asuransi kesehatan cashless

GLOBALIS

PRODUCT AT GLANCE

GLOBALIS protects you and your family against the financial impact of costly medical expenses incurred both at home and abroad. GLOBALIS provides an incomparable level of coverage flexibility, allowing you to customize a plan to suit your individual requirements.

 
Key Features:

  1. Overall Annual Limit up to USD 3,000,000
  2. Comprehensive coverage: Inpatient, Outpatient, Wellness, Dental, Vision, and Maternity
  3. Has 8 design options allowing you to create a tailored, cost-effective, and sustainable solution, at a premium that suits any budget
  4. MemberOnline web portal allows you to get full access to policy information, including submitting claims electronically

 
Safe Meridian has partnered with Great Eastern General Insurance Indonesia to introduce the GLOBALIS international health insurance plans.

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PRODUCT BENEFITS
  1. INPATIENT BENEFITS
    Inpatient & Day Patient Admissions; Hospital Accomodation; Day-Care Treatment; Parent Accommodation; Surgery; Specialist Consultations; Nursing; Prescribed Medicines, Drugs & Dressings; Diagnostic Tests; Intensive Care; Prosthetic Implants, Appliances, Devices; Organ & Bone Marrow Transplants; Complications of Maternity; Reconstructive/Remedial Treatments; Rehabilitation; Accidental Damage to Teeth; Ambulance; Pre-Hospitalization Outpatient Services (up to 30 days); Post-Hospitalization Outpatient Services (up to 90 days); Home Nursing; Psychiatric Care; Hospice & Palliative Care; Hospital Cash Benefit.
  2.  

  3. COVER BOTH INPATIENT or OUTPATIENT TREATMENT
    Cancer Treatment & Oncology; Kidney Dialysis; Treatment of Chronic Conditions; Congenital Conditions Manifesting more than 60 days after birth; HIV/AIDS.
  4.  

  5. OUTPATIENT BENEFITS
    Consultations & Doctor Fees; Prescribed Medicines, Drugs & Dressings; Diagnostic Tests; Hormone Replacement Therapy; Complementary Therapies; Traditional Chinese Medicine; Physiotherapy; Speech Therapy; Durable Medical Equipment; Psychiatric & Psychological Care.
  6.  

  7. WELLNESS
    Annual Health Check-up; Well Child Examinations; Vaccinations; Eye Examinations; Cancer Screenings.
  8.  

  9. DENTAL
    Preventative Treatment; Basic Restorations; Complex Dental & Major Restorations.
  10.  

  11. VISION
    Eye Examinations; Eyeglasses & Contact lenses.
  12.  

  13. MATERNITY
    Prenatal Check-ups and Treatments; Delivery; Postnatal Outpatient Treatments; Newborn Care.
  14.  

  15. EMERGENCY ASSISTANCE
    Emergency Medical Evacuation; Medical Repatriation; Return to Country of Residence after Evacuation; Round-trip airfare for a family member; Accommodation Expenses for a family member; Dispatch of Essential Medication Not Available Locally; Repatriation of Mortal Remains; Local Burial or Cremation if outside of Country of Residence or Nationality; Compassionate Visit; Second Medical Opinion; 24/7 Medical Information and Advice.

 

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PRODUCT EXCLUSIONS

In addition to the limitations and exclusions already noted, this Policy will not pay Benefits in respect of any treatment that is not prescribed by a competent, licensed medical authority, is not medically necessary according to our Medical Team or contracted Emergency Assistance Company, or for which extravagant or unreasonable charges were incurred in our opinion.

  1. Addictive Disorders, Development Disorders, Eating Disorders, Sleep Disorders;
  2. Administrative & Shipping Fees, Bank Charges, Travel Cost for treatment;
  3. Allergy Testing & Desensitization;
  4. Alternative treatments and therapies, Experimental Treatments;
  5. Artificial Life Maintenance;
  6. Assisted Living;
  7. Benefits Not Purchased & Treatments received outside of the Period of Insurance;
  8. Conflict & Disaster;
  9. Costs related to the gradual recovery of health and strength after treatment for an illness or injury has ended, including:
    • Hospital costs from the date your treating doctor has advised you can be discharged;
    • General nursing care or supervision at home (unless home nursing was Preauthorized by us);
    • Services of a therapist or complementary therapist at home;
    • Domestic/living assistance such as for bathing and dressing;
  10. Cosmetic & Remedial Treatments;
  11. Donor Organs, Surrogates;
  12. Treatment Outside of Your Area Cover;
  13. Treatment of refractive illnesses; correctional surgery or treatment such as laser treatment, refractive keratotomy (RK) and photorefractive keratectomy (PRK);
  14. Situations or costs arising because of complications or extended hospital stays arising from a failure to follow the medical advice of a treating Doctor or Hospital;
  15. Treatments involving surgery on a foetus (meaning before the birth of the child);
  16. Treatment for corns, calluses, and thickened or misshapen nails, unless provided by a podiatrist;
  17. Genetic testing of any kind, including any consultations related to it;
  18. Situations or costs arising from treatments not following or based on established clinical and medical practices;
  19. Pharmaceuticals, drugs or other compounds that have not been prescribed and any pharmacy item that can be legally sold without prescriptions (even when a prescription has been obtained) including but not limited to Panadol, vitamins and supplements, suncream, cosmetics, skin lotions, food supplements and baby formula;
  20. Any test, examination or consultation that is not medically necessary; or which cannot contribute to, improve or change the treatment of a Covered Condition. This includes such costs as telephone, television, radio, newspaper, guests’ meals and other optional costs not covered within a hospital’s standard accommodation fee when confined as an Inpatient or for Day Surgery. Hospitalizations primarily for diagnosis, x-ray examinations, general physical or medical check-up will be considered not medically necessary and any Benefits payable will be in accordance with Outpatient or Wellness Benefits, where entitlements exist, only;
  21. Treatment for obesity is not covered including weight reduction aids or drugs and weight reduction classes;
  22. Costs incurred once the treating doctor has determined the Member is in a persistent vegetative state or Inpatient treatment exceeding 90 continuous days for permanent neurological damage;
  23. Pre-Existing Conditions are not provided unless they have been accepted by us, and conditions of this acceptance is noted on your Policy. A Pre-Existing condition is defined as being a medical condition that has one or more of the following characteristics: It was foreseeable, It was known or suspected by you or the Member, It was in discussion between yourself and a medical professional, It was found to be responsible for signs or symptoms you were experiencing, It was a medical condition caused by a Pre-Existing Condition;
  24. Medical consultations, examinations or tests undertaken when no symptoms exist including health screening/check-ups, preventive treatments and cancer screenings. Note that some of these will be available to Members who have subscribed to a Plan that includes Wellness Benefits;
  25. Neither SAFE MERIDIAN nor its Insurers shall be deemed to provide cover or be liable to pay any claim or provide any Benefit hereunder to the extent that the provision of such cover, payment of such claim or provision of such Benefit would expose SAFE MERIDIAN or its Insurers to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of any country;
  26. Self-inflicted Injury or Death;
  27. Sexual problems, such as impotence, whatever the cause, or sex changes or gender reassignments, Infertility Treatment, Treatment or investigation related to any disease or condition that is sexually transmitted, Birth Control;
  28. Unlawful & Dangerous Acts or Activities;
  29. Unreasonable Charges;
  30. Unrecognized Practitioners, Facilities or Providers;
  31. Unrelated Specialist Fees.
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IMPORTANT INFORMATION
  1. GEOGRAPHICAL AREAS OF COVER
    You may choose the area of cover, so long as your country of residence is included within that area of cover. Members enjoy full access to benefits within their selected area of cover, and are covered for emergency treatment for unexpected illness or injury outside your area of cover for trips of up to 30 consecutive days.

    • Worldwide excluding USA
    • Southeast Asia including Singapore, Australia & New Zealand: Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia, Myanmar, Papua New Guinea, Philippines, Thailand, Vietnam, Singapore, Australia, New Zealand
    • Southeast Asia excluding Singapore, Australia & New Zealand: Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia, Myanmar, Papua New Guinea, Philippines, Thailand, Vietnam
  2.  

  3. WAITING PERIODS
    • 6 months: Wellness, Basic Dental, Vision, Outpatient Psychiatric & Psychological Care (not applicable if premium paid annually)
    • 6 months: Complex Dental and Major Restoration
    • 12 months: Complications of Pregnancy, Maternity, Hospice & Palliative Care, Inpatient Psychiatric Care
    • 24 months: Congenital Conditions manifesting more than 60 days after birth, HIV/AIDS
  4.  

  5. NO CLAIM DISCOUNT
    (Available for Silver, Gold, and Platinum Plan members only)

    • 1 year: Discount 10% for next policy renewal
    • 2 consecutive years: Discount 15% for next policy renewal
    • 3 consecutive years: Discount 20% for next policy renewal
    • 4 consecutive years: Discount 25% for next policy renewal
  6.  

  7. DEDUCTIBLE & CO-INSURANCE
    • Deductible is the fixed amount of eligible medical expenses for which a Member is responsible before we begin to reimburse eligible Inpatient expenses. Deductibles apply to eligible Inpatient expenses. These include Maternity and Newborn Care Inpatient expenses, where provided by the subscribed Plan. The Deductible also applies to the Pre-Hospitalization and Post-Hospitalization Outpatient expenses provided under the Inpatient Plan. The Deductible is selected at Application or at Plan renewal.
    • Co-Insurance is the percentage of eligible Outpatient expenses for which each Member is responsible.

    Even if you use direct billing, you are still responsible for any applicable Deductible or Co-Insurance payments. You should submit your Claim Form and supporting documents, even if the Deductible is greater than the reimbursement you are submitting, so that we can administer your Plan Benefits correctly.

  8.  

  9. INPATIENT ROOM TYPE
    • Standard Private Room: Single occupancy accommodation in a Hospital. If multiple levels of single occupancy accommodation exist within a given Hospital, it shall mean the lowest cost level providing for a single patient in one room with a private bathroom. Deluxe, executive rooms and suites, for instance, are not covered.
    • Semi-Private Room: Dual occupancy accommodation in a private Hospital. If multiple levels of dual occupancy accommodation exist within a given Hospital, it shall mean the lowest cost level providing for 2 patients in the one room and a shared bathroom.
  10.  

  11. ELIGIBILITY
    To become a Policyholder, you must be between 18 and 74 years of age at the time of Application or enrolment. Your Dependants may be enrolled into the same Plan, or you may choose different Plans and cover options for each of them.
    Dependants are defined as being:

    • Your wife or husband (or domestic partner) aged 74 years of age or younger
    • Unmarried children who are younger than 18 years of age
    • Unmarried children under the age of 26 who are enrolled as full-time students at a recognized education institute and who are dependent upon you for financial support. A letter from the college/university confirming the full-time student status is required before benefits can be paid.

    If children are being enrolled on their own and are between the ages of 31 days and 17 years, they must be enrolled with a parent or guardian as the Policyholder until they reach the age of 18. In this case, the Policyholder (the parent or guardian) will not be eligible for benefits. Upon reaching the age of 18, the child will become the Policyholder.

  12.  

  13. PERIOD OF INSURANCE
    • This is a 12-month, annually renewable policy. The start and end dates of the Individual Policy will be noted on the Insurance Certificate. Coverage will only be provided for eligible expenses incurred and provided while the Individual Policy is in force and premiums invoiced are fully paid.
    • Requests for plan changes, such as adding or removing coinsurances or deductibles, is only allowed at the date of policy renewal.
  14.  

  15. PRE-AUTHORIZATION
    Certain Benefits provided by this Policy require Pre-Authorization. When a treatment is Pre-Authorized by us, we will send confirmation of Pre-Authorization to you in writing. We recommend you request Pre-Authorization at least 5 working days prior to the scheduled date of treatment, to ensure that treatment is eligible for reimbursement and the direct billing can be arranged accordingly. Where Pre-Authorization is required and not obtained, Benefits may be declined or reduced.
    Pre-Authorization is required for the following: All Inpatient (Hospitalization) & Day-Care services; Advanced Diagnostics (e.g. MRI, CT, PET scans); All Emergency Assistance Benefits; Outpatient Physiotherapy exceeding 7 sessions for a single condition; Nursing Care at home; Treatment for HIV/AIDS or Cancer; Kidney Dialysis; Rehabilitation; Delivery; Hormone Replacement Therapy; Second Medical Opinions.
  16.  

  17. HIGH COST PROVIDERS ACCESS
    Depending upon the access option applicable to your Policy, Benefits payable for treatments provided by a High-Cost Provider are provided as usual, are subject to a Co-Insurance, or no Benefits are provided. The access applicable to your Policy is noted on your Insurance Certificate. If you have chosen the option to remove access to those facilities indicated on our High-Cost Providers list, we will not pay Benefits for any incurred costs at those facilities. High-Cost Providers are named in the SAFE MERIDIAN High-Cost Providers list (available for viewing and downloading in your secure MemberOnline website). Please check this list periodically, as it is updated from time to time.
  18.  

  19. POLICY CANCELLATION
    We reserve the right to terminate your Policy from its inception date if we find any of the following:

    • You failed to fully disclose any information we requested from you;
    • You have misled us by misstatement;
    • You or your dependant(s) submitted a claim which is false, fraudulent, or intentionally exaggerated;
    • You or your dependant(s) or anyone acting on your or their behalf used fraudulent means or devices to obtain a Benefit under this Policy;
    • Any law, regulation, or sanction requires us to do so.

    If this Policy is cancelled for any of the above reasons, we will not refund any premiums paid, you will not be entitled to Benefits in respect of any claims not yet processed by us, and you will be responsible for any costs we have incurred in respect of your claims.

  20.  

  21. RENEWING AND CHANGING YOUR POLICY
    This Policy is an annual contract. At the end of each period of insurance, if your Policy is still available, we will offer terms of renewal. We shall notify you of any renewal offer at least 30 days prior to your Policy expiration date. Should your Policy not still be available, we will provide you due notice prior to your renewal date. Your Policy will not otherwise be cancelled, unless required under the cancellations terms of this contract. When renewing your Policy, you may also request to change your Plan options, such as your Deductible. If your request is to increase your Benefits payable, you will need to provide us an updated Medical History Declaration. We reserve the right to decline, accept, or apply special terms to such requests.
  22.  

  23. CHANGE OF ADDRESS, COUNTRY OF RESIDENCE OR COUNTRY OF NATIONALITY
    You must inform us as soon as possible, and no later than 30 days, of any change in your name or contact information, so that we can contact you as needed. We will not be responsible for any failure to communicate with you or to offer renewal if you have failed to notify us of a change in your residential, correspondence, or email address. 90 consecutive days within a country that is not indicated in your Insurance Certificate as your Country of Residence will constitute a change of Country of Residence. This change may impact your premium.
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PRODUCT PREMIUM

Use the “Get A Quote” menu at the bottom of this page to calculate premiums according to the benefits you choose.

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CLAIM PROCEDURE

We always aim to settle your claim directly with your Healthcare Provider. If we cannot do this for any reason, you will need to pay the Provider and submit a claim to us for reimbursement later. Claims must be submitted within 180 days of date of treatment. Claims received more than 180 days after date of treatment is declined.

  • You must attach original invoices and medical reports to your Claim Form before submitting it to us. If you need to retain copies for your own records, please do so before sending the originals to us.
  • You may upload claims to us via the MemberOnline portal we provide you. If you submit a claim electronically, you are required to retain the original documents relating to that claim for 24 months and to provide them to us upon request. If you are unable to provide them to us, any Benefit paid to you in respect of the claims in question will become immediately repayable to us. If you lose your original documents, we will only be able to accept authorized copies from the Medical Practitioner or Healthcare Facility involved.

 
For Outpatient Treatments (where included in your Plan):

  • Upon arrival at an outpatient clinic in our Outpatient Direct Billing Network, you will need to show your Health Insurance Card and one form of photo-identification to access direct billing arrangements. Clinics in our Outpatient Direct Billing Network can be found on MemberOnline.
  • The medical facility may ask you to complete and sign a Claim Form, that they will submit to us later.
  • The medical facility may check if your medical condition is eligible for direct billing arrangements. If your treatment is not eligible, you will be required to pay any treatment costs incurred to the clinic. If you believe your treatment is eligible for Benefits, submit a claim to us for reimbursement and we will be happy to review it.
  • Direct Billing arrangements cease once your Benefits limits have been exceeded. If you have a Coinsurance applicable to your Plan, you will be responsible for settling that percentage of the bill with the Healthcare Provider. Should the clinic require us to pay any costs that are not covered by your Policy, we will deduct those from your credit card on file or ask you to reimburse them to us.
  • Please note: Members accepted with special terms or exclusions, may not be able to access direct billing services at certain outpatient providers. Please call or email us if you would like more information.
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APPLYING THE INSURANCE
  1. The Applicant fills in the application form (download link: GLOBALIS Application Form)
  2. We will inform the Applicant if additional information or documents are needed for the underwriting process
  3. Safe Meridian will writing a covenote of approval after doing the underwriting process
  4. The applicant pays insurance premium
  5. The policy is issued and then sent to the applicant
  6. If you have anything to ask, please email us to: bondan@pusatasuransi.com or chat via WhatsApp at +6281331064766
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Get A Quote Brochure OP Provider

AXA SmartCare Executive

executives-in-window

Apa Itu SmartCare Executive?

SmartCare Executive (SCE) merupakan produk asuransi kesehatan dengan benefit rawat inap dan rawat jalan yang dapat dimiliki secara individual maupun keluarga. Produk ini memberikan perlindungan penuh terhadap penyakit atau kecelakaan.

 
Keistimewaan:

  • Manfaat besar dengan premi yang terjangkau
  • Terdapat jaminan rawat jalan
  • Layanan cashless di jaringan Rumah Sakit provider yang luas
  • Customer Service 24 Jam
  • Diskon premi 50% untuk Anak ke 2 sampai dengan Anak ke 5
  • Mudah dijangkau dengan klaim online

 
Produk ini dijamin oleh Asuransi AXA Indonesia.

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Apa Saja Yang Dijamin?

Produk ini memberikan jaminan biaya perawatan kesehatan yang dialami oleh Tertanggung atas manfaat-manfaat berikut ini:
tabel-manfaat-sce

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Apa Saja Yang Tidak Dijamin?

Penanggung tidak akan membayar biaya untuk perawatan, pengobatan, jasa atau barang yang timbul oleh:

  1. Semua Keadaan yang Telah Ada Sebelumnya, kecuali jika dihapus secara tertulis oleh Perusahaan.
  2. Semua penyakit khusus selama dua belas (12) bulan pertama sejak tanggal berlakunya Polis.
  3. Setiap Ketidakmampuan yang dimulai atau terjadi dalam Masa Tunggu 30 (tiga puluh) hari, kecuali untuk Luka-luka / Cidera Tubuh akibat Kecelakaan.
  4. Rawat Jalan yang tidak terkait dengan Rawat Inap atau Pembedahan Pulang hari, kecuali yang disebabkan karena Kecelakaan dan Jaminan Khusus Rawat Jalan Umum.
  5. Keadaan apapun yang disebabkan oleh kehamilan termasuk melahirkan, aborsi, keguguran oleh sebab apapun, pengujian atau pengobatan impotensi, kemandulan, ketidaksuburan dan semua komplikasi yang terjadi karenanya.
  6. Setiap keadaan yang timbul akibat pembedahan, metode-metode mekanis dan kimiawi untuk pengaturan kelahiran, sterilisasi baik itu kastrasi, ligasi tuba, tebektomi, vasektomi.
  7. Pemeriksaan fisik rutin, pemeriksaan (checkup) kesehatan atau uji lainnya dimana tidak terdapat indikasi obyektif tentang adanya gangguan kesehatan normal atau perawatan yang bersifat preventif termasuk vaksinasi, akupuntur, perawatan yang secara khusus ditujukan untuk pengurangan berat badan atau perawatan yang tidak Diperlukan Secara Medis.
  8. Perawatan bagi Kelainan Bawaan dan/ atau Kelainan Fisik akibat Kelahiran yang timbul karenanya.
  9. Perawatan Tidak di Rumah Sakit (Non-Hospital Nursing Care) atau Rawat Jalan.
  10. Istirahat atau perawatan di sanatorium, perawatan yang terjadi karena keadaan kesehatan usia lanjut (geriatrik), keadaan mental usia lanjut (psiko-geriatrik) atau ketidakmampuan yang bersifat emosional, mental, kelainan mental atau keadaan kejiwaan (psikiatrik), atau penyakit jiwa, pengobatan atau perawatan untuk penyalahgunaan zat, obat, narkotik, alkohol atau untuk sindrom ketergantungan zat, obat, narkotik atau alkohol.
  11. Ketidakmampuan yang secara langsung atau tidak langsung timbul karena Acquired Immuno Deficiency Syndrome (AIDS), keadaan apapun yang terkait dengan AIDS atau infeksi oleh Human Immuno-Deficiency Virus.
  12. Bunuh diri atau percobaan bunuh diri, luka yang diakibatkan oleh diri sendiri, baik dilakukan secara sadar atau tidak.
  13. Perawatan gigi atau pemeriksaan atau pengobatan atau pembedahan gigi, gusi, atau struktur penyanggah langsung dan pengobatan yang terkait dengannya, kecuali bila diperlukan karena luka/cidera tubuh akibat Kecelakaan pada gigi alami sehingga membutuhkan jasa ahli bedah maksilofasial (maxillofacial surgeon).
  14. Bedah kosmetik atau bedah plastik, pengobatan, perawatan dan pembedahan untuk perubahan jenis kelamin, sirkumsisi (sunat) kecuali jika diperlukan secara medis, uji mata, kesalahan refraktif mata.
  15. Segala bentuk penyediaan perangkat / alat bantu, termasuk kacamata, lensa kontak, kursi roda dan alat bantu lainnya seperti pacemaker, stan, alat bantu pendengaran dan alat bantu lainnya yang berhubungan dengan ketidakmampuan.
  16. Penyakit yang ditularkan secara seksual.
  17. Perawatan rumah sakit terutama untuk diagnosis, pemeriksaan sinar-X, pemeriksaan fisik umum atau check up.
  18. Biaya telepon, televisi, radio, surat kabar, makanan untuk tamu dan hal-hal non-medis lainnya ketika dirawat sebagai Pasien Rawat Inap atau Pembedahan Rawat Jalan.
  19. Sakit atau luka fisik yang terjadi karena balap apapun jenisnya (kecuali dengan kaki), olahraga profesional, parasut, terjun payung, tinju, gulat, scuba-diving profesional, bungee jumping.
  20. Pelanggaran atau upaya pelanggaran apapun terhadap hukum atau penolakan terhadap penahanan sah.
  21. Penerbangan atau kegiatan udara lainnya, kecuali sebagai penumpang yang membayar tarif pada pesawat udara yang mempunyai izin lengkap yang dikelola oleh perusahaan penerbangan komersial berizin atau perusahaan sewa yang diakui.
  22. Perawatan yang timbul sebagai akibat dari perang, penyerbuan, aksi musuh asing, permusuhan atau kegiatan yang menyerupai suasana perang (baik dengan pernyataan perang ataupun tidak), perang saudara, pemberontakan, revolusi, pemberontakan umum, pergolakan sipil (huru hara) yang diasumsikan sebagai bagian dari atau menjurus kepada suatu pemberontakan, kekuatan militer atau pengambilalihan kekuasaan; atau segala tindakan teroris.
  23. Perawatan yang timbul sebagai akibat dari ke-ikutsertaan langsung dalam kerusuhan, pemogokan, huru hara atau ketika sedang bertugas aktif dalam angkatan bersenjata atau kepolisian.
  24. Perawatan yang timbul sebagai akibat (baik langsung atau tidak langsung) oleh bahan senjata nuklir atau radiasi ionisaisi atau kontaminasi dari radio aktif yang berasal dari bahan nuklir atau limbah dari pembakaran bahan bakar nuklir. Untuk menerangkan pengecualian ini “Pembakaran” termasuk proses fisi nuklir yang terjadi secara terus menerus.
  25. Mereka yang tinggal di luar Indonesia secara terus-menerus selama lebih dari tiga (3) bulan kalender.
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Apa Saja Yang Perlu Diketahui Mengenai Produk Ini?
  1. Masa Tunggu Benefit
    1. Masa Tunggu 12 bulan untuk penyakit-penyakit khusus di bawah ini:
      • Batu di dalam sistem Saluran Kemih, gagal ginjal kronis; Batu atau radang pada Kandung Empedu (sistem bilier);
      • Tekanan Darah Tinggi, Penyakit Jantung dan Pembuluh Darah (Kardiovaskuler), Penyakit Pembuluh Darah Otak (Cerebro Vasculer Disease), Kelainan Darah;
      • Katarak;
      • Semua jenis kanker / tumor / polip / kista/ benjolan termasuk benjolan apapun di payudara;
      • Keadaan rongga hidung atau sinus yang membutuhkan pembedahan, Kelainan pada Sekat Rongga Hidung (Nasal Septum) atau tulang-tulang Turbin (Turbinate);
      • Peradangan Tonsil;
      • Segala jenis Hernia, Wasir (Haemorrhoid), Fistula;
      • Kencing manis (Diabetes melitus), Pembesaran kelenjar gondok (Hipertiroid), Kekurangan hormon tiroid (Hipotiroid);
      • Hepatitis;
      • Radang atau tukak pada lambung atau pada usus dua belas jari;
      • Endometriosis, termasuk penyakit-penyakit pada sistem reproduksi, dan Adenomiosis;
      • Radang persendian (rheumatik/ gout) atau gangguan tulang persendian dan penyakit otot lainnya;
      • TBC, Asma.
    2. Masa Tunggu 30 hari untuk manfaat lainnya yang dijamin dalam polis, kecuali yang diakibatkan karena kecelakaan.
  2. Syarat Kepesertaan
    • Mereka yang berumur antara 15 hari sampai dengan 60 tahun, dan dapat dijamin hingga usia 70 tahun dengan persetujuan Penanggung.
    • Mereka yang tinggal secara sah di Indonesia. Seseorang tidak dapat dipertanggungkan untuk perawatan darurat jika ia telah menetap secara terus-menerus selama 90 hari dalam satu tahun kalender di luar Indonesia. Perawatan di Indonesia masih tetap berlaku.
    • Setiap Pemegang Polis (Pemohon) berusia minimal 18 tahun dan menjadi Tertanggung Utama.
    • Peserta anak-anak harus diajukan oleh minimal satu dari kedua orang tuanya sebagai Tertanggung.
  3. Batas Penggantian
    Perawatan akan dibayarkan penuh sesuai manfaat hanya apabila Tertanggung dirawat di jaringan Rumah Sakit provider, baik secara cashless ataupun reimburse. Perawatan yang terjadi di luar jaringan Rumah Sakit provider akan diganti sebesar 80%. Untuk perawatan di luar negeri yang disetujui Penanggung akan diganti 100%.
  4. Batas Geografis
    Pertanggungan di luar negeri hanya untuk Perawatan Darurat, kecuali untuk Plan SCE-1000 ke atas dimana terdapat penjaminan untuk perawatan luar negeri.
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Berapa Premi Yang Harus Saya Bayarkan?
  1. Simulasi Premi
    Gunakan menu “Get A Quote” di bawah halaman ini untuk menghitung premi.
  2. Premi dibayarkan secara tahunan melalui transfer ke rekening AXA ataupun Kartu Kredit VISA/MasterCard.
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Bagaimana Prosedur Mengajukan Klaim?
  1. KLAIM RAWAT INAP (CASHLESS)
    • Peserta dapat memilih Rumah Sakit provider sesuai dengan List Rumah Sakit AXA.
    • Peserta menunjukkan kartu Peserta Asuransi Kesehatan.
    • Pihak Rumah Sakit akan menghubungi Provider pada saat Peserta di Rumah Sakit.
    • Saat Rawat Inap, Peserta (atau perwakilannya) wajib menandatangani surat pernyataan.
    • Penanggung menjamin maksimum sebesar plafon manfaat. Kelebihan biaya (ekses) yang terjadi wajib diselesaikan Peserta sebelum keluar Rumah Sakit.
    • Fasilitas cashless hanya berlaku untuk perawatan rawat inap dan pembedahan yang disertai rawat inap. Selain daripada itu dibayarkan melalui prosedur reimbursement.
  2. KLAIM RAWAT INAP DAN RAWAT JALAN (REIMBURSEMENT)
    Tertanggung wajib menyerahkan:

    • Formulir klaim yang telah dilengkapi oleh Tertanggung beserta Dokter yang merawat.
    • Tagihan/kwitansi asli beserta rincian biaya dengan cap penyedia layanan disertai salinan resep dokter.
    • Salinan hasil pemeriksaan diagnostik (Laboratorium, Radiologi, Patologi, dll).
    • Resume medis.

 
CATATAN PENTING:

  • Fotocopy kwitansi ataupun print-out komputer saja dari penyedia layanan tidak bisa diterima.
  • Kwitansi yang bernilai Rp. 1 juta ke atas, harus dilengkapi dengan materai Rp. 6.000.
  • AXA atau rekanannya berhak meminta tambahan dokumen jika dokumen yang diberikan belum mencukupi untuk proses pembayaran klaim.
  • Seluruh dokumen klaim harus diserahkan paling lambat 30 hari sejak tanggal pelayanan diberikan. Anda wajib melampirkan Surat Keterangan Keterlambatan disertai alasan keterlambatan jika melebihi ketentuan tersebut, dan Penanggung berhak menolak klaim apabila alasan tersebut tidak akurat.
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Bagaimana Cara Mengajukan Permohonan Asuransi?

Anda cukup mengisi formulir aplikasi melalui menu “Apply Now!” yang terdapat di bagian bawah halaman ini. Polis akan langsung diterbitkan dalam bentuk e-Polis (PDF) dan dikirimkan via email sesaat setelah formulir dilengkapi dan premi telah dibayarkan.

Jika ada yang ingin ditanyakan, silahkan email kami ke: bondan@pusatasuransi.com atau melalui WhatsApp di +6281331064766.

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