CONFIDENTIAL

PROPOSAL
GROUP HEALTH INSURANCE PROGRAM
FOR

PT. F-TECH INDONESIA

Prepared by:
EMPLOYEE BENEFITS DIVISION
PT. Willis Indonesia
26th Floor, Wisma Keiai
Jl. Jend. Sudirman Kav. 3-4 Jakarta 10220
Tel. +62 21 2924 5300 - Fax. +62 21 2924 5398
Website: www.willis.com

19 February 2013

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CONFIDENTIALITY
This Proposal contains information which is confidential to both
PT. F-Tech Indonesia and
PT. Willis Indonesia.
Accordingly, we trust you will understand this Proposal is given to
PT. F-Tech Indonesia and their officers and employees in confidence and
may not be reproduced in any form or communicated to any other person,
firm or company without the prior approval of
PT. Willis Indonesia.

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TABLE

OF

CONTENTS

1. EXECUTIVE SUMMARY..............................................................................
2
SUMMARY..............................................................................2
2. INSURANCE GENERAL UNDERWRITING AND SERVICES COMPARISON........................
4
COMPARISON........................4
3. INSURANCE BENEFIT COMPARISON..............................................................
9
COMPARISON..............................................................9
4. PARTICIPANT LIST.................................................................................
16
LIST.................................................................................16
5. PREMIUM COMPARISON..........................................................................
17
COMPARISON..........................................................................17
6. TOTAL NUMBER OF PLUS POINTS...............................................................
19
POINTS...............................................................19

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1. EXECUTIVE SUMMARY
We would like to thank PT Screenplay Produksi Indonesia (Screenplay Productions) for this opportunity to
submit our Proposal for Medical Insurance Program.
Currently, PT Screenplay Produksi Indonesia (Screenplay Productions) has Medical Insurance Policy
underwritten by PT Asuransi Jiwa Manulife Indonesia with the following Benefits Plan :
o
o
o
o

Plan
Plan
Plan
Plan

1,
2,
3,
4,

room
room
room
room

and
and
and
and

board
board
board
board

Rp.1,200,000 per day + outpatient Rp. 150,000

Rp.700,000 per day + outpatient Rp. 70,000
Rp.500,000 per day + outpatient Rp. 50,000
Rp.300,000 per day + outpatient Rp. 40,000

Refer to our meeting dated 5 February 2013 in this Proposal we provide complete Medical Insurance
program to cover Inpatient, Outpatient, Maternity, Dental and Optical with the 2 (two) alternatives
options as below:
Alternative 1: Employee Only
Alternative 2: Employee & Dependents
Total employees are 252 (two hundred fifty two) persons based on the membership data received by us
on 11 February 2013.
MARKET APPROACH
We have obtained quotations from 5 (five) insurance companies to ensure your insurance cover
maintains its high level quality and benefits at an affordable price, they are as follows:
1.
2.
3.
4.
5.

PT. Asuransi AXA Indonesia; a Joint Venture Insurance Company

PT. Avrist Assurance; a Joint Venture Insurance Company
PT. Asuransi Aviva Indonesia; a Joint Venture Insurance Company
PT. Asuransi Sinar Mas; a Local National Insurance Company
PT. Asuransi Bina Dana Arta Tbk; a Local National Insurance Company

Based on our analysis and general knowledge on your existing program, this proposal includes the key
features of the coverage which an improvement from your existing policy:
Inpatient
Semi ICU, Intermediate and Isolation room covered under ICU benefit limit IMPROVED!
Room tolerance if entitled Room & Board (R&B) not available or entitled R&B full occupied is
available IMPROVED!
Hospitalization due to complication of pregnancy covered under Inpatient benefit IMPROVED!
Upgrade Miscellaneous Benefit limit per disability IMPROVED!
Upgrade emergency dental and outpatient treatment due to accident per occurrence
IMPROVED!
Profit Sharing is available IMPROVED!
Outpatient
100% Reimbursement IMPROVED!

--------------------------------------------------------------------------------------------------------------------------------

Claim reimbursement submission within 90 days from the date as shown in the receipt
IMPROVED!

CONCLUSION
Due to the fact that the (five) Insurers comply with all of specification as requested, the task of
selecting has been difficult. Having compared in every single details, please find the conclusion below:

SIMAS provides the most comprehensive benefits with the most competitive premium for both
Alternative 1 and 2 compared with other quoting Insurers

Furthermore, please see our Insurance General Underwriting and Benefit Comparisons on Chapter 2 for
your further review. Coverage that is clearly better (plus points) is identified in yellow.
This summary has been prepared by PT. Willis Indonesia to assist PT Screenplay Produksi Indonesia
(Screenplay Productions) in evaluating the benefits provided by the quoting Insurers. For complete
details of plan benefits, conditions, limitations and exclusions, PT Screenplay Produksi Indonesia
(Screenplay Productions) should refer to the policy wording, copy of which will be provided upon
request.
We look forward to seeing you to discuss further details, in the mean time should you have any further
inquiries please do not hesitate to contact our office
Jakarta, 19 February 2013
Employee Benefits Team

Savitri Sri Lestari

Senior Client Executive

Dewita Anggraeni
Deputy CEO

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2. INSURANCE GENERAL
UNDERWRITING AND SERVICES
COMPARISON
Coverage that is clearly better is identified in yellow.

UNDERWRITING

INSURER
PROFILE
POLICY
CURRENCY

SIMAS

MANULIFE

A joint venture
Insurance company

A local national
insurance company

RELIANCE

Employee is
covered up to

55 years old

(> 55 yrs. old cover

with an extra
premium)

Child is covered
from 0 25 years
old (subject to fulltime students and
unmarried)

Child is covered
from 0 day (for
baby born less than
37 weeks or weight
is less than 2500
grams is covered
from 15 days) up to
23 years old

(subject to full-time
students &
unmarried)

IDR

EMPLOYEES AGE
RESTRICTION
(with standard
premium)

Employee is
covered with
maximum age of 65
years old
Employee is
covered up to 60
years old
(> 60
years old cover with
an extra premium)

CHILDRENS AGE
RESTRICTION
(with child
premium)

Child is covered
from 15 days up to
23 years old
(subject to full-time
students and
unmarried)

GEOGRAPHICAL
LIMITS

AVIVA

Worldwide

UNDERWRITING

SIMAS

MANULIFE

AVIVA

RELIANCE

PREMIUM
CALCULATION
FOR ADDITION &
DELETION
MEMBER

Prorate Basis

ANNUAL BENEFIT
FOR ADDITIONAL
MEMBER

Full Benefit apply

for Inpatient,
outpatient will be
prorated

Full Benefit apply

for all benefits

Full Benefit apply

for Inpatient, other
benefits will be
prorated

Full Benefit apply

for all benefits

Waived only for

existing member
Waived for existing
& upcoming
members

Waived only for

existing member.
Waived for existing
& upcoming
members

Waived only for

existing member

Waived for existing

& upcoming
members

Inpatient
90 days

Outpatient
30 days
30 days

90 Days
30 days

90 Days
60 days

OP & Dental

7 working days
10 working days

PRE-EXISTING
CONDITION(S)

CLAIM
REIMBURSEMENT
SUBMISSION
(FROM THE DATE
AS SHOWN ON
THE RECEIPT)
CLAIM
REIMBURSEMENT
PAYMENT
(Subject to
Claim Documents
received in
Complete)
METHOD OF
PREMIUM
PAYMENT
PROFIT SHARING
(SUBJECT TO
RENEW FOR
ANOTHER 12
MONTHS &
AVAILABLE 3
MONTHS AFTER
RENEWAL
CONFIRMATION

14 Working Days
14 Working Days

Inpatient &
Maternity
14 working days.

Annually

No information
Good Claim
Discount 10%
discount if loss ratio
below 50% and 5%
discount if loss ratio
50% up to 60%
50% x (50%
premium claims
loss carry forward)

(applied if premium
> Rp.300 mio)
50% (73% Premium
Claim)

25% (60%
premium) claims
paid loss in the
previous year
50% x (60%
premium claims
paid)

(applied if premium
> Rp.400 mio)

INPATIENT

UNDERWRITING

SIMAS

MANULIFE

REINSTATEMENT
BENEFIT (PER
DISABILITY)

ROOM & BOARD

(R&B)
TOLERANCE

RELIANCE

Inner limit,
Unlimited

INPATIENT
TYPE OF
PRODUCT
OVERSEAS
TREATMENT

AVIVA

Reimbursement
basis

14 days

No information
Entitled R&B is
fully occupied or
not available
Upgrade to nearest
available higher
class with tolerance
25% or IDR 50,000
whichever the
lesser for maximum
2 days
No Tolerance

30 Days

Entitled R&B is
fully occupied
Upgrade to nearest
available higher
class for maximum
of 2 days
Entitled R&B is
not available:

14 days

Upgrade to nearest
available higher
class with tolerance
50% or IDR 75,000
whichever the
lesser up to
discharge
Entitled R&B is
fully occupied or
not available
Upgrade to nearest
available higher
class with tolerance
up to IDR 50,000 up
to discharge
Entitled R&B is
fully occupied

CONTINUITY OF
COVER IF POLICY
LAPSED
(Subject to
Inpatient Benefit
limits are still
available)

Treatment will be
covered until the
patient is released
from the hospital
(excluding post
hospitalization
treatment)

Treatment will be
covered up to max.
30 days from the
date of expiry
policy

Treatment will be
covered until the
patient is released
from the hospital
(excluding post
hospitalization
treatment)

HOSPITALIZATIO
N DUE TO
COMPLICATION
OF PREGNANCY

No information

Covered under
Maternity Benefits

Covered under
Inpatient benefit

Upgrade to nearest
available higher
class for maximum
of 3 days
Entitled R&B is
not available:
Upgrade to nearest
available higher
class with tolerance
25% or IDR 50,000
whichever the
lesser up to
discharge

Covered under
Maternity Benefits

UNDERWRITING

ISOLATION
ROOM, SEMI ICU
& INTERMEDIATE
ROOM
ONE DAY
SURGERY
IMPLANT
PROTHESIS
(pen, stent, kwire, screw,
plate, IOL)
HAEMODIALYSIS
&
CHEMOTERAPHY

SIMAS

MANULIFE

Benefit treated as
daily room and
board

Benefit treated as
ICU room and board

AVIVA

RELIANCE

Covered under
Surgical benefit
limit

No information

Not covered

Covered except IOL

& hearing aids

Covered

No Information

Covered under
Inpatient

Covered under
inpatient and
outpatient benefit
limit

Covered under
Inpatient Benefit

Covered excluding
Dermoid Cyst

Covered

OPERATION FOR
ORGAN
TRANSPLANT

Covered excluding
the cost of organ
and the donor

ENDOMETRIOSIS
(non-infertility
cases)

Covered

OUTPATIENT
OUTPATIENT
TYPE OF
PRODUCT

Inner Limit with

Annual Limit

Inner limit, without

Annual Limit

Inner Limit with

Annual Limit

REIMBURSEMENT
PERCENTAGE

Provider & Non

Provider 80%

Provider & Non

Provider

100%

CONSULTATION
DIRECT TO
SPECIALIST
VITAMIN
(MEDICALLY
NECESSARY)

Provider & Non

Provider 80%

Direct consultation
to all specialist
without GP referral

Covered

BASIC
IMMUNIZATION

Not covered

FAMILY PLANNING

Not covered

UNDERWRITING

SIMAS

MANULIFE

AVIVA

RELIANCE

DENTAL
DENTAL TYPE OF
PRODUCT

N/A

As charged with
annual limit

Inner Limit with

Annual Limit

As charged with
annual limit

REIMBURSEMENT
PERCENTAGE

N/A

Provider & Non

provider

100%

Provider & Non

provider 80%

ADMINISTRATION
CHARGES

N/A

Covered

MATERNITY
MATERNITY TYPE
OF PRODUCT

N/A

Limit per package

WAITING PERIOD
FOR MATERNITY

N/A
Waived for existing
& upcoming
member

1 year waiting
period applies
8 months waiting
period applies if
only insuring the
employees

280 days waiting

period applies.

Waived for existing

& upcoming
members

N/A
Full Benefit apply
for Maternity

Full Benefit apply

for Maternity as
long as waiting
period has waived

Prorated basis if the

case has not
reached 280 days

Full Benefit apply

for Maternity

MATERNITY
BENEFIT FOR
ADDITIONAL
MEMBER

OPTICAL (EMPLOYEE ONLY)

OPTICAL TYPE OF
PROGRAM
TOTAL PLUS
POINTS

N/A

Limit per year for

Frame & Lens

Covered under ASO

program

Limit per package

for Frame & Lens

4 (four)
plus points
11 (eleven) plus
points

8 (eight)
plus points

13 (thirteen)
plus points

12 (twelve) plus
points
9 (nine) plus points

3. INSURANCE BENEFIT
COMPARISON
3.1. HOSPITALISATION & SURGICAL BENEFIT
Benefits expressed in IDR and coverage that is clearly better is identified in yellow.
SIMAS

MANULIFE

AVIVA

RELIANCE

DAILY HOSPITAL
ROOM & BOARD
(R&B) per day

1,200,000
700,000
500,000
300,000

Max. 365 days

1,200,000
700,000
500,000

300,000
Max. 180 days per
disability
1,200,000
700,000

500,000
300,000
Max. 365 days

INTENSIVE CARE
UNIT (ICU) per
day

1,300,000
800,000
600,000
400,000
Max. 365 days

1,300,000
800,000
600,000
400,000
Max. 20 days
including 180 days
per disability

1,300,000
800,000
600,000
400,000
Max. 365 days

1,300,000
800,000
600,000
400,000
Max. 20 days

IN-HOSPITAL
DOCTOR VISIT
PER DAY

300,000
170,000
130,000
100,000
Max. 365 days
300,000

650,000
420,000
330,000
250,000
Max. 180 visits per
disability

300,000
170,000
130,000
100,000
Max. 365 days

2,400,000
1,400,000
1,000,000
600,000
Max. per disability
incl. Prehospitalization
350,000
250,000
200,000

150,000
Max. 365 days
350,000
240,000
180,000
120,000
Max. 365 days

BENEFIT

DOCTOR
SPECIALIST
CONSULTATION
IN HOSPITAL,
PER DAY

350,000
240,000
180,000
120,000
Max. 365 days

170,000
130,000
100,000
Max. 365 days
Max. 1 visit per day

350,000
250,000
200,000
150,000
Max. 365 days
Max. 1 visit per day

BENEFIT

PRIVATE NURSE,
PER DAY

MISCELLANEOUS
HOSPITAL
EXPENSES PER
DISABILITY

SIMAS

MANULIFE

AVIVA

RELIANCE

600,000
160,000
130,000
80,000
Max. 365 days
600,000
160,000

130,000
80,000
Max. 90 days
300,000
170,000
130,000

100,000
Max. 30 days per
disability
600,000
160,000
130,000
80,000

Max. 365 days

600,000
160,000
130,000
80,000
Max. 30 days

25,000,000
7,750,000
5,750,000
3,750,000
25,000,000

5,000,000

8,000,000
6,000,000
5,000,000
25,000,000
8,000,000
6,000,000

(incl. Operation
Theatre &
Anesthesiologist

25,000,000
7,750,000
5,750,000
3,750,000

25,000,000
8,000,000
6,000,000
5,000,000

COMPLEX
OPERATION

127,500,000
75,000,000
54,000,000
33,000,000

127,500,000
75,000,000
54,000,000

33,000,000
Surgeon only
127,500,000

75,000,000
54,000,000
33,000,000

MAJOR
OPERATION

95,625,000
56,250,000
35,100,000
21,450,000

95,625,000
56,250,000
35,100,000

21,450,000
Surgeon only
95,625,000

56,250,000
35,100,000
21,450,000

INTERMEDIATE
OPERATION

51,000,000
30,000,000
24,300,000
14,850,000

51,000,000
30,000,000
24,300,000

14,850,000
Surgeon only
51,000,000

30,000,000
24,300,000
14,850,000

MINOR
OPERATION

28,000,000
15,000,000
13,500,000
8,200,000

28,000,000
15,000,000
13,500,000

8,200,000
Surgeon only
28,000,000

15,000,000
13,500,000
8,200,000

645,000
200,000
180,000

130,000
645,000
250,000

200,000
150,000
645,000

200,000
180,000
130,000

LOCAL
AMBULANCE
CHARGES,
per disability
PRE & POST
HOSPITALIZATIO
N PER
DISABILITY

4,500,000
2,150,000
1,550,000
960,000
(30 days before and 30 days after
hospitalization)
4,500,000
2,500,000
2,000,000
1,500,000
(30 days before and 30 days after
hospitalization)
Specialist Consultation
2,250,000
1,250,000
1,000,000

750,000
2,400,000
1,400,000
1,000,000
600,000
Post Hospitalization limit only
(30 days after hospitalization)
4,500,000
2,150,000
1,550,000
960,000
(30 days before and 30 days after
hospitalization)
Covered under outpatient

BENEFIT

EMERGENCY
OUTPATIENT
TREATMENT,
PER DISABILITY

EMERGENCY
DENTAL
TREATMENT,
PER DISABILITY

CHEMOTHERAPY
&
HAEMODIALYSA,
PER YEAR

ANNUAL LIMIT
PER PERSON

DEATH BENEFIT

TOTAL PLUS
POINTS

SIMAS

MANULIFE

AVIVA

RELIANCE

Diagnostic Tests
2,250,000
1,250,000

1,000,000

750,000

31 days before & 90

days after
hospitalization

4,500,000
1,600,000
1,350,000
850,000
4,500,000
2,000,000
1,500,000

1,250,000
9,000,000
4,000,000
3,000,000
2,500,000
4,500,000

2,000,000
1,500,000
1,250,000
per policy year
4,500,000
1,600,000

1,350,000
850,000
4,500,000
1,600,000
1,350,000
850,000

4,500,000
2,000,000
1,500,000
1,250,000

4,500,000
2,000,000
1,500,000

1,250,000
per policy year
4,500,000

1,600,000
1,350,000
850,000

No information
Covered under
Inpatient Benefit
Limit

Covered under
Inpatient &
Outpatient Benefit
Limit
Covered under
Inpatient Benefit
(Miscellaneous
benefit)

50,000,000
15,500,000

11,500,000
7,500,000

12,500,000
7,500,000
6,000,000
4,000,000
(Employee &
Dependents)
10,000,000

All Plans
(Employee &
Dependents
min. 6 months - 65
years old)
10,000,000
All Plans

(Employee only)
10,000,000
For all plans
(Employee &
Dependent)
10,000,000

7,500,000
6,000,000
4,000,000
(Employee &
Dependents)

9 (nine)
plus points
10 (ten)

plus points
4 (four)
plus points

8 (eight)
plus points
12 (twelve)

plus points
6 (six)
plus points

Unlimited

3.2. OUTPATIENT BENEFIT

Benefits expressed in IDR and coverage that is clearly better is identified in yellow.

BENEFIT

GENERAL
PRACTITIONER
CONSULTATION
PER VISIT PER
DAY

DOCTORS
SPECIALIST PER
VISIT PER DAY

SIMAS

MANULIFE

150,000
70,000
50,000
40,000
150,000
70,000
300,000
210,000
150,000
120,000
300,000
210,000
170,000

60,000
50,000
Max. 1 visit per day
150,000
70,000
60,000
150,000
Max. 1 visit per day
300,000
210,000
170,000
150,000
450,000

AVIVA

RELIANCE

50,000
150,000
70,000
60,000
50,000

Max. 1 visit per day

150,000
70,000
50,000
40,000

300,000
250,000
200,000
300,000
210,000
150,000

120,000
Max. 1 visit per day
300,000
210,000
150,000
120,000

140,000
100,000
80,000

DOCTORS
TREATMENT
PACKAGE PER
VISIT PER DAY

300,000
140,000
100,000
80,000

225,000
157,500
127,500

112,500
Covered under
Doctors
Consultation &
Medicines
300,000

PRESCRIBED
MEDICINE PER
POLICY YEAR

5,000,000
2,310,000
1,650,000

1,320,000
5,000,000
2,400,000

1,700,000
1,400,000
5,000,000

2,310,000
1,650,000
1,320,000

3,500,000
1,540,000
1,100,000
880,000

1,600,000
1,200,000
1,000,000
3,487,500

1,200,000
1,000,000
3,500,000
1,600,000

3,500,000

1,600,000

1,500,000
840,000
600,000
480,000

1,500,000
840,000
600,000

1,200,000
500,000
Covered under
Doctor Specialist
Consultation per
visit/day
1,500,000

1,000,000
3,500,000
1,540,000
1,100,000
880,000

DIAGNOSTIC
LABORATORY
SERVICES per
POLICY YEAR

PHYSIOTERAPY,
PER YEAR

840,000
600,000
480,000

BENEFIT

REIMBURSEMENT
PERCENTAGE
ADMINISTRATION
CHARGES

ANNUAL LIMIT
PER PERSON

TOTAL PLUS
POINTS

SIMAS

MANULIFE

AVIVA

80%

100%

80%

150,000
150,000

150,000

Covered under
Doctors
Consultation

3,000,000
2,500,000
Unlimited
12,000,000
5,600,000

4,800,000
4,000,000
10,500,000
5,250,000
4,500,000

3,750,000
13,000,000
6,440,000
4,600,000
3,680,000

7 (seven)
plus points
8 (eight)

plus points
6 (six) plus points

1 (one)
plus points

Covered under
Doctors
Consultation
150,000
13,000,000
6,440,000
4,600,000
3,680,000
7,500,000
3,500,000
1 (one)
plus points
6 (six) plus points

RELIANCE

3.3. MATERNITY BENEFIT

Benefits expressed in IDR and coverage that is clearly better is identified in yellow.

BENEFIT

SIMAS

MANULIFE

AVIVA

RELIANCE

12,000,000
7,000,000
5,000,000
3,000,000
Doctor

5,000,000
4,000,000
3,000,000
2,000,000

12,000,000
10,000,000
8,000,000
7,000,000

12,000,000
7,000,000
5,000,000
3,000,000

Midwife
1,500,000
1,200,000

900,000
600,000
Home Delivery

4,000,000
3,333,000

2,666,000
2,333,000

18,000,000
10,500,000
7,500,000
4,500,000

6,250,000
5,000,000
3,750,000
2,500,000

16,000,000
13,333,000
10,666,000
9,333,000

24,000,000
14,000,000
10,000,000
6,000,000

6,000,000
3,500,000
2,500,000
1,500,000
7,000,000

3,333,000
2,667,000
2,000,000
1,333,000

8,000,000
6,666,000
5,333,000
4,666,000

7,200,000
4,200,000
3,000,000
1,800,000

NORMAL DELIVERY

CAESARIAN
DELIVERY

MISCARRIAGE

SIMAS

MANULIFE

AVIVA

RELIANCE

COMPLICATION OF
PREGNANCY

Covered under
Delivery Benefits
Covered under
Inpatient benefit

6,000,000
3,500,000

2,500,000

1,500,000

PRE & POST NATAL

CARE

2,400,000
1,400,000
1,000,000
600,000
3,000,000

1,750,000
1,250,000
750,000
1,250,000
1,000,000

750,000
500,000
4,000,000
3,333,000
2,666,000

2,333,000
3,000,000
1,750,000
1,250,000
750,000

1 (one)
plus point

5 (five)
plus points

1 (one)

plus point

BENEFIT

TOTAL PLUS
POINTS

3.4. DENTAL BENEFIT

Benefits expressed in IDR and coverage that is clearly better is identified in yellow.

SIMAS

MANULIFE

AVIVA

RELIANCE

PREVENTIVE
TREATMENT, PER
YEAR

As Charged
(Max. scaling
twice a year)
As Charged

75,000
62,500
50,000

37,500
157,500
146,250

135,000
120,000
As Charged

BASIC DENTAL
TREATMENT, PER
YEAR

As Charged
300,000
250,000

200,000
150,000
825,000

750,000
675,000

575,000
As Charged

COMPLEX DENTAL
TREATMENT, PER
YEAR

As Charged
150,000
125,000

100,000
75,000
Limit per tooth

342,500
316,250
290,000

255,000
As Charged

PROSTHETIC
TREATMENT, PER
YEAR

As Charged
375,000
313,000

250,000
188,000
342,500

316,250
290,000

255,000
As Charged

BENEFIT

10

SIMAS

MANULIFE

AVIVA

RELIANCE

REHABILITATIVE
TREATMENT, PER
TOOTH

As Charged
Not covered
150,000

125,000
100,000
75,000

Limit per tooth

735,000
682,500

630,000
560,000
As Charged

GUM TREATMENT,
PER YEAR

As Charged
Not Covered
75,000

62,500
50,000
37,500

157,500
146,250
135,000

120,000
As Charged

2,400,000
1,400,000
1,000,000
600,000
2,500,000

1,200,000
850,000
750,000
900,000
750,000

600,000
450,000
3,000,000
2,700,000
2,400,000

2,000,000
2,400,000
1,400,000
1,000,000
600,000

100%

80%

6 (six)
plus points
5 (five)

plus points
1 (one)
plus points

2 (two)
plus points

6 (six)
plus points

BENEFIT

ANNUAL LIMIT PER

PERSON

REIMBURSEMENT
PERCENTAGE
TOTAL PLUS
POINTS

3.5. OPTICAL BENEFIT

Benefits expressed in IDR and coverage that is clearly better is identified in yellow.

BENEFIT

FRAME PER POLICY

YEAR

LENS / CONTACT
LENS PER POLICY
YEAR

SIMAS

MANULIFE

AVIVA

RELIANCE

1,200,000
700,000
500,000
300,000
Limit per year
Proposed Cover
under ASO
Program

1,250,000
1,000,000
750,000
500,000
Limit per 2 (two)
years

1,000,000
750,000
600,000
500,000
Once within 2
years

1,200,000
700,000
500,000
300,000
Limit per 2 (two)
years

500,000
375,000
300,000

250,000
Once in a year

600,000
350,000

250,000
150,000

11

BENEFIT

REIMBURSEMENT
PERCENTAGE
TOTAL PLUS
POINTS

SIMAS

MANULIFE

AVIVA

RELIANCE

0 (zero) plus
points

1 (one) plus point

0 (zero) plus
points

100%

1 (one) plus point

4. PARTICIPANT LIST
As of data received 11 February 2013

Band

EMPLOYEE

SPOUSE

CHILD

Total

11

14

19

60

41

69

219

Male

Female

Male

Female

Plan 2 RB 700

16

Plan 3 RB 500

82

23

Plan 1 RB 1,200

12

Plan 4 RB 300
Total

119

75

118

313

220

32

133

211

603

* RB = Room and Board (IDR 000)

5. PREMIUM COMPARISON
We would like to inform you that the premium below is an estimation premium based on
summary data given dated 11 February 2013 with 252 employees and 603 participants
(including dependents).
Premium mentioned below are indicative premium from the insurer. Insurer will recalculate the
actual premium subject to receive data at the beginning of the coverage and the benefit
chosen by the Company.
This quotation is valid until 30 days from proposal date.

5.1. Alternative 1 Employee Only

13

PREMIUM
(in IDR 000)

SIMAS

MANULIFE

AVIVA

RELIANCE

Inpatient

131,651
309,062

260,147

169,714

253,242

Outpatient

355,706
224,377

266,238

123,617

250,256

Maternity
(32 members)

59,160
51,638

25,378

32,518

95,418

Dental

52,272
39,602

26,932

71,957

76,177

Optical

76,230
30

ASO Fee
/member)

59,808
87,578

84,930

TOTAL

675,019
624,679

638,503

485,385

760,025

* Notes:
- The above premiums are excluding policy cost (if any)
- The above est. premiums to be recalculated upon receiving confirmation of insurance benefit being
purchased and
the final number of participants to be covered.
- The above est. premiums are valid if total premium is fully paid up front. There will be additional
loading for Semiannual payment.

5.2. Alternative 2 Employee & Dependents

PREMIUM
(in IDR 000)

Inpatient

SIMAS

MANULIFE

AVIVA

266,327
706,122

600,632

386,505

RELIANCE

535,031

14

PREMIUM
(in IDR 000)

Outpatient
Maternity

(No. of Members)

SIMAS

MANULIFE

AVIVA

727,113
573,414

563,310

291,622

529,776

(140)
79,767
(165)

112,315
(119)

149,987
(65)

199,184

156,254

(Employee only)

87,578

84,930
(Employee only)

989,627

1,455,981

134,980
(94)

179,541

Dental

114,432
101,550

61,260

Optical

166,880

ASO Fee /member)

(all members)

30

(all members)

TOTAL

1,409,732
1,560,628

1,446,699

141,730

RELIANCE

* Notes:
- The above premiums are excluding policy cost
- The above est. premiums to be recalculated upon receiving confirmation of insurance benefit being
purchased and
the final number of participants to be covered.
- The above est. premiums are valid if total premium is fully paid up front. There will be additional
loading for Semiannual payment.

6. TOTAL NUMBER OF PLUS POINTS

Coverage that is clearly better is identified in yellow.

15

YELLOW
HIGHLIGHTED

SIMAS

MANULIFE

AVIVA

RELIANCE

General
Underwriting

4
11

8
13

12

Inpatient

9
10

4
8

12

Outpatient

1
6

7
8

Maternity

N.A
1

1
1

Dental

N.A
6

5
1

Optical

N.A
1

0
0

Combined

14
35

25
31

38

23

16