Health Insurance
Health is one of the valuable things in life. Quite often when someone is sick he will pay a high in the healing process. In fact, sometimes these costs can spend most of the wealth / property owned.
One way to anticipate the high cost is through health insurance programs.
In general, health insurance programs provide specific benefits to the participant / insured if illness, accident or getting a medical service.
Health insurance programs are most commonly known widely that there are two day-care allowance (income hospital / hospital cash plan) and medical costs (hospital benefits).
Daily Care Benefit (Hospital Cash Plan / Hospital Income)
These programs typically provide benefits in the form of a fixed income benefit in a certain amount each day for participants to be hospitalized. For example a person would be given compensation / revenue of Rp 500,000 / day for hospitalized. Who benefit the most common types that exist today are the benefits of hospitalization and surgery.
Medical Expenses (Hospital Benefit)
If the above program provides benefits in the form of compensation / income are fixed, the program provides benefits in the form of reimbursement of medical expenses when a person must be hospitalized. Costs are generally covered in this program are: the room, ICU costs, cost of medicines and miscellaneous, surgery cost, cost of care for physician visits and specialist consultations, outpatient costs before and after treatment, ambulance fees, costs of outpatient and teeth due to accidents.
There are two ways to set boundaries in the reimbursement of expenses is usually applied in the program. First use the boundary in the (inner limit). In this system, masing2 cost components by the insurance is limited to a certain limit. Example: a doctor's visit cost component limit of Rp 125,000 per day. Component surgery cost Rp 10 million per period of hospitalization, etc.. If then the cost of recrudescent higher than the maximum limit which is given then the insurance company will reimburse only for the maximum limit and the rest borne by the participants. In this system usually within a year the total nominal claims are not restricted.
The second limitation is to use the outer boundary. The system is also known as the "as charged" the cost will be reimbursed according to the bill listed in the receipts. Although labeled as charged, does not mean the program has no restrictions / limits. In this system the limit does not apply to masing2 cost components, but applied in a nominal amount of total claims cost component (usually a year). For example in year one participant has a nominal limit of Rp 100 million total claims. So long as the claim does not exceed the total nominal value of Rp 100 jt limit in a year the participants will receive full reimbursement.
In matters of this program claims to use two systems of reimbursement and managed care / cashless. On the reimbursement system participants are required to pay in advance all maintenance costs incurred. Then ask the reimbursement of new participants to the insurers in accordance with the scope and limitations of benefits contained in the policy. Meanwhile, cashless system participants are not required to pay in advance the cost of the hospital. In a cashless system of the hospital which will be billed the cost incurred to the insurers. So participants can come straight home after being treated any tanpamembayar. If then there was the difference between the cost incurred with coverage limits in the policy benefits (excess claims), then usually the insurance to participants will be billed later. But there are also requiring participants to pay the excess costs in the hospital before the participants go home.
Currently this type of health insurance program not only provides benefits expense reimbursement during the hospitalization but can be expanded to replace other biaya2 such as: outpatient costs that are not associated with hospitalization, delivery fees, cost of dental care and eyeglasses.
Claim Documents
In the system of reimbursement required supporting documents to make claims, the documents typically are:
Resume · medical / original diagnosis
· Original receipt and the details of the cost.
· Copies Recipes
· A copy of the request supporting diagnostic (X-ray, laboratory, anatomic pathology, etc.) follows a copy of the results
· Operations report including details of the operating costs if carried out surgery.
Usually for a resume document care benefit programs of medical and does not need the original receipt, simply copy it (legalized).
Besides the documents, the participants must also pay attention to the requirements of the final boundaries of a claim can be filed. Normally a claim must be filed no later than 30 days since the medical services performed.
Health is one of the valuable things in life. Quite often when someone is sick he will pay a high in the healing process. In fact, sometimes these costs can spend most of the wealth / property owned.
One way to anticipate the high cost is through health insurance programs.
In general, health insurance programs provide specific benefits to the participant / insured if illness, accident or getting a medical service.
Health insurance programs are most commonly known widely that there are two day-care allowance (income hospital / hospital cash plan) and medical costs (hospital benefits).
Daily Care Benefit (Hospital Cash Plan / Hospital Income)
These programs typically provide benefits in the form of a fixed income benefit in a certain amount each day for participants to be hospitalized. For example a person would be given compensation / revenue of Rp 500,000 / day for hospitalized. Who benefit the most common types that exist today are the benefits of hospitalization and surgery.
Medical Expenses (Hospital Benefit)
If the above program provides benefits in the form of compensation / income are fixed, the program provides benefits in the form of reimbursement of medical expenses when a person must be hospitalized. Costs are generally covered in this program are: the room, ICU costs, cost of medicines and miscellaneous, surgery cost, cost of care for physician visits and specialist consultations, outpatient costs before and after treatment, ambulance fees, costs of outpatient and teeth due to accidents.
There are two ways to set boundaries in the reimbursement of expenses is usually applied in the program. First use the boundary in the (inner limit). In this system, masing2 cost components by the insurance is limited to a certain limit. Example: a doctor's visit cost component limit of Rp 125,000 per day. Component surgery cost Rp 10 million per period of hospitalization, etc.. If then the cost of recrudescent higher than the maximum limit which is given then the insurance company will reimburse only for the maximum limit and the rest borne by the participants. In this system usually within a year the total nominal claims are not restricted.
The second limitation is to use the outer boundary. The system is also known as the "as charged" the cost will be reimbursed according to the bill listed in the receipts. Although labeled as charged, does not mean the program has no restrictions / limits. In this system the limit does not apply to masing2 cost components, but applied in a nominal amount of total claims cost component (usually a year). For example in year one participant has a nominal limit of Rp 100 million total claims. So long as the claim does not exceed the total nominal value of Rp 100 jt limit in a year the participants will receive full reimbursement.
In matters of this program claims to use two systems of reimbursement and managed care / cashless. On the reimbursement system participants are required to pay in advance all maintenance costs incurred. Then ask the reimbursement of new participants to the insurers in accordance with the scope and limitations of benefits contained in the policy. Meanwhile, cashless system participants are not required to pay in advance the cost of the hospital. In a cashless system of the hospital which will be billed the cost incurred to the insurers. So participants can come straight home after being treated any tanpamembayar. If then there was the difference between the cost incurred with coverage limits in the policy benefits (excess claims), then usually the insurance to participants will be billed later. But there are also requiring participants to pay the excess costs in the hospital before the participants go home.
Currently this type of health insurance program not only provides benefits expense reimbursement during the hospitalization but can be expanded to replace other biaya2 such as: outpatient costs that are not associated with hospitalization, delivery fees, cost of dental care and eyeglasses.
Claim Documents
In the system of reimbursement required supporting documents to make claims, the documents typically are:
Resume · medical / original diagnosis
· Original receipt and the details of the cost.
· Copies Recipes
· A copy of the request supporting diagnostic (X-ray, laboratory, anatomic pathology, etc.) follows a copy of the results
· Operations report including details of the operating costs if carried out surgery.
Usually for a resume document care benefit programs of medical and does not need the original receipt, simply copy it (legalized).
Besides the documents, the participants must also pay attention to the requirements of the final boundaries of a claim can be filed. Normally a claim must be filed no later than 30 days since the medical services performed.
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