Group Hospitalization and Surgical

Period : 01 Jun 2019 – 31 May 2020

MARSH 102 July 2019

Objective

• Current Program

• Benefit

• Exclusion

• Service Procedures

MARSH 202 July 2019

Providers

• Risk Consulting (Broker)

• PT. MARSH INDONESIA

Sentral Senayan II, Lt. 15

Jl. Asia Afrika No. 8

Jakarta 10270

• Tel. 021 5790 0110

• Fax. 021 5790 0120

• Marsh Helpline : 0811 – 8886694

(After working hours, including holiday)

• Insurance

• PT. AIA FINANCIAL

AIA Central

Jl. Jend. Sudirman kav. 48A

Jakarta Selatan

• AIAF Client Services

Tel. 021 5421 8888 (office hour)

Email. id.care@aia.com

• 24 hour Contact Number

Tel. 021 1500980

MARSH 302 July 2019

Participant

• ACTIVE EMPLOYEE

– Entry Age : 16 – 59 years old

– Renewal : up to 64 years old

• DEPENDENTS

– Spouse : 16 – 59 years old

– Child : 0 days up to 25 years old*

*Student, unmarried, unemployed

MARSH 402 July 2019

Participant

IMPORTANT !!

• Inform HR to have you registered

• Inform HR to add your new spouse immediately after marriage

• Inform HR to add your new born child immediately after the date of birth

• Report for any status changes

• Remind HR should your child exceed the maximal age

MARSH 502 July 2019

INPATIENT BENEFIT

PLAN

Daily Hospital Room & Board, per person / day - max.120 days / disability 800,000 Intensive Care Unit ( ICU ), per person / day - max.30 days / disability 1,600,000

In Hospital Doctor Visit, max. 1 visit per day 400,000 Consultation fee for Specialist per day 450,000

Operating Theatre Charges

- Complex

- Major

- Intermediate

- Minor

Anaesthesist's Fee

- Complex

- Major

- Intermediate

- Minor

Surgeon' s Fee

- Complex 66,375,000

- Major 42,500,000

- Intermediate 26,209,375

- Minor 17,473,300

Other Hospital Services 22,000,000

Pre and post Inpatient, 31 days before and 90 days after discharged from hospital 5,000,000

Emergency Outpatient Treatment due to accident 4,000,000

Emergency Dental Treatment due to accident 2,850,000

Ambulance Fee 500,000

200,000,000 Overall Annual Limit

INPATIENT

Cover under Surgeon's fee

Cover under Surgeon's fee

MARSH 602 July 2019

Terms & Conditions

• 100% cashless facility and reimbursement, no co sharing

• Waive pre-existing conditions for all members

• Reinstatement benefit 0 day

• Claim Reimbursement Process is 14 working days subject to receiving complete claim

document

• Hospital cash plan with amount as per R&B limit, if member use full BPJS for his/her

hospitalization treatment, as long as no excess claim submitted and paid by AIA. For this

Hospital cash plan benefit, reimbursement system applies

MARSH 702 July 2019

Room and Board

• Occupied the room and board as per your entitlement

• Should the entitled room and board is not available or full, the member can upgrade up to one

level higher from his room entitlement during his treatment in the hospital until discharge.

Other benefits will be covered in accordance to the table of benefit

• Should participant occupying higher room and board as per their own request, than the

benefit payable maintain the inner limit, and the difference between occupied RB and entitled

RB will be paid by the member (from day 1)

MARSH 802 July 2019

MATERNITY BENEFIT

PLAN

Normal Maternity, per pregnancy 10,500,000 Caesar Manternity, per pregnancy 16,000,000

Miscarriage, per pregnancy 5,000,000 Pre/Post-Natal, per year 6,400,000

MATERNITY

MARSH 902 July 2019

Terms & Conditions

• 100% cashless facility and reimbursement, no co sharing

• No waiting period for maternity benefit

• Benefit limit per pregnancy

• Cover female employee and female spouse with age < 45 years old

• Cover delivery by midwife

• Cover health baby in mother’s maternity limit (example: baby well-check up)

• Cover pre & post natal care including Torch and USG 4 dimension

• Pregnancy complication is covered in Inpatient (if member has to be hospitalized and not

ended with termination/delivery of the baby)

MARSH 1002 July 2019

Exclusions

• Injuries arising directly or indirectly from war, declared or undeclared

• Special nursing care; non medical personal and services such as radio, telephone;

and use of special equipment

• Treatment/surgery for cosmetics and communicable disease requiring isolation or

quarantine under the law

• Routine physical examinations and any treatment which is not medically necessary

• Eye refraction, eye glasses; hearing aids; and any dental treatment/surgery (except

due to accident)

• Treatment or surgery for congenital anomalies; treatment relating to birth control,

illegal abortion, sterilization, and infertility

• Treatment for functional disorder of the mind; self-inflection; drug addiction,

alcoholism

• Alternative medication/treatment

MARSH 1102 July 2019

Claim Procedures in Providers (1)

Admission at

Hospital

Provide Membership card

and ID Card

ID Card 1Hospital check to

AIA Financial

MARSH 1202 July 2019

Claim Procedures in Providers (2)

1 Cover?

Rejection letter

Send to Hospital

AIA Financial Issue

Guarantee letter to

Hospital

Y

N

• If there is any excess, excess to be paid on the spot. Should there is any further excess, AIA will charge to member through the company

• Reason for excess : non medical expenses, exceed limit, exclusion

MARSH 1302 July 2019

Claim Procedures outside Providers

• Free to choose any hospital

• Claim reimbursement submission within 60 days from date of treatment

• Completed claim Form

• Original Receipt, stamp duty and detail billing

– Stamp duty for amount above IDR 1.000.000 : Rp6.000

• Detail of medicine, doctor reference for diagnostic test (Lab, X-ray), copy of

diagnostic test result, medical resume

• For hospitalization overseas, should submit Official Receipt and tax invoice

• Claim reimbursement within 14 working days from completed documentation

received by Insurer

MARSH 1402 July 2019

Claim Form

MARSH 1502 July 2019

Resume Medis Rawat Inap Hasil Laboratorium

Medical Resume & Laboratory Result

MARSH 1602 July 2019

Inpatient Receipt

MARSH 1702 July 2019

Inpatient Billing Detail

MARSH 1802 July 2019

REJECTED PAYMENT RECEIPT - SAMPLE

MARSH 1902 July 2019

Diagnose must be written by the DoctorDoctor’s stamp and

signature

Nama Pasien

ACCEPTED PAYMENT RECEIPT - SAMPLE

MARSH 2002 July 2019

Sample of Claim Document

Outpatient – Medicine Receipt

Patient’s name

Pharmacist’s

stamp

Name &

address of

the

Pharmacist

Copy

prescription

ACCEPTED PAYMENT RECEIPT - SAMPLE

MARSH 2102 July 2019

Example of Official Receipt (Overseas Treatment)

MARSH 2202 July 2019

Example of Tax Invoice (Overseas Treatment)

MARSH

FAQ

Upgrade Room and Board

How if member upgrade room and board on own request?

• Answer: If a member upgrade room and board as their own request, the difference for room and board and

other excess (if any) will be born by the member.

Category surgery

Who is determined the category for any surgery?

• Answer : It is decided by Insurer upon receiving the medical data. Insurer has the list consist of the surgical

category.

List of Hospitals

How can member know the updated provider list?

• The updated providers listing will be sent monthly to HRD, or member can ask to AIA customer care or

check on AIA’s mobile application

Sharing the limits

Can employees limit be shared with dependents?

• Answer : No. It should be based on policy guideline. The benefits limit is based on market study and

practice.

2302 July 2019