Health Insurance

Health insurance is a type of insurance that provides health insurance in the form of financial risk protection in the form of reimbursement of medical costs for insurance participants if they experience illness or an accident. In general, health insurance consists of two types, namely inpatient treatment, and outpatient treatment.

In addition to medical expense coverage, some health insurances also have coverage for hospital room fees, ICU accommodation, doctor consultations, specialist doctor consultations, surgery, outpatient care, home care, ambulance services, dialysis, critical illnesses, and so on.

To get health insurance benefits, health insurance participants are required to pay health insurance premiums regularly. The amount itself depends on several factors, such as the participant's health condition, the level of risk, and other provisions of the insurance company.

The many benefits you can get to make health insurance important. These benefits include:

• Provide health protection if you fall sick in the form of reimbursement of medical expenses, such as examinations, treatments, medicines, and others.
• Reducing the burden of hospitalization costs when the hospital falls ill or has an accident.
• Ease the financial burden on your family or relatives if you have to be hospitalized within a certain period.
• Protect yourself from rising health costs. In Indonesia, each year, health costs increase by about 10% to 15%. The long-term medical expenses can be huge, especially if you have a critical illness and need to be hospitalized. Moreover, there is a possibility that the increase in health costs will not be balanced by an increase in your income. By having health insurance, you can protect your assets from the number of medical costs.

Also keep in mind that the younger you are, the cheaper the insurance premiums you have to pay. This value is determined by your risk of contracting certain diseases. The younger you are, your risk of getting diseases is generally lower, so the premiums paid are low.

Like the way other insurance products work, health insurance involves two parties who are bound to one another's responsibilities, namely insurance customers and insurance companies.
Insurance customers are required to pay a monthly fee, which is called a premium, to the insurance company. As long as the customer regularly pays the premium within the period of protection, the insurance company is required to fulfill its obligation to provide all health insurance benefits whose coverage refers to the pre-determined agreement between you and the insurance company.

In Indonesia, health insurance can be divided into several categories, namely based on the type of treatment, type of participation, the amount of costs borne, and based on the party covered.

Choosing the right health insurance for you also depends on your choice of choosing a trusted insurance company.

In Indonesia, well-known companies that provide health insurance include Prudential Health Insurance, Allianz Health Insurance, Sinarmas Health Insurance, Manulife Health Insurance, AXA Mandiri Health Insurance, BNI Life Health Insurance, AIA Health Insurance, Cigna Health Insurance, Health Insurance AXA, Takaful Health Insurance, Bumiputera Health Insurance, Avrist Health Insurance, Chubb Health Insurance, Jagadiri Health Insurance, Adira Health Insurance, Equity Health Insurance, MAG Health Insurance, Tokio Marine Health Insurance, and CAR Health Insurance.

The benefits of health insurance are only felt when we fall sick. Imagine when you are sick and have to be hospitalized with high hospitalization costs, and you have to bear all these costs with your own money.

With health insurance, your medical costs will be borne by the insurer whose value matches the benefits in your policy, so you don't have to worry about having to pay your own costs. This will really help you, especially when you face emergencies, such as when you have a critical illness, accident, or childbirth.

The Government of the Republic of Indonesia launched the National Health Insurance (JKN) program which culminated in the establishment of the Health Social Security Administering Body (BPJS Kesehatan). The objective of BPJS Kesehatan is to provide health care insurance for all Indonesians. Formerly known as Askes (Health Insurance) managed by PT Askes Indonesia (Persero), this name has been changed since January 1, 2014, in accordance with Law No. 24 of 2011 concerning BPJS.

Conceptually, health insurance and BPJS have many similarities, among which is that each participant is required to pay a number of costs to get medical expense reimbursement facilities when falling ill or in an accident.

However, unlike BPJS Health, health insurance has several advantages, such as superior service, flexibility in choosing a hospital, and there is a claim disbursement facility on several health insurance products.

Health insurance and life insurance are two types of insurance with different benefits. Health insurance benefits are reimbursement of medical expenses incurred when the insured is hospitalized or outpatient. Meanwhile, life insurance has a benefit that is given to the heirs when the insured dies.

Accessing online health insurance gives you a variety of benefits, including the transaction process without meeting in person, relatively cheaper policy costs, more product variations, and the availability of features to make comparing various insurance products available more easily. In addition, an insurance portal allows you to buy and manage policies online, without any physical files.

Reimbursement of costs in health insurance is divided into two types, namely without cash ( cashless health insurance ), and paid in advance (health insurance reimbursement ).

With a cashless system , insurance companies will reimburse medical costs directly without customers having to pay their own expenses first. Customers only need to show their insurance membership card to the hospital.

Meanwhile, with the reimbursement system , customers will pay medical costs in advance. The insurance company will reimburse the costs incurred by the customer on the condition that they complete the required documents and requirements.

Before buying health insurance, there are several things you need to consider, namely the type of protection, the type of copayment or costs borne by insurance participants (generally 10% of the cost of treatment), the period of protection, the waiting period, the amount of room fees, and how to claim. insurance.

Because insurance, in this case health insurance, is included in a form of agreement, insurance practice refers to Article 1320 of the Civil Code. In addition, the insurance agreement is also regulated in Article 251 of the KUHD concerning the principles of good faith, Article 272 of the KUHD concerning written agreements, Article 282 of the KUHD concerning fraud, and Article 599 of the KUHD concerning the prohibition of trafficking.

There are several things you need to pay attention to before you submit a health insurance claim. First, you have to make sure you always pay your health insurance premiums on time. Second, you must pay attention to the active period of your health insurance policy. Third, make sure you understand the insurance exclusion rules, for example, the minimum period before you can make a claim.

When the time comes for you to file a health insurance claim, the process isn't too complicated. You only need to complete a few requirements / documents. The required documents include a completed insurance application form, photocopy / Scan of KTP, birth certificate, family card, proof of first premium payment.

For the steps, first, you must complete the insurance claim form provided by your insurance company with accurate and detailed information. Second, you must attach details of the hospital bill, which generally consists of the patient's identity, disease report, doctor's information, and drug costs during the treatment period.

Make sure all the information you provide is accurate and detailed, because if the information provided cannot be verified by the insurance company, your claim submission is at risk of being rejected.

Here are terms that you commonly find as a health insurance owner.

• Agent: a person who works for or is tied to an insurance company and is tasked with promoting and selling insurance products, as well as serving policyholders.
• Annuity: a series of payments within a specified time provided by the insurance company to the annuity policyholder.
• Actuary: people who have professionally undergone various training and have knowledge about insurance technically to estimate the amount of the premium on prospective customers.
• Bancassurance: a method of distribution of insurance sales where the bank acts as a distributor where the target customer is the customer of the bank. Usually the services provided are a combination of banking and insurance services.
• Bancatafakul: distribution method in Islamic insurance where the distributor is a sharia bank where the target customer is the bank's customer. Usually the services provided are a combination of banking and insurance services.
• Copayment : fees that must be paid when you claim bills at the hospital (usually 10% of the cost of the bill of care).
• Insurance Claim: a formal request made to an insurance company for compensation based on the terms of the insurance policy or agreement.
• Commission: The portion of the premium paid to agents or salespeople in return for policy services performed.
• Grace Period: the period of time after the premium due date where the premium can still be paid without interest and the policy can still be accounted for.
• Waiting Period: the period after the policy is issued during which the insurance policy does not cover the insured's medical expenses until a certain period.
• Proposal: a collection of information provided by the insurance company regarding the policy benefits that will be provided to prospective customers. This proposal is usually offered to provide information on the product to be provided, such as the amount of the premium and the terms of coverage.
• Policy: a binding agreement agreed upon by the insurance company and policyholder in writing.
• Premium: money that must be paid at a certain time as the obligation of the insurance policy holder. The amount of premium paid is determined by the policy and approval of the insurance company in accordance with the conditions of the insured.
• Insurer: a person who is legally listed in the insurance policy to make premium payments for the said policy.
• Insured: a person who is legally listed in the insurance policy to receive benefits from the policy.
• Risk: losses incurred to individuals or objects insured.