proposal - pt. istana karang laut.ghs

8/10/2019 Proposal - Pt. Istana Karang Laut.ghs

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CONFIDENTIAL

PROPOSAL

GROUP Health INSURANCE programFOR

PT. ISTANA KARANG LAUT

Prepared by:EMPLOYEE BENEFITS I!ISION

PT. "#ll#$ I%&o%e$#a26th Floor, Wisma Keiai

Jl. Jend. Sdirman Ka!. "#$Ja%arta &'22'

(el. 2)2$*"'' # Fa+. 2)2$*")Website: ---.-illis.om---.-illis.om

2/ September 2'&"
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 both PT Istana!aran" La#t andPT $illis Indonesia

Accordin"l%& we tr#st %o# will #nderstand this Proposal is "i'en to PTIstana !aran" la#t and their o(cers and emplo%ees in condence and ma%not be reprod#ced in an% form or comm#nicated to an% other person& rm

or compan% witho#t the prior appro'al of PT $illis Indonesia


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TABLE OF CONTENTS

&. 0103(450 S3AR7..................................................................................2

2. 48S3RA80 9080RAL 380RWR4(489 A8 S0R540S OPAR4SO8..........*

". 48S3RA80 ;080F4( OPAR4SO8............................................................&&

$. 0O9RAP?..................................................................2&

6. PR043 OPAR4SO8?............................................................................26

/. (O(AL 83;0R OF PL3S PO48(S...............................................................2/

. W4LL4S SOP0 OF S0R540S. W4LL4S SOP0 OF S0R540S.......................................................................2/


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'. E(ECUTI!E SUMMARY

We -old li%e to than% P(. 4stana Karan@ Lat or this opportnity to sbmit or Proposal or


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We approahed D!e =*> 4nsrane ompanies, they are:

&> P(. Asransi AllianG Lie 4ndonesia? : a Joint 5entre 4nsrane ompany2> P(. Asransi A545A 4ndonesia : a Joint 5entre 4nsrane ompany"> P(. Asransi A1A 4ndonesia : a Joint 5entre 4nsrane ompany$> P(. Asransi Ji-a anlie 4ndonesia : a Joint 5entre 4nsrane ompany*> P(. Asransi Reliane 4ndonesia : a Loal 8ational 4nsrane ompany

*PT. Asuransi Allianz Life Indonesia is unable to support Willis because you have approachedthem directly unless the

Letter of Appointment is issued to PT. Willis Indonesia.

)* CONCLUSION

A545A pro!ides the hi@hest nmber o pls points =yello-#mar%ed> ompared -ith other

Botin@ 4nsrers.

(he most ompetiti!e premim is oered by R0L4A80. 4 yo -ish to e+lde 5ision

pro@ram, A1ACs premim -ill be the most ompetiti!e.

omparin@ to yor medial ost =sel#insred> e+periene the total premim=s> oered

by the 4nsrers may ost hi@her.


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o!era@e that is learly better =pls points> is identiDed in yello-.

We loo% or-ard to hearin@ rom yo and shold yo need rther details, please do not hesitateto ontat or oNe.

Ja%arta, 2/ September 2'&"Emplo-ee Be%et$ Team

R#/a -ah Ta%t# Ma&el#%e Le$ma%aAssistant lient 0+eti!e lient ana@er

4


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0. INSURANCE GENERAL UNER"RITING ANSER!ICES COMPARISON

Co'era"e that is clearl% better is identied in %ellow

UNER"RITINGUNER"RITING 1 SER!ICES

RELIANCE MANULIFE A!I!A A(A

INSURER PROFILE A Loal 8ational4nsrane ompany

A Joint 5entre 4nsrane ompany

AGE LIMITS

0mployee andspose are o!eredp to 6* years old.

=Sbet to loadin@premim or a@e

abo!e ** years old>

0mployee and Female spose are o!ered p to 6* years old.

hild o!ered rom' day p to 2"

years old=&* days i

prematre deli!ery="/ -ee%s>

-ei@ht 2,*''@ram>

=sbet to ll#timestdents,

nemployed,nmarried and

Dnaniallyspported by0mployee>

a+. " hildren

hild is o!ered rom ' day p to 2* years old.

=sbet to ll#time stdents, nemployed, nmarried andDnanially spported by 0mployee>

a+. " hildren

GEOGRAPHICAL AREA World-ide, "6* days, 2$ hors

AUTOMATIC AITIONAN ELETIONMEMBERS

a+imm "' days rom reportin@ date

PREMIUM CALCULATIONFOR AITION 1ELETION MEMBER

Prorate basis!eletion*"proratepremium # claims

*$ormula %&'()Premium

after !iscount+ &Number of !aysthat has not been

passed, Number of!ays the Periods of

Insurance+# -laimspaid

Prorate basisreardless claims have occurred

Prorate basisNo premium refund

if claims haveoccurred

5


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FULL ANNUAL LIMITFOR AITIONMEMBERS

4npatient aternity:Fll limit

Otpatient, entaland 5ision :

Fll Limit


Otpatient, entaland 5ision :Prorate Limit


Otpatient, ental and 5ision :Fll Limit

PRE,E(ISTING MEICALCONITION2S*

Atomatially o!ered

"AITING PERIO

4npatient, Otpatient, ental, 5ision:8one

aternity:8one

4npatient,Otpatient, ental,

5ision:8one

aternity: onths Waitin@

Period

4npatient,Otpatient, ental,

5ision:8one

aternity:8one

ORGANTRANSPLANTATION

o!ered=e+ldin@ the ost o or@an>

HAEMOIALYSIS o!ered

CHEMOTHERAPY o!ered

ENOMETROSIS o!ered

CRITICALILLNESS3CHRONICCONITIONS

o!ered

HEART SURGERY o!ered

CIRCUMCISSION2RELATE TO MEICALINICATION ONLY*

o!ered p to ma+* years old

o!ered o!ered p to ma+* years old

o!ered

IMPLANT PROSTHESES o!ered

!ITAMIN 2CURATI!ETREATMENT4 RELATETO IAGNOSE ANRECOMMENE BYOCTOR*

o!ered/ther vitamins 0hich are not related to dianose and recommended by !octor are not

covered

FOO SUPLEMENT2RELATE TO IAGNOSEAN RECOMMENE BYOCTOR*

o!ered/ther food supplement 0hich are not related to dianose and recommended by !octor

are not covered

6


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!ALIITY CLAIMREIMBURSEMENTSUBMISSION

4nitial laim:4npatient and

aternity6' ays

Otpatient, entaland 5ision:

6' ays

Re#laim:"' ays

&from the /riinal

1eceipt2s !ate+

4nitial laim:4npatient and

aternity)' ays

Otpatient, entaland 5ision:

"' ays

Re#laim:"' ays

&from the /riinal

1eceipt2s !ate+

4nitial laim:4npatient and aternity

6' ays

Otpatient, ental and 5ision:6' ays

Re#laim:"' ays

&from the /riinal 1eceipt2s !ate+

CLAIM REIMBURSEMENTSETTLEMENT

&' Wor%in@ ays=Sbet to laim oments reei!ed in ompletely>

Payment is transerred to 0mployeeCs ;an% Aont

&$ Wor%in@ ays=Sbet to laim

oments reei!edin ompletely>

Payment istranserred to

0mployeeCs ;an%Aont

NET"ORK

HOSPITALS3CLINICS"ITHIN REPUBLIC OFINONESIA2CASHLESS FACILITY*

7es

Pro!ided appro+.*$6

Pro!ider 8et-or%sarran@ed by

R0L4A80#Adedi%a

7es

Pro!ided appro+.$6

Pro!ider 8et-or%sarran@ed by AJ4#

Adedi%a

7es

Pro!ided appro+.*&

Pro!ider 8et-or%sarran@ed by A545A#

Adedi%a

7es

Pro!ided appro+."&&Pro!ider 8et-or%sarran@ed by A1A#

Adedi%a

CASHLESS FACILITYSTILL APPLIE ATHOSPITAL NET"ORKREGARLESS MEMBERTAKING HIGHER ROOMAN BOAR UE ANYREASONS

Flly OpiedM8otA!ailable:

ember an ha!etheir preerene tolo-er R; or not.

8o ertainperenta@eondition on

9arantee Letterissed =ashlessaility -ill still

apply>

3p@rade R; byo-n reBest:

Reimbrsementsystem -ill apply

Flly OpiedM8ot A!ailableM3p@rade R;by o-n reBest:

ember an ha!e their preerene to lo-erR; or not. 8o ertain perenta@e

ondition on 9arantee Letter issed=ashless aility -ill still apply>

Flly OpiedM8otA!ailable:

ember an ha!etheir preerene tolo-er R; or not.

8o ertainperenta@eondition on

9arantee Letterissed =ashlessaility -ill still

apply>

3p@rade R; byo-n reBest:

Reimbrsementsystem -ill apply

E(CESS CLAIM ATNET"ORKHOSPITALS3CLINICS

4npatient, Otpatient, ental aternity:Settled pon dishar@ed

7


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EMERGENCYOUTPATIENT 1 ENTALTREATMENT 2"ITHIN0(08 HOURS*

o!ered=Within &+2$ hors>

o!ered=Within 2+2$ hors>

o!ered=Within &+2$ hors>

INPATIENT ROOM 1BOAR TOLERANCE IFFULLY OCCUPIE 3 NOTA!AILABLE

Flly Opied:3p@rade *' or 4R/*,''' =-hihe!er

is lesser> romhisMher entitlement

Plan -ith nolimitation days

8ot A!ailable:3p@rade *' or 4R/*,''' =-hihe!er



Other beneDts -illbe o!ered as per

Shedle o ;eneDts

Flly Opied:3p@rade 4R *','''hi@her rom hisMher

entitlement Plan-ith no limitation

days

8ot A!ailable:3p@rade 4R *','''hi@her rom hisMher


days


Shedle o ;eneDts

Flly Opied:3p@rade *' or 4R/*,''' =-hihe!er



8ot A!ailable:3p@rade *' or 4R/*,''' =-hihe!er




Shedle o ;eneDts

Flly Opied:3p@rade 4R *','''hi@her rom hisMher


days

8ot A!ailable:3p@rade 4R *','''hi@her rom hisMher


days


Shedle o ;eneDts

EATH BENEFITBECAUSE OF ACCIENTOR SICKNESS

o!ered or all embersas lon as not fall into policy eclusions

o!ered or allembers

3in ; months 8 3a;5 years old

as lon as not fallinto policyeclusions

O,TPATIENT AND DENTAL P)O*)A+

OUTPATIENT TYPE OFPROGRAM

4nner Limit

OUTPATIENT IRECT TOALL SPECIALITS

7es

ACUPUNCTURE

TREATMENT PERFORMEBY A REGISTERELICENSE OCTOR2ONLY THE OCTOR FEE*

o!ered

AMINISTRATION FEEo!ered nder dotorCs limit o!ered -ith

separate limito!ered nderdotorCs limit

+ATE)NITY P)O*)A+

MATERNITY TYPE OFPROUCT

Limit per pa%a@e

AGE LIMITS a+ $* years olda+imm " hildren =$thhild 4s not o!ered>

9


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PRE 1 POST NATAL 89AYS 2MATERNITY*CONSULTATION

o!ereddurin prenancy and :( days after delivery

-I.ION P)O*)A+

!ISION TYPE OFPROGRAM

Pa%a@e limit

ELIGIBILITY 0mployee Only

LENS FOR E!ERY YEAR 7es

FRAME FOR E!ERY T"OYEARS

7es 8o, per year

TOTAL PLUS POINTS2YELLO",MARKE*

: POINTS '0 POINTS '; POINTS '9 POINTS

10


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BENEFITSINPATIENT 2IR*


ONE AY SURGERY

/,2'','''",/','''",'6','''

Per year

o!ered in Sr@ial beneDt limit

Per disability

CHEMOTERAPY ANHAEMOIALYSIS >HOSPITALI5ATION

&2,''',''',''','''/,''','''

Per year

o!ered in isellaneos 4npatient beneDt limit

Per disability

CHEMOTERAPY ANHAEMOIALYSIS >OUTPATIENT

o!ered in Presription dr@s OtpatientbeneDt limit

Per year

&2,''',''',''','''/,''','''

Per year

o!ered inPresription dr@sOtpatient beneDt

limit

Per year

HOSPITALI5ATION UE TOCOMPLICATIONS URINGPREGNANCY

&2,''',''',''','''/,''','''

Per year

&&,''',''','','''6,6'','''

Per year

o!ered nder4npatient shedle

o beneDts

8ot o!ered

O!ERALL LIMIT PERPERSON PER POLICY YEAR

3nlimited

EATH BENEFIT UE TOSICKNESS AN ACCIENT

&',''','''All members


? POINTS ; POINTS '9 POINTS @ POINTS

MATERNITY

BENEFITS

MATERNITY 2IR*


NORMAL ELI!ERY2PHYSICIAN3MI"IFE*

$,''','''2,&'','''&,/'','''

13


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BENEFITS

MATERNITY 2IR*


CAESAREAN ELI!ERY&',''','''/,&'','''6,$'','''

,''','''$,&'','''",$'','''

&',''','''/,&'','''6,$'','''

MISCARRIAGE&,2'','''6"','''*&','''

8ot o!ered &,2'','''6"','''*&','''

PRE 1 POST NATAL'','''$2','''"$','''


0 POINTS ' POINT ' POINT 0 POINTS

14


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OUTPATIENT

BENEFITS

OUTPATIENT 2IR*


OUTPATIENT GENERALPRACTITIONER

','''','''*','''

Per visit 3a 4 visitper day

','''','''*','''

Per =isit

','''','''*','''

Per day

','''','''*','''


OUTPATIENT SPECIALISTCONSULTATION

2'','''2'','''&*','''


2'','''2'','''&*','''

Per =isit

2'','''2'','''&*','''

Per day

2'','''2'','''&*','''


PHYSIOTHERAPY

2'','''2'','''&*','''


2,''','''2,''','''&,*'','''

Per year

2'','''2'','''&*','''

Per day

2'','''2'','''&*','''


OUTPATIENT IAGNOSTICLABORATORY SER!ICESINCLUING (,RAY

2,*'','''2,*'','''2,''','''

Per year

&,)&2,*''&,)&2,*''&,2"/,*''

Per year

2,*'','''2,*'','''2,''','''

Per year

OUTPATIENT OCTORSTREATMENT PACKAGES

As per dotor andpresription dr@s

beneDtsC limit

&2','''&2','''/*,'''

Per =isit

As per dotor and presription dr@sbeneDtsC limit

OUTPATIENTPRESCRIPTION RUGS

",''','''",''','''

2,*'','''

Per year

",''','''",''','''

2,''','''

Per year

",''','''",''','''

2,*'','''

Per year

AMINISTRATION As per dotor beneDt limit $','''$','''$','''

Per day

As per dotorbeneDt limit


6,''','''6,''','''*,''','''

15


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BENEFITS

OUTPATIENT 2IR*



0 POINTS 8 POINTS ' POINT 0 POINTS

16


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ENTAL

BENEFITS

ENTAL 2IR*


BASIC TREATMENTSAs har@ed

&,*'','''&,2*','''&,''','''

Per year

As har@ed

PRE!ENTI!E TREATMENTS

As har@ed As har@ed As har@ed

3a < visits peryear

REHABILITATIONTREATMENTS

As har@ed

3a. 4 visit per day

As har@ed As har@ed

3a 4 visit per day

GUM TREATMENTS As har@ed As har@ed As har@ed

3a < visits peryear

COMPLE( TREATMENTS As har@ed

3a. 4 visit per day

ENTURE TREATMENTS As har@ed


&,*'','''&,2*','''&,''','''


8 POINTS 9 POINT 8 POINTS 8 POINTS

17


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!ISION

BENEFITS

!ISION 2IR*


FRAME

$'','''$'','''$'','''

/nce every < years

$'','''$'','''$'','''

Per year/'','''/'','''/'','''

Per year

LENS

"'','''

"'','''"'','''

3a 4 time per year

"'','''

"'','''"'','''

Per year


9 POINT ' POINT ' POINT ' POINT

18


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?. ANNUAL UNIT PREMIUM 2IR*)

PREMIUM UNIT PER PERSON AN PER YEAR

PT.ASURANSI RELIANCE INONESIA

INPATIENT

INPATIENTPla% '

2#retor Ma%ager*

Pla% 02S


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!ISIONPla% '

2#retor

Ma%ager*

Pla% 02S


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PT.ASURANSI MANULIFE INONESIA

INPATIENT

INPATIENTPla% '

2#retor Ma%ager*

Pla% 02S


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PT.ASURANSI A!I!A INONESIA

INPATIENT

INPATIENTPla% '

2#retor Ma%ager*

Pla% 02S


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@. "ILLIS SCOPE OF SER!ICES

RE!IE" 1 ASSESSMENT an!ass 4nsrane mar%et

Feasibility stdyU rrent !erss tre pro@ram

Re#desi@n or impro!ement on e+istin@ beneDts

INSURANCE PLACEMENTSER!ICES

Rene-al ne@otiatin@

an!ass 4nsrane mar%etU obtainin@ Botations,

omparin@ ompetiti!e terms o o!era@e and priin@ Presentin@ proposal on beneDts, osts omparison

EMPLOYEECOMMUNICATIONS

;rieDn@ sessions on han@es =i any>, beneDts o!era@e Re!ie- membership handboo%

Re!ie- meetin@ -ith

proposal - pt. istana karang laut.ghs

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