The types of health insurance claims are divided into two, namely non-cash (cashless) and cash (reimbursement) claims:

• Non-cash claims (cashless): customers show their insurance participant cards at insurance company partner hospitals/clinics. After that, the hospital bill will automatically be covered by the insurance company.
• Cash claims (reimbursement): customers pay hospital bills with personal funds at non-partner hospitals/clinics. Then submit a claim, and the hospital will reimburse the customer for the funds that have been spent.

1. Report the claim immediately within 5 x 24 hours of the loss.
2. Prepare claim documents such as driver’s license, STNK, policy documents, claim form.
3. The insurance team will conduct a survey and analysis to calculate estimated losses.
4. If approved, the car can be repaired at a partner workshop.
5. Customers must pay an own risk fee of IDR 300 thousand.

1. The best insurance can be obtained by knowing your current needs and budget. Then compare several policies from insurance companies in Indonesia online and follow these tips on how to choose the best insurance:

   1. Choose insurance benefits according to your needs

      Tailoring insurance benefits to your needs is very important to get the best policy with cheap premiums. For example, now you have BPJS Health protection and a private health insurance policy from the office. However, because you are worried that the policy provided by the office cannot cover the costs of critical illness, you are interested in completing it with critical insurance.

      So, you should not be careless and do a complete blood test first in the laboratory to find out your health risks. If the result is that there is no risk of critical illness, there is no need to complete a rider or additional critical illness insurance policy. Vice versa.

   2. Compare policies online

      To avoid making the wrong choice, you can use insurance marketplace sites such as Lifepal.co.id to compare 500+ policies from several insurance companies in Indonesia. Through the Lifepal website, prospective customers can easily compare details of benefits and premiums for one policy with another.

   3. Choose policy benefits that are comparable to hospital costs

      Don’t be immediately tempted to see cheap premiums. It is best to choose an insurance premium that is commensurate with the benefits provided. Because, it’s useless if the premium is IDR 30 thousand per month but the policy only covers inpatient costs of IDR 100 thousand per day. Of course, it cannot cover the costs of hospital stays which are around IDR 500 thousand per day.

   4. Choose a credible insurance company

      Currently, more and more insurance companies are emerging in Indonesia. Therefore, it is important for every customer to be more careful and discerning in choosing a credible brand or insurance company. Find out the company’s track record, whether it has ever encountered problems or not. Apart from that, make sure the company is licensed by the Financial Services Authority (OJK) and registered with AAJI for life insurance companies or AAUI for general insurance companies.

1. Indonesia is one of the countries that has a low insurance penetration rate. This is due, in part, to the fact that there is a lot of stigma and misunderstanding regarding insurance which makes people reluctant to be protected by insurance.

   Here are some misunderstandings about how insurance works that need to be fully understood:

   1. Insurance loses because it doesn’t necessarily make a claim

      It needs to be underlined that the risk of illness and death can occur at any time and to anyone. With insurance protection, you don’t need to be afraid when you have to pay large costs for inpatient or outpatient care.

      Apart from that, health insurance can also be used not only when customers have been diagnosed with illness. Because, there are several policy options that cover preventative care such as HPV vaccination, cleaning tartar, and physiotherapy which are generally not covered by BPJS Health.

   2. Health insurance premiums are expensive

      Currently there are many choices of health insurance policies that offer various price ranges, so that they can be adjusted to each prospective customer’s budget. For example, at Lifepal you can find a choice of health insurance policies with prices ranging from IDR 50 thousand to millions of rupiah per month.

      Apart from that, when compared to hospital costs which continue to increase from year to year, the premiums paid are cheaper than the costs if you have to pay hospital bills with personal funds.

   3. Already have BPJS, private health insurance is no longer necessary

      It is true that BPJS Health will be very helpful if you experience health risks. Because, BPJS Health has the same function as health insurance, where medical costs will be covered. However, BPJS Health has an administrative process that is quite complicated. For example, there are several cases where customers have to queue for days to be able to receive surgery at the hospital. Apart from that, there are also several types of medicines that are not covered by BPJS.

      Meanwhile, with private health insurance, you can immediately get health services at the best hospitals, both in Indonesia and abroad (depending on the policy you have). In conclusion, if you have a very limited budget, BPJS Health could be the right solution. However, if you have more budget, you should supplement your BPJS benefits with private health insurance.

   4. Insurance makes it difficult to submit claims

      Most claims that are rejected by insurance are generally due to insurance exclusions. It should be understood that each insurance policy will state what benefits the insurer can cover and what risks are excluded.

      For example, a customer submits a claim for health care due to a congenital disease. In fact, pre-existing conditions (congenital diseases) are included in the policy exceptions. Then the claim will be rejected. Therefore, before buying insurance, you should read the policy benefits and exclusions carefully.

1. The following are insurance terms that often appear in policies or when talking to insurance agents or brokers:

   • Amount Payable in insurance is: An amount of funds (premium) agreed by the insurance policy holder customer to be paid to the insurance company.
   • Agent: Insurance company partner whose job is to market insurance products or serve prospective insurance participants. Starting from conveying the policy provisions to the contents of the policy agreement after becoming an insurance participant.
   • Actuary: A profession in insurance that applies mathematics, finance, and statistics to calculate risks and premiums.
   • Adjudication: The stage of dispute resolution to decide whether the claim submitted by the insured can be accepted or rejected by the insurance company (insurer).
   • Annuity: Payments made by an insurance company periodically over a certain period of time.
   • Assignment: A term used to refer to transfers in insurance.
   • Assignor: The party in charge of assigning insurance rights and benefits from insurance participants (insured) to other people.
   • Automatic Premium Loan (APL): Provision for automatically withdrawing the cash value from the policy if the insurance participant does not pay the premium until the grace period ends.
   • Bancassurance: Insurance products marketed and sold by banks.
   • Excess (cut limit): Costs that must be paid by insurance participants to cover the shortfall in costs paid by the insurance company to the hospital.
   • Acquisition Costs: Costs incurred when the policy is issued.
   • Top-up Fees: Costs incurred when insurance participants pay periodic premiums and single premiums.
   • Cash value: The total money given by the insurance company to insurance participants within a certain time period or at the end of the policy period
   • Contestable Period: The time given to insurance participants to cancel the policy.
   • Premium Leave: A feature in insurance that allows insurance participants to stop paying premiums for a while.
   • Investment Funds: The amount of funds obtained from premium payments within a certain period of time which has been deducted from acquisition costs and several other costs.
   • Endowment Plan: Insurance program with two benefits: protection and savings.
   • Explanation of Benefits (EOB): A letter from the insurance company as a sign of receipt of the claim which will later be given to the insurance participant.
   • Field Underwriting: Initial selection of prospective insurance participants carried out by insurance companies.
   • Flat Rate: The premium fee determined by the insurance company is the same nominal for each payment period during the policy term.
   • Free-Look Period: Prospective insurance participants have 14 days to decide to cooperate/cancel the policy because they do not agree with the terms and conditions in the policy.
   • Grace Period: The grace period given to insurance participants is 30 days from the due date of payment.
   • Unit Price: The return obtained from an investment portfolio which is obtained from the asset value plus profits from investment returns.
   • Policy Illustration: Projection of insurance benefits that insurance participants will receive.
   • Investment-linked Plan: Often referred to as unit-linked insurance which offers two benefits: protection and investment.
   • Protection Guarantee: Guarantee provided by the insurance company so that insurance participants can purchase additional insurance products without the need for a selection process.
   • Guarantee/Guarantee Statement: A statement issued by a prospective insurance participant regarding the condition of the person or object insured.
   • Joint life annuity: Premium payments will stop if the insured person dies.
   • Insurance Card: Membership card given by the insurance company to the insured. This card can be used when you want to submit a claim.
   • Key Employee (Key Person): Expert staff from the insurance company with all the abilities that support the success of the insurance company.
   • Insurance claims are: Submission of reimbursement provided by the insurance participant to the insurance company. In this way, insurance participants have the proper rights so that the insurance company pays for conditions according to existing procedures.
   • End of Contract Claim: A claim for the insurance participant’s rights because the contract has ended with the insurance company.
   • Delayed Claim: A claim made by an insurance participant and which the insurance company cannot pay for certain reasons.
   • Clauses: Articles contained in the policy agreement that insurance participants and insurance companies must comply with.
   • Lapse: The period of time that premiums are not paid until the policy is canceled (the effective period of the policy stops).
   • Life Insurance Company: Insurance company with insurance products to accept the transfer of risks regarding life (economic value and the insured).
   • Loan of Policy: If the insurance participant requests a loan from the insurance company in a certain amount and is approved with a guarantee of the cash value of the policy.
   • Late Remittance Offer: A final offer from an insurance company used to restore a canceled insurance participant’s policy.
   • Law of Large Numbers: Calculations using the concept of the law of large numbers based on statistical data to be able to provide an overview of the percentages of everything that is likely to happen to insurance participants.
   • Main Reserve: The premium reserve owned by insurance participants will be calculated in the middle of the year.
   • Mail Kit: Sales brochure used to send various information related to insurance programs sent by post to prospective insurance participants to make it easier to make decisions about joining the insurance program.
   • Grace Period: The deadline given by the insurance company to insurance participants to pay the agreed premium.
   • Waiting Period: A certain period or time that must pass before benefits or claims can be disbursed again.
   • Minor: Insurance participants who are under 21 years of age.
   • Mortality: Estimated time of death that is uncertain or can also be used to refer to the frequency of death.
   • Net Asset Value (NAV): The basic value of investment in a unit link insurance policy.
   • Investment Value: The total value of link units formed in a period.
   • Occupational Risk/Hazard: Risk from the work of insurance participants.
   • Payor: The term used for insurance participants as the party who pays the premium.
   • Policy Holder: A person who is bound by an agreement made with an insurance company and is responsible for all his obligations to the insurance company.
   • Insurer: The party that provides insurance coverage, in this case the insurance company. The insurer in sharia insurance (Islamic insurance) has the same designation as conventional insurance.
   • An insurance policy is: A letter of agreement (insurance contract) which is called a policy. This means the agreement made by the insurance participant with the insurance company.
   • Premium or policy expense: What is meant by the definition of insurance premium is the nominal payment agreed upon by the insurance participant and the insurance company. Premium payments can be made according to the agreement, monthly, annually, or as agreed.
   • Quarterly Premium: Premium payments once every three months.
   • Reinsurance: Efforts by insurance companies to protect themselves by transferring insurance risks to other insurance companies.
   • Rider: Other benefits obtained outside of the main benefits.
   • Risk: Various bad possibilities that can happen to someone.
   • Insured: The insured party in insurance is the customer who receives insurance benefits, in this case it can be the policy holder or another person listed as the insured party.
   • Sum Insured: The amount of compensation provided by the insurance company in the event of a claim from an insurance participant for risks guaranteed in the insurance program.
   • Underwriter: A person who has expertise in assessing or reviewing various risks of insurance participants so as to determine whether prospective insurance participants are entitled to receive insurance or not.

1. The legal basis for insurance in Indonesia is regulated through Law no. 2 of 1992 and the Commercial Law Law (KUHD).

   It is explained that the insurer or insurance company binds itself to the insured or customer. Customers as policy holders are required to pay insurance premiums. By accepting the premium paid by the customer, the insurer is obliged to provide compensation for damage or loss of profits suffered by the insured due to unintentional actions or in accordance with the policy agreement.

   Meanwhile, the definition of insurance according to Law (UU) no. 1 of 1992, it is explained that insurance is an agreement between two or more parties, where the insurance company binds itself to the insured (insurance customer), by receiving insurance premiums as compensation to the insured in the event of a loss.

   Apart from following the 1992 Law, the insurance mechanism in Indonesia is also regulated by the Financial Services Authority (OJK). The function of the OJK itself is to regulate and supervise the activities of the financial sector of insurance companies. One of them, OJK ensures that every insurance company has healthy financial reports from year to year.

   *Apart from solvency, there are a number of other financial ratios that also need to be considered.

1. In insurance, there are 6 basic principles that must be fulfilled. The following is the explanation:

   • Insurable Interest: the right to insure, which arises from a financial relationship, between the insured and the insured and is legally recognized.
   • Utmost good faith: the act of disclosing accurately and completely, all material facts regarding something to be insured, whether requested or not. This means: the insurer must honestly explain everything regarding the extent of the terms/conditions of the insurance and the insured must also provide clear and correct information regarding the objects or interests insured.
   • Proximate cause: an active, efficient cause that gives rise to a chain of events that give rise to a result without any intervention that starts and is active from a new and independent source.
   • Indemnity: a mechanism where the insurer provides financial compensation in an effort to place the insured in the financial position he had immediately before the loss occurred (KUHD articles 252, 253 and emphasized in article 278).
   • Subrogation: transfer of claim rights from the insured to the insurer after the claim is paid.
   • Contribution: the right of the insurer to invite other insurers who share the same liability, but not necessarily the same obligation to the insured to contribute to providing indemnity

1. To maximize the function of insurance in Indonesia, there are also insurance business supports whose function is to ensure insurance companies run as they should:

   • Insurance Brokerage Company: a company that provides intermediary services in closing insurance and provides solutions for handling compensation by insurance companies to the insured.
   • Reinsurance Broker Company: a company that provides intermediary services in placing reinsurance and solutions for handling compensation settlements by reinsurance companies to insurance companies.
   • Insurance Loss Appraisal Company: a company that provides assessment services for claims or consultation on insured insurance objects.
   • Bancassurance: insurance companies as non-bank financial institutions, collaborate with banking companies to offer insurance products.