In Indonesia there are two types of health insurance is health insurance collective (group) and individual health insurance. Insurance is usually reserved for private individuals or families, while insurers collectively as found in many companies already provide health coverage to their employees. Individual insurance premiums to be paid relatively higher than the collective health insurance. Why is that? Because of the collective, then the number of participants who took part individually or bigger so the risk of a claim can be evenly by all the individual within the group. The greater the number of groups or members within a single institution or company, it will lower the premium to be paid.
Health Insurance BenefitsHealth insurance is a type of insurance that helps the availability of health insurance funds if participants develop health problems or illnesses. All the needs of seeing a doctor, stay (care) in hospitals, drug costs in the hospital until the operation, all that can be covered by insurance companies. Generally this type of treatment or programs that are available are the benefits of ambulatory (outpatient), benefit of inpatient care (inpatient), labor benefits and dental benefits.
In general, the benefits of ambulatory (outpatient) are covered by insurance companies is as consulting fees or general practitioner and specialists, prescription medication costs, costs of preventive measures, the cost of assistive devices required by doctors, and others. In the outpatient benefits have maximum limits use of funds each year. While hospitalization benefits that can be enjoyed by participants of health insurance is like the hospital costs, lab fees, delivery fees, the cost of emergency service (emergency). The benefits of preventive dental care, basic dental care, dental care complex, and the installation of dentures.
Third-care benefits, namely outpatient, maternity and dental benefits is an additional option that we can take the following basic program, which benefits of hospitalization. So, we are not allowed to just take advantage of outpatient care, childbirth or dental work alone without following the basic program of hospitalization benefits.
The amount of premium to be paid and the amount of value in health insurance is dependent on the health insurance program that we choose. Various insurance companies have the types of programs and premiums vary by the details of benefits also varies. Typically, insurance companies limit the amount of the total cost that can be used per year.
The system claims / reimbursement of health insurance
The system used by health insurance companies there are 2 ie the reimbursement system (reimbursement) or the system provider. With the reimbursement system, insurance participants have to spend money first to pay for treatment then can we claim or request a replacement to the insurer in which we become participants of insurance. With this system we are then free to choose a hospital anywhere, but certainly the maximum reimbursement has been determined in advance. That need to be our primary concern in making the claim is the completeness of letters of administration that became the main requirement for the reimbursement of expenses that we can be paid out by insurance companies. How quickly depends on the disbursement of claims services provided by insurance companies, but generally ranges from 7 working days.
For those who embrace the system provider, we do not need to spend money first. We only provided with health insurance membership card in order to obtain needed health care in a hospital or health clinic that we selected earlier based on a list of hospitals that work with the insurance company.
Choosing health insurance
What kind of health insurance that we need to look at and we choose? Here are some tips that may help us in choosing health insurance
- Principle carefully before buying. As a potential participant health insurance, we are entitled to get the right information, clear and honest about the terms / conditions stated in the insurance agreement. We should first read the instructions, information, and procedures are carefully and do not hesitate to ask the insurance company if there is something less obvious. Learn the agreement properly so that it can make the right decisions. Given the usual clause or clauses written in small letters on the back of the agreement and use a term that is sometimes difficult to understand layman, then we must be diligent in asking to avoid conflict in the future as a result of the difference between our interpretation as a participant, or insured by the company insurer or the insurer.
- Choose the insurance companies are reliable and have good products and services. Try to compare with some health insurance companies are reliable and have excellent service. Compare the benefits and premiums to be paid between the various health insurance products. Choose one that suits your needs and our ability to pay premiums.
- If the company where we work do not provide health insurance, then we can take the initiative to follow the collective health insurance program with fellow employees in our company. This will benefit because the premium paid would be lower if the collective, but the losses may not be able to adopt 100% according to our will as well adapted to the needs of the group.
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