Provides Group Health Care Coverage

The Healthcare Program provides participants with comprehensive and structured services, including Outpatient, Inpatient, Dental, Maternity, and Optical (Eyeglasses) care, along with other supplementary benefits (Prosthetics, Critical Illness, etc.) delivered through a Provider network. Participants can access these services from the Provider with no out-of-pocket costs. Additionally, participants may select one family doctor for both general and dental care, which will be listed on the Participant Card.

Group Managed Health Care is a product that provides Inpatient, Outpatient, and other medical services through healthcare facilities provided by Providers appointed by PertaLife Insurance.

– Access Provider networks across Indonesia (no upfront payment required);
– No annual limit;
– Comprehensive and structured healthcare services.

The Group Managed Health Care Plan provides comprehensive healthcare coverage, including Outpatient Care, Dental Care, Medications, Diagnostic Tests, Inpatient Care, Surgery, Prosthetics, Optical, Medical Evacuation, Hospital Cash Benefit, and other customized benefits as required by the company for its employees.

The Group Managed Health Care Plan provides 24-hour services to assist participants in obtaining medical assistance and other information related to their Health Insurance program.

 

SERVICE METHOD

We implement a Managed Services approach through our affiliated Healthcare Provider Network, which includes: General Practitioners, Dentists, Specialists, General and Specialist Clinics, Pharmacies, Opticians, and Hospitals. Our Provider Network is extensive, covering nearly all major cities and various other regions throughout Indonesia.

 

CORE SERVICE COVERAGE

1. Primary Outpatient Care (General Practitioners and Dentists);
2. Specialist Outpatient Care (Specialists, etc.);
3. Inpatient Care and Surgical Packages;
4. Emergency Services;
5. Diagnostic Tests and Procedures;
6. Prescription Drugs / Therapy;
7. Specialized Care Packages (including Critical Illness, etc.)

 

 

There is no Annual Limit for:

– General Practitioner consultations;
– Dental treatments;
– Specialist consultations;
– Prescription medications;
– Inpatient hospital charges (excluding surgical procedures);
– Supporting diagnostic tests.

Benefit flexibility (customized) to align with:

– The Company’s specific needs;
– Company regulations;
– Existing benefits from the Company’s previous insurance provider;
– The Company’s budget.

 

ADDITIONAL SERVICE COVERAGE

Additional services in the first year of participation include:
– Maternity package benefit allowance;
– Daily hospital cash allowance;
– Eyeglasses;
– Prosthetics (dental, eye, leg, hand);
– Domestic Medical Assistance.

 

CONVENIENCE

No advance payment is required for doctors, pharmacies, hospitals, or any healthcare providers, provided that participants follow the established medical procedures.

Every participant, including employees and all registered family members, even infants, will be issued an individual Participant Card.

 

GROUP PARTICIPATION REQUIREMENTS

– Minimum number of participants as determined by the Insurer;
– Minimum age of 1 (one) month and maximum age of 55 (fifty-five) years;
– Completion of the SPAK (Insurance Application Form) for the company;
– Submission of medical questionnaires and health forms only for participants within specific categories determined by the Insurer;
– Premium per participant as determined by the Insurer.

 

INSURANCE ENTRY AGE

Minimum 1 (one) month and maximum 55 (fifty-five) years old..

 

CURRENCY

IDR (Indonesian Rupiah)