------------------------------------------------------------------

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.

--------------------------------------------------------------------------------------------------------------------------------

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

--------------------------------------------------------------------------------------------------------------------------------

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.

--------------------------------------------------------------------------------------------------------------------------------

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

dr. Ferryanto C Nugroho


Assistant Client Executive

Savitri Sri Lestari


Client Manager

--------------------------------------------------------------------------------------------------------------------------------

2. INSURANCE GENERAL
UNDERWRITING AND SERVICES
COMPARISON
Coverage that is clearly better is identified in yellow.
AVRIST
UNDERWRITING

RELIANCE
Existing

INSURER PROFILE

A joint venture insurance


company

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

Maximum age for Employee


joining is 59 years old can be
renewed up to 65 years old

Waived for existing & upcoming


members

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)

Child with age


23-25 years
old subjected
to adult
premium
FULL ANNUAL
LIMIT FOR
ADDITION MEMBER
AUTOMATIC
ADDITION AND
DELETION
MEMBERS
ORGAN
TRANSPLANTATIO
N

Full Benefit apply for Inpatient benefit

Able to backdated the effective date within 30 days from reporting


date

Covered

(Excluding the Cost


of Organ)

HAEMODIALYSIS

Covered under Inpatient benefit terms

CHEMOTHERAPY

Covered under Inpatient benefits terms

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 excluding IOL

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

(FROM THE DATE AS


SHOWN ON THE
RECEIPT)

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. 30 days from the date of
expiry policy

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

Worldwide, 365 days, 24 hours

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

Covered under ICU benefit limit

6 hours

ONE DAY SURGERY

PRE AND POST


HOSPITALIZATION
PER DISABILITY
DEATH BENEFIT
DUE TO ANY
CAUSE (accident
and illness)

14 Days

8 hours

6 hours

30 days before
and 30 days
after
hospitalization

31 days before
and 90 days
after
hospitalization

Covered

31 days before and 90 days after


hospitalization

Available only for employee

Covered for all member

10

AVRIST
UNDERWRITING

ROOM & BOARD


(R&B) TOLERANCE

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

Outpatient, Dental and Maternity

ABILITY TO
FOLLOW ASO
BENEFITS
PROGRAM AS
REQUESTED BY
THE COMPANY

ASO DEPOSIT
REQUEST

ASO FEE PER


PERSON PER YEAR

Yes, for all benefits

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)

Covered under Miscellaneous


Hospital expenses

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

Covered under In-Hospital Doctors Visit Benefit

ONE DAY SURGERY

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

PRE & POST


HOSPITALIZATION
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

Covered under Surgical benefit limit

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

Covered under Inpatient benefit

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

ANNUAL LIMIT PER


PERSON
TOTAL PLUS POINT

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

3 (three) plus points

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

4.2. DENTAL BENEFIT


Benefits expressed in IDR and cover under ASO Program.

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

4.3. MATERNITY BENEFIT


18

Benefits expressed in IDR and cover under ASO Program.


ABDA is unable to provide Maternity benefits as per Companys request program

BENEFITS

DAILY ROOM &


BOARD

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

Follow the daily room and board

MISCARRIAGE

PRE & POST NATAL


CARE

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

* RB = Room and Board (IDR 000)

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

GROUP TERM LIFE

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

7. TOTAL NUMBER OF PLUS POINTS


Coverage that is clearly better is identified in yellow.
YELLOW
HIGHLIGHTED

AVRIST
ABDA

RELIANCE

LIPPO

16

10

10

15

18

12

19

16

15

33

1st

2nd

General
Underwriting
& Services

Inpatient

Combined

22