Group Medicare Plan is a healthcare product offering service flexibility through a combination of reimbursement and provider-based (Swipe/Show Card) systems. Its core benefits include Inpatient Care and Surgical Procedures, with optional supplementary benefits such as Outpatient Care, Dental Care, or others tailored to the Company’s specific needs. Premiums are payable in an annual lump sum, determined by the selected plan and the participant’s gender and age category (Male/Female/Child).

Group Medicare Plan combines Indemnity (proportional reimbursement) and Managed Healthcare Plan (provider network) systems.

SERVICE METHODS

– Provider / Cashless (Swipe/Show Card)

– Reimbursement (Indemnity)

PRIMARY BENEFITS

Inpatient Care

– Guarantees inpatient treatment coverage for employees and/or their families due to illness or accidents;
– 100% reimbursement of actual expenses, subject to the maximum benefit limit.

Flexible Benefit Options
Core benefits serve as the basic benefits, while supplementary or additional benefits can be customized to meet the Company’s specific needs.

SUPPLEMENTARY BENEFITS

Outpatient Care
An additional program to Inpatient Care, providing coverage for outpatient treatment due to illness or accident. It offers reimbursement of 80% to 100%, as selected by the Policyholder, subject to the maximum benefit limit.

Dental Care
An additional program to Outpatient Care, providing reimbursement of 80% to 100%, as selected by the Policyholder. Coverage includes tooth extraction, dental fillings, treatment, and care for dental conditions, subject to the maximum benefit limit.

Optical (Vision Care)
Provides 100% reimbursement up to the maximum limit for prescription eyewear, covering lenses, frames, and contact lenses.

SUPPLEMENTARY BENEFITS

– Maternity
– Daily Hospital Cash Benefit
– Domestic Medical Assistance

GROUP PARTICIPATION REQUIREMENTS

1. Minimum number of participants as determined by the Insurer;
2. Minimum entry age from 1 (one) month to 55 (fifty-five) years;
3. Completion of the SPAK (Insurance Application Form) for the Company;
4. Submission of health forms and medical questionnaires only for participants within specific categories determined by the Insurer;
5. Premium per participant as determined by the Insurer.

Premium
Premiums are payable in a single annual lump sum, based on the entry age at inception and the selected plan.

ENTRY AGE FOR COVERAGE

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

CURRENCY
IDR (Indonesian Rupiah)