What Is Health Insurance Benefits

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The definition of health insurance is an insurance product  that covers medical expenses and other medical care if the insured falls ill. Medical expenses or health insurance benefits in general are inpatient,  outpatient, and surgery. Currently, most health insurance provides BPJS Health Coordination of Benefit (CoB) benefits. This means that BPJS Kesehatan will guarantee hospital costs at rates according to the JKN program, while the difference can be covered by private health insurance.

Health Insurance Benefits

After knowing how health insurance works and what it means, it’s also important to know its benefits. Health insurance benefits are coverage for medical expenses or health care in hospitals or other medical services. The benefits are divided into two categories, namely basic benefits and additional benefits (rider) 

1. Basic Benefits

The basic health insurance benefit is the primary coverage. This means that when enrolling in a policy, the insurance company will automatically cover the following treatment costs:

  • Hospitalization:  The cost of hospital rooms, doctor visits, medicines, and other costs associated with hospitalization.
  • Surgery:  The cost of surgical procedures, such as resection, amputation, or reconstructive surgery. The health insurance policy also covers operating room costs, surgeons, and anesthesiologists.
  • Outpatient:  Expenses for medical procedures that do not require hospital stay. Either pre-hospital or post-hospital as well as outpatient diagnosis and treatment.

2. Additional Benefits

Additional benefits or known as rideris an extension of the coverage of a health insurance policy. That is, to get a riderThis customer will be charged an additional fee.

For example, if you have received basic health insurance benefits in the form of inpatient, outpatient, and surgery, then the customer wants to get other additional benefits such as medical check-up  (MCU), maternity insurance, health insurance covering dental care, and eye care.

  • Medical check-up :  Usually, MCU fees are only borne at the beginning of insurance registration in order to measure the health risk of potential customers.
  • Maternity insurance:  The cost of giving birth, starting from  check-ups , cesarean or normal delivery, and aftercare.
  • Dental care:  The cost of health insurance cover dental care, ranging from examination, cleaning, filling, or tooth extraction.
  • Eye care:   The cost of eye health care, starting from the examination and including glasses.

Some insurance companies offer a choice of policies with basic to additional benefits (rider) complete with low premiums.

Definition of Health Insurance Exception

In addition to the benefits or functions of health insurance, there are also exclusion clauses that need to be considered. This means that there are some risks that are not borne by the company and are written in full in the policy. Here are some of the exceptions:

  1. Suicide or self-inflicted injury
  2. Organ transplants, including related treatments and medications
  3. Supporting equipment such as wheelchairs, prosthetic limbs, heart trigger devices, hearing aids, vision aids, and the like
  4. Dialysis or dialysis and other related
  5. Experimental, traditional, or alternative treatments and remedies
  6. Mental or nervous disorders and addiction
  7. Weight-related care and/or treatment
  8. Treatment and/or treatment related to plastic surgery
  9. Periodic physical examination or  medical check up  (MCU)
  10. Treatment and/or treatment related to hernia or developmental delay
  11. Circumcision that is not related to illness or accident
  12. Treatment and/or treatment related to HIV/AIDS to sexually transmitted diseases
  13. Coverage for the cost of vitamins and supplements without medical indication
  14. Family planning costs

It should be understood that each of the best insurance companies has different exclusion clauses. Therefore, before deciding to buy a health insurance policy, you should pay attention and study the policy carefully, yes.

Health Insurance Premium Fee

Health insurance premiums are costs that must be paid periodically (monthly) or all at once by the policy holder (the insured) to the insurance company (the insurer). The amount of health insurance costs varies per month. It should be understood that the benefits of the policy will be frozen if the customer does not pay the insurance premium. In insurance the freezing time is known as Lapse.

In order not to make the wrong choice, try to do how to calculate health insurance premiums by comparing policies.

Determinants of Health Insurance Premium Prices

The list of health insurance premiums varies, depending on the profile of the prospective customer and the extent of coverage of the selected policy. The following are some of the factors that determine the cost of health insurance:

1. Insurance Policy Benefits

The more complete the policy benefits provided, the higher the insurance premium. Most health insurance provides basic inpatient, outpatient, and surgical benefits. Well, if you want to get more complete insurance benefits, prospective customers can buy a rider policy (additional benefit) which will incur additional premiums.

In addition, insurance policies that cover claims up to overseas reach the premiums will also be more expensive. Therefore, to reduce premium prices and get the cheapest and best health insurance, make sure the benefits of the policy you buy are according to your needs.

The customer profile also plays an important role in determining the price of health insurance. For example, a simulation of a list of health insurance premiums for a customer aged 20 years will certainly be cheaper than an elderly customer or over 30 years old. This is because the older you get, the higher the chance of getting sick.

Not only that, gender is also a determining factor for premiums. In fact, men are 19 percent more likely to have a stroke and heart attack than women. Therefore, generally the policy price for the male insured is more expensive.

The customer profile also plays an important role in determining the price of health insurance. For example, a simulation of a list of health insurance premiums for a customer aged 20 years will certainly be cheaper than an elderly customer or over 30 years old. This is because the older you get, the higher the chance of getting sick.

Not only that, gender is also a determining factor for premiums. In fact, men are 19 percent more likely to have a stroke and heart attack than women. Therefore, generally the policy price for the male insured is more expensive.

Prior to policy registration, several insurance companies require their customers to do a  medical check-up  (MCU) to find out the insured’s medical history. If the results show there is a congenital disease or have experienced severe illness before, usually the premium will be more expensive.

In addition to  medical check-ups , usually the insurance company will also ask the insured’s lifestyle, for example whether he has a smoking habit, extreme sports, and the like. If the possibility of a health risk is high enough, then the price of health insurance will be more expensive.

In health insurance, there is a premium return term or  no claim bonus. That is, if there is no claim until the insurance period ends, a certain percentage (according to the policy agreement) of the premium that has been paid will be returned to the insurance participant.

Policies that provide  no claim bonus benefits,  usually the health insurance premiums will be much more expensive.

Types of health insurance are divided into two categories,  pure health insurance  and  unit link . Pure health insurance is a product that provides insurance benefits without investment frills or often referred to as pure health insurance without investment. Meanwhile, unit-linked health insurance is a health insurance product and an investment at the same time.

Unit-linked health insurance premiums   are generally more expensive than pure health insurance. Therefore, the premium paid will be divided for insurance benefits and partly for investment instruments.

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