MITRA MEDICARE

Insurance protection to cover all the costs of treatment and surgical operations.

Mitra Medicare Group Life Insurance provides vital healthcare through PT Administrasi Medika (AdMedika), PT Intensive Medicare (I'MCARE 177), a healthcare provider network affiliated with Bumiputera.

The provider network includes:
- General Practitioners / General Practitioner Policlinics
- Specialist Medical Practitioners at Hospitals
- Pharmacies
- Hospital laboratories
- Hospitals and all of their supporting facilities

Facility

This insurance program provides easy service to each participant, as it requires no advanced payment for physicians, pharmacies, hospitals or healthcare facilities as long as participants follow the healthcare procedures.

Advantages

a. Flexible benefits that can be tailored to:
    - Need, budget, and company policies
    - Benefits received by the company from previous insurance.
b. Easy service with cashless system
c. Unlimited choice of physicians and hospitals within the provider's network
d. Responsive 24/7 customer service
e. 24 hour Hot Line Service
f. No requirement for Medical test
g. Fee payable on half-yearly or yearly basis
h. 65 Group Insurance Branches and Representatives throughout Indonesia
i. Group Insurance claim service operated under a ‘one window' system between Agencies acting as Policyholder and Underwriter (AJB Bumiputera 1912)

Benefits

Benefits for the Company:

a. The Company can determine the regular fixed amount cost of providing employees' welfare budget or work safety or healthcare.

b. The Company can focus on core business as the insurance or employees' welfare improvement program is outsourced to a professional management company.

c. The Human Resources Department can focus on strategic programs such as "efficient human resources development".

d. The Company can cut time-consuming "claim paperwork".

Benefits for the Employee or Participant:

a. Peace of mind as healthcare protection has been secured.

b. Participants don't need to prepare a healthcare fund to cover emergencies.

c. They don't need to borrow money from the company for healthcare when the need arise.

d. They can check their health or receive medication anytime, anywhere within the provider's hospital network.

e. Each participant will receive a membership card. For parents, Group Health Insurance will also provide membership cards for their children.

 

Service Procedures

1. General Provisions

a. Each member must show their membership card when seeking healthcare from healthcare service providers.

b. Healthcare service conducted outside of the provider's network will receive reimbursement in accordance with the healthcare service receipt, or to the maximum amount of benefit listed in the benefit table, whichever is lower.

2. Provider's Healthcare Service Provisions

If participants require inpatient treatment (not including emergencies) the participant can visit the provider's hospitals under the following conditions:

a. The Member must show a valid membership card on registration at the Provider.

b. The Participant will receive healthcare in accordance with each provider's healthcare service standard.

c. Inpatient and surgery costs arising thereof will be borne by, and paid directly by, Bumiputera, up to the maximum amount in accordance with the bill from the hospital or the Insurance Benefits Statement at the end of this proposal.

d. If, for whatever cause, the inpatient cost and/or surgery cost surpasses the maximum benefit stated in the Insurance benefit Statement in this proposal, then the additional cost is borne by the Participant.

e. Any additional cost must be paid by the Participant when leaving the hospital.

f. The Participant must stay in a hospital room in accordance with their right as stated on their membership card, or in line with the inpatient and/or surgery benefits that they are entitled to.

g. If the Participant doesn't get the inpatient treatment room entitled to him/her during registration due to room unavailability based on a written statement from the hospital, the Underwriter will allow the Participant to stay for 24 hours in a superior room with a maximum room fee of 20% or Rp. 40.000, whichever is lower.

If after 24 hours the Participant still does not have a room to which he/she is entitled, or is asked to stay in a room to which they are not entitled, the reimbursement system will start on the second day of treatment.

h. If the Participant doesn't get the inpatient treatment room entitled to him/her during registration due to room unavailability based on a written statement from the hospital, the Participant can stay in a room one level higher than she/he is entitled to, for two 24-hour periods. If after two 24-hour periods, the Participant doesn't return to the room she/he is entitled to, the extra cost of the third day will be borne by the Participant and must be paid when they leave the provider.

i. If the Participant stays in a room she/he is not entitled to, based on his/her own accord, the reimbursement system applies.

 

Membership

The Group Life Insurance membership requirements are:

1. The Applicant is an employee, married or single, and officially registered by the Policy Holder with Bumiputera.

2. Aged between 0 days and 55 years.

3. All applicants must be in good physical and mental condition and not under medical treatment.

4. If, during the activation of the insurance, one of the employee's family members is ill, the insurance will only be activated after she/he recovers and the application is approved by AJB Bumiputera 1912.

 

Certification & Insurance Period

To confirm that a Company or Participant is registered to Group Life Insurance, Bumiputera issues certifications in the form of:

1. A cooperation contract between the Underwriter and the Company
2. A Membership card for members, valid only for their respective product. Lost membership cards will be penalized through the issuance of a new card under the applicable rules and regulations.

3. A Master Policy in the name of the Company to signify the Insurance Agreement between the Underwriter and the Insured.

Premium

1. Premium payment methods are:
a Contributional where the premium is paid by the Company;
b Non-contributional where the premium is paid by the Participant, without a contribution by the company;

2. THE COMPANY (POLICY HOLDER) must pay the premium to the Underwriter (Bumiputera) for each employee or couple, determined by the actuary, based on the employee's age, premium sum, and the benefits determined for each Participant.

3. Premiums are paid annually or semi-annually.

4. The Premium is to be paid within 14 working days after the premium invoice has been received by the Company.

5. Premiums are to be paid to AJB Bumiputera 1912 via transfer through banks appointed by AJB Bumiputera 1912.

 

Insurance Basic Benefits

Costs covered include:

a. Room cost (HSI)

b. Intensive Care Unit (HS2)

c. Personal nurse (HS3)

d. Physicians visitation at hospital (HS4)

e. Physicians/specialist practitioner consultation at the hospital before and during inpatient treatment (HS5)

f. Various hospital treatments (HS6)

g. Ambulance cost (HS7)

h. Surgery (HS8)

i. Anesthetic (HS9)

j. Surgery room (HS10)

k. Emergency outpatient treatment (HS11)

l. Emergency dental treatment (HS12)

m. Post inpatient treatment physicians/specialist practitioner consultation (HS13)

 

 

 

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