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Case Study - Group Health Insurance Indonesia
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Company Name |
: PT. XYZ |
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No. of employees |
: 25 Employees |
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Program |
: Inpatient |
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Plan |
: Plan 75, plan 100, plan 150 and plan 250 |
Premium Calculation
Group Insurance Health Program - Inpatient (SmartHealth Sapphire)
PT. XYZ
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PLAN |
SEX |
ANNUAL PREMIUM PER MEMBER |
NO. OF MEMBERS |
TOTAL PREMIUM (Rp) |
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PLAN75 |
Male |
324,800 |
8 |
2,598,400 |
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Female |
361,600 |
2 |
723,200 |
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PLAN100 |
Male |
398,100 |
4 |
1,592,400 |
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Female |
443,900 |
3 |
1,331,700 |
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PLAN150 |
Male |
544,700 |
3 |
1,634,100 |
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Female |
608,600 |
3 |
1,825,800 |
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PLAN250 |
Male |
837,900 |
1 |
837,900 |
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Female |
937,900 |
1 |
937,900 |
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TOTAL |
25 |
11,481,400 |
Benefit Table
SmartHealth - Sapphire
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INPATIENT |
Maximum Limit |
IIP75 |
IIP100 |
IIP150 |
IIP250 |
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Benefit for each Class (in Rupiah) |
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Room & Board |
per day
180 days per year |
75,000 |
100,000 |
150,000 |
250,000 |
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ICU |
per day
15 days per year |
275,000 |
300,000 |
350,000 |
450,000 |
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Doctor’s visit |
per day
180 days per year |
43,750 |
50,000 |
62,500 |
87,500 |
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Specialist’s visit |
per day
180 days per year |
68,750 |
75,000 |
87,500 |
112,500 |
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Surgery |
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Complicated |
per disability |
14,000,000 |
18,000,000 |
26,000,000 |
42,000,000 |
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Major |
per disability |
9,100,000 |
11,700,000 |
16,900,000 |
27,300,000 |
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Intermediate |
per disability |
6,300,000 |
8,100,000 |
11,700,000 |
18,900,000 |
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Minor |
per disability |
3,500,000 |
4,500,000 |
6,500,000 |
10,500,000 |
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Miscellaneous |
per disability |
2,125,000 |
2,500,000 |
3,250,000 |
4,750,000 |
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Pre-Hospitalization |
per disability
30 days before |
150,000 |
200,000 |
300,000 |
500,000 |
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Post-Hospitalization |
per disability
30 days after |
150,000 |
200,000 |
300,000 |
500,000 |
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Home Nursing |
per day
180 days per year |
37,500 |
50,000 |
75,000 |
125,000 |
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Local Ambulance |
per disability |
137,500 |
150,000 |
175,000 |
225,000 |
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Emergency Accidental Outpatient |
per event
within 14 days |
750,000 |
1,000,000 |
1,500,000 |
2,500,000 |
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Emergency Accidental Dental |
per event
within 14 days |
750,000 |
1,000,000 |
1,500,000 |
2,500,000 |
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Death Benefit |
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1,750,000 |
2,000,000 |
2,500,000 |
3,500,000 |
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Maximum Payable per Year |
Unlimited |
Unlimited |
Unlimited |
Unlimited |
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