Health insurance has become an important need for
everyone so that financial risk is better managed. What are the types and
benefits?
Having health insurance is now an important
requirement so that financial risk can be better managed. By having health
insurance, a person can anticipate the risk of financial loss that might occur
when one day falls ill and requires treatment costs. However, although
awareness of the importance of health insurance is increasingly widespread in
the community, not a few people are still confused when they want to buy health
insurance.
Do you also experience it? Want to have health
insurance but are hesitant to choose because there are so many different types
of health insurance products available on the market today. In order to get the
right health insurance products, it helps you understand in advance the
following sundries of health insurance.
Types of health insurance
There are several types of health insurance currently
available in the market, namely :
1. Hospital benefit insurance, which is health
insurance that provides protection in the form of reimbursement of medical
costs when the Insured falls ill, according to the coverage covered in the
policy. For example, reimbursement of inpatient fees, surgery costs, doctor
visit fees, outpatient fees, and so on. Medical expense reimbursement uses
cashless or reimbursement methods. Almost all insurance companies provide this
type of health insurance.
2. Disability insurance. This insurance provides
protection in the form of compensation for lost income due to conditions of
illness, disability, injury, illness or accident that makes you lose income.
Usually this insurance applies a payment method in the form of daily
compensation or cash plan. For example, you are hospitalized for 7 days and
have a disability insurance scheme with a cash plan of Rp1 million per day.
Then the insurance will provide Rp. 7 million in exchange for lost income due
to illness.
3. Critical illness insurance. This insurance provides
Sum Assured when the Insured is convicted of suffering from a critical illness.
The amount of Sum Assured varies according to the policy purchased. Critical
illness insurance usually applies the article survival period and the waiting
period.
4. Long term care insurance. This insurance provides
protection in the form of reimbursement for the Insured who needs daily health
care in the long run. For example, for nurse costs, maid fees, and others. This
insurance is rather rare in Indonesia even though abroad is very commonly
available. The premiums are quite expensive.
Health insurance based on payment of benefits
1. Cashless / reimbursement, which is health insurance
that reimburses medical costs according to the coverage covered on the policy.
The method of payment of benefits is available in the form of cashless where
you just have to hand over your insurance card to the collaborating health care
provider. There are also those who apply the reimbursement method in which you
have to pay in advance for treatment in hospital and later the insurance will
replace it once you finish submitting the receipts and administrative
requirements as required conditions.
2. Daily compensation (cash plan), namely health
insurance where the payment of benefits is given based on the number of days
the Insured is treated in the hospital. For example, you buy a cash insurance
health plan that provides compensation of Rp1 million per day. One time you are
hospitalized for up to 10 days. Then the insurance will pay a compensation of
Rp10 million to you in cash. Compensation is provided with a reimbursement
system where you have to submit original receipts containing information on the
cost of treatment at the hospital.
Health insurance based on benefit limits
Health insurance provides protection for the risk of
financial loss due to illness. Even so, health insurance has a benefit limit.
There are several types of health insurance when viewed from the limits of
benefits, namely:
1. Total annual value (as charged). This type of
health insurance provides protection with an annual limit. For example, health
insurance A provides reimbursement of medical costs with a maximum annual value
of Rp. 100 million. That is, when the insurance benefit claim has reached Rp100
million, you can no longer use the insurance.
2. Number of treatment days in a year. Health
insurance also usually has a limit on the number of treatment days that can be
claimed in one year. For example, a health insurance product provides intensive
care coverage of Rp.2 million per day, a maximum of 45 days a year. So, when
the Insured is treated for more than 45 days, the insurance will only pay for
45 days according to the policy provisions.
3. Treatment room class. Health insurance generally
applies a large benefit threshold for inpatient care costs. For example, for a
basic plan the cost of a hospital room is limited to Rp. 300,000 per day. If
you want to go to the treatment room class, you will have to pay the rest of
the costs yourself.
Types of benefits covered by health insurance
There are various types of benefits that can be
protected by health insurance. In principle, the more or more complete the
types of benefits covered by insurance, the premiums are usually more
expensive. The following types of benefits are usually covered by health
insurance:
1. Benefits of hospitalization. Namely, protection
against costs that arise when you fall ill and must be admitted to the
hospital. This includes, among other things, the cost of a treatment room, ICU
fees, doctor's visit fees, surgery fees, drug costs, ambulance fees, burial
fees, and so forth.
2. Outpatient benefits. Namely, protection against
costs that arise when you are sick and need treatment without having to stay in
the hospital. Among other things, the cost of consulting a doctor, the cost of
physiotherapy, drug costs, and so on.
3. Benefits of labor. Namely, protection against costs
that arise when you give birth to a baby in the hospital. Among other things,
the cost of a normal delivery, the cost of labor by surgery (caesarean
section), the cost of complications of pregnancy, and others.
4. Benefits of dental care. Included here include,
among others, costs associated with preventing dental diseases such as tartar
cleaning, basic dental care, complex to the cost of pairs of dentures.
5. No claim bonus. This is the insurance benefit
provided if you don't make any claims for one year. The benefits provided are
in the form of a 20% discount from the total value of the basic premium. For
example, the premium charged was IDR 6 million last year. Because you did not
claim at all for one year, then for the next premium payment, you only need to
pay Rp. 4.8 million.
Article the exception in health insurance
Every health insurance policy has an exemption clause
that contains things that make insurance benefits cannot be given or claimed by
the Insured. Before buying, you must be observant to read the rules of this
exception so you know the extent of the coverage of health insurance that you
want to buy. The following are a few exceptions to health insurance that are
commonly applied:
1. Pre-existing disease. Pre-existing disease is a
disease that has been suffered (already diagnosed) by the insured before the
insured buys an insurance policy. Pre-existing disease is generally not covered
by health insurance. health insurance only provides protection for diseases
that appear (diagnosed) after the policy is active (inforce). For example, Mr.
A was diagnosed with heart disease on January 1, 2019, then on March 1, Mr. A
bought health insurance, so the heart disease is a pre-existing disease that is
not covered by health insurance.
2. Waiting period. That is, the waiting period for a
disease arises since the enactment of the policy. For example, 12 months after
the policy goes into effect, the benefits of protecting against certain
diseases will only take effect. If the Insured is treated for the disease
before 12 months from the policy's validity period, the benefits cannot be
claimed. Usually this article is on health insurance and critical illness
insurance.
3. Excluded diseases. Not all types of diseases can be
covered by health insurance. There are several types of diseases that are not
covered by health insurance, such as HIV / AIDS, early critical illness, and so
on.
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