A problem with a healthcare insurance company

[Samoerai]

With so many cases involving unit-link insurance in the past, I would personally not touch this type of insurance; not even with a barge pole.

Which cases? ... I enrolled my wife to Allianz unit-link health insurance, a year ago.

 

[pantaiema]

Which cases? ... I enrolled my wife to Allianz unit-link health insurance, a year ago.

You might be familiar with the insurance like Prudential, Allianz AXA, Aviva, Ing, Lloyds etc in Europe. But if you purchase it in Indonesia especially from an agent, they might not be the same as you might have thought, as they are subject to a deferent regulator, watchdog, quangos, etc. What you will need to be aware of in many cases in Indonesia you purchase the insurance via the agent where the agent take a fat cut

In Europe they will be thinking twice to deny a genuine claim if they could see clear evidence/proofs have been submitted. In Indonesia the regulator, watchdogs, the policemen will not be necessarily on your side especially if there are a lot of incentive money getting involved. A very recent example, David Ozora Insurance claim a boy who were heavily assaulted by the son of an Indonesian custom official. The insurance claim were originally rejected as the regional policemen issued a letter stating the Victim (David) started the fight making the claim to be void.

Unit link is a linked/combined product of Insurance and INVESTMENT. An investment scammer might convince and work together with a reputable insurance companies to combine and co-market their products. When you get a story people could easily get rejected for a claim of an insurance let alone if it is linked to an investment product where there are a lot of investment frauds have been discovered recently.

You ask about which case ?? A few of them are actually already presented in this forum, even in this thread with link to original articles in the press. A few to name
Kresna Life insurance
Wanartha Life
Indosurya Life
Sinarmas MSIG life
Jiwasraya
Bumiputra

This is a personal opinion, not an advice. You might want to do your own DDs and make decision which one you believe will work the best for you.
These are old article about Insurance scandal in Indonesia dated back 2022-02-07 so the newest cases have not been included

Sederet Skandal Asuransi RI, dari Jiwasraya Hingga Unit Link

OJK menyebutkan terdapat sejumlah masalah yang dialami oleh industri asuransi di dalam negeri.

www.cnbcindonesia.com

 

[Samoerai]

I just got back from Customer Services. The decision was made to stop my insurance and give me back my paid premiums.
They will transfer the money in 7-14 days to my bank account.
So, this ends well for me.

 

[snpark]

Yes lucky you

 

[harryopal1]

I just got back from Customer Services. The decision was made to give me back my paid premiums.
They will transfer the money in 7-14 days to my bank account.
So, this ends well for me.

Well, as they say, don't count your chickens before they are hatched. You may well find there are "administrative charges" that will substantially reduce your returned funds or there may be "technical difficulties" impeding a transfer. Good luck but please report back if and when you actually receive a return.

 

[Samoerai]

Well, as they say, don't count your chickens before they are hatched. You may well find there are "administrative charges" that will substantially reduce your returned funds or there may be "technical difficulties" impeding a transfer. Good luck but please report back if and when you actually receive a return.

I got the statement on paper saying "yaitu mengembalikan seluruh premi". But, yes .. dont count your chickens ...

 

[Rellek]

I just got back from Customer Services. The decision was made to stop my insurance and give me back my paid premiums.
They will transfer the money in 7-14 days to my bank account.
So, this ends well for me.

I'm glad it worked out for you. I'm also with "P" and not impressed. I haven't had a claim yet either. Any communication is in Bahasa which is difficult for me. I would switch to Allianz but I don't want another 'one year waiting period' for major illness treatment just in case something happens; a year is a long time to wait.

For BPJS folks, I see dental and vision treatment is covered; has anyone used BPJS-approved dentists for something like a root canal? How about vision-related surgery for cataracts? If so, I would like to know how good the hospital and doctors were and how many hoops were required to leap through. Thanks in advance.

 

[centurion]

For BPJS folks, I see dental and vision treatment is covered; has anyone used BPJS-approved dentists for something like a root canal? How about vision-related surgery for cataracts? If so, I would like to know how good the hospital and doctors were and how many hoops were required to leap through. Thanks in advance.

Catharact I thing it would be covered in JEC.

Rooth canal I would do only in a place where I am sure in their work.

 

[Hawk256]

For BPJS folks, I see dental and vision treatment is covered; has anyone used BPJS-approved dentists for something like a root canal? How about vision-related surgery for cataracts? If so, I would like to know how good the hospital and doctors were and how many hoops were required to leap through. Thanks in advance.

I have found dental work to not be that expensive, even a root canal and cap. Personally I would rather go to who I want and pay out of pocked instead of dealing with BPJS for dental. No idea about vision. I had laser surgery in the US years ago and vision has not been a problem since then. I guess I'm just waiting for cataracts now.

 

[pantaiema]

For BPJS folks, I see dental and vision treatment is covered; has anyone used BPJS-approved dentists for something like a root canal? How about vision-related surgery for cataracts? If so, I would like to know how good the hospital and doctors were and how many hoops were required to leap through. Thanks in advance.

For dental health, this is what's covered by BPJS. Root canal treatment is not on the list.

9 Perawatan Gigi yang Ditanggung BPJS Kesehatan

BPJS Kesehatan memberikan dan menanggung biaya pelayanan perawatan serta pemeriksaan gigi dan mulut. Ini rinciannya!

www.kompas.com

However, based on this person's personal experience, they mentioned that root canal treatment is covered.

Perawatan Saluran Akar dan Cabut Gigi Gratis Dicover BPJS

Cerita tentang pengalaman pribadi saat melakukan perawatan gigi yang di-cover BPJS

www.kompasiana.com

So, it remains unclear.

Nevertheless, as others have pointed out, I will be extremely careful when allowing an unknown dentist to perform a root canal. Root canal procedures are well-known for their complexity, and for the utmost precision in treatment, they should ideally be performed with a surgical microscope. Unfortunately, not many dentists possess this equipment.

Regarding cataract treatment, it is covered. This treatment is explicitly mentioned in the regulation issued by the Minister of Health (PMK) No. 28 Tahun 2014.

Apakah Operasi Katarak Ditanggung BPJS Kesehatan? Berikut 4 syaratnya

Faktanya operasi Katarak ditanggung BPJS Kesehatan, apa saja sayarat dan ketentuannya? Baca untuk info lebih lengkap.

kmu.id

 

[Rellek]

Hello, Does anyone know if enrolling in BPJS is compulsory for foreigners living on Bali?.

Mandatory Healthcare & Social Security BPJS In Indonesia | Acclime

This is a fundamental guide of the mandatory healthcare and social security BPJS in Indonesia for companies and employees.

indonesia.acclime.com

Residents and non-residents who have lived in Indonesia for more than six months are required to register for the healthcare program (BPJS Kesehatan) and social security scheme (BPJS Ketenagakerjaan).

Has anyone heard of this? What are the consequences for not registering?

Call me a conspiracy theorist, but after you enroll and money starts being taken from your account on a monthly basis, can it ever be stopped? Withdrawal from BPJS doesn't seem common and I don't know if it's even possible.

I'm putting off enrolling in BPJS only because I have high quality health insurance and I don't care for redundant redundancy and I'm considering leaving Bali in a year.

Thoughts, anyone?

 

[snpark]

What account are they taking it from? You pay annually when you redo your kitas

 

[Rellek]

What account are they taking it from? You pay annually when you redo your kitas

OK, my bad, I thought it was 150.000 per month from an Indonesian account. My apologies. You do need to hand over banking details when signing up for BPJS though.

 

[pantaiema]

Hello, Does anyone know if enrolling in BPJS is compulsory for foreigners living on Bali?.

Mandatory Healthcare & Social Security BPJS In Indonesia | Acclime

This is a fundamental guide of the mandatory healthcare and social security BPJS in Indonesia for companies and employees.

indonesia.acclime.com

Residents and non-residents who have lived in Indonesia for more than six months are required to register for the healthcare program (BPJS Kesehatan) and social security scheme (BPJS Ketenagakerjaan).

Has anyone heard of this? What are the consequences for not registering?

Call me a conspiracy theorist, but after you enroll and money starts being taken from your account on a monthly basis, can it ever be stopped? Withdrawal from BPJS doesn't seem common and I don't know if it's even possible.

I'm putting off enrolling in BPJS only because I have high quality health insurance and I don't care for redundant redundancy and I'm considering leaving Bali in a year.

Thoughts, anyone?

It is mandatory if you are working in Indonesia for more than six months. This requirement is stated in Law No. 24 of the year 2011, Article 14:

Article 14 states that everyone, including foreigners or foreign nationals who work for a minimum of 6 months in Indonesia, is obliged to become a participant in the Social Security program.

AFAIK, they have not differentiated the premiums for foreigners and local people. If so, you pay a pittance. Currently:

1st Class: Rp150,000.

2nd Class: Rp100,000.

3rd Class: Rp35,000.

If you want to avoid money being taken from your account without your authorization, do not provide them with your bank account details. I think those who are working have this automatically sorted by their employers and not by employees. So you do not even need to think about this.

 

[Rellek]

It is mandatory if you are working in Indonesia for more than six months. This requirement is stated in Law No. 24 of the year 2011, Article 14:

Article 14 states that everyone, including foreigners or foreign nationals who work for a minimum of 6 months in Indonesia, is obliged to become a participant in the Social Security program.

AFAIK, they have not differentiated the premiums for foreigners and local people. If so, you pay a pittance. Currently:

1st Class: Rp150,000.

2nd Class: Rp100,000.

3rd Class: Rp35,000.

If you want to avoid money being taken from your account without your authorization, do not provide them with your bank account details. I think those who are working have this automatically sorted by their employers and not by employees. So you do not even need to think about this.

I don't work here. I am on retirement kitas.

 

[pantaiema]

I don't work here. I am on retirement kitas.

So it is not mandatory

 

[Rellek]

So it is not mandatory

All foreigners who have resided on Bali for 6 months.

 

[pantaiema]

All foreigners who have resided on Bali for 6 months.

Only for WORK KITAS holders and KITAP holder
The explanation of it from this forum site

Registration in the National Health System - Indonesia - for expats and Indonesian nationals

www.expat.or.id

For retirement, they do not even qualify for it.
"Foreign retirees are NOT eligible to enrol in BPJS Kesehatan - the National Health Insurance in Indonesia. This program is limited to expats with a working visa (index 312)."

But I remember reading posts in this forum few people on retirement manage to get BPJS. That is why I said previously if you could get it is no brainer considering the premium.

 

[Rellek]

Only for WORK KITAS holders and KITAP holder
This is the explanation of it from this forum site

Registration in the National Health System - Indonesia - for expats and Indonesian nationals

www.expat.or.id

I can post SEVERAL sources like this one.

BPJS is required not only for Indonesian but also for expatriates or foreigners who have been living in Indonesia for 6 (six) months or more to obtain BPJS Kesehatan (Health Security BPJS).

In addition, if you are a KITAS holder, you will not able to extend it, unless you have a BPJS.

I've also seen articles which completely agree with what you have posted. This is my confusion.

 

[pantaiema]

I can post SEVERAL sources like this one.

BPJS is required not only for Indonesian but also for expatriates or foreigners who have been living in Indonesia for 6 (six) months or more to obtain BPJS Kesehatan (Health Security BPJS).

In addition, if you are a KITAS holder, you will not able to extend it, unless you have a BPJS.

I've also seen articles which completely agree with what you have posted. This is my confusion.

What about referring directly to the regulation in here

https://peraturan.bpk.go.id/Download/28701/UU%2024%20Tahun%202011.pdf

The only mandatory is
Article 1
"4. Peserta adalah setiap orang, termasuk orang asing yang bekerja paling singkat 6 (enam) bulan di Indonesia, yang telah membayar iuran."
"4. Participants include everyone, including foreigners who work for a minimum of 6 (six) months in Indonesia and have paid contributions."

Article 14
Setiap orang, termasuk orang asing yang bekerja paling singkat 6 (enam) bulan di Indonesia, wajib menjadi Peserta program Jaminan Sosial.
Article 14
Everyone, including foreigners who work for a minimum of 6 (six) months in Indonesia, is required to become a Participant of the Social Security program.

As for the rest:
Why not try enrolling and see whether they even allow you to have it? It's a hit and miss situation, with more misses than hits, depending on who assists you when you apply for it. There are already a few people reporting in this forum that they have tried, but they are not allowed to have it.

With the current premium, BPJS in Indonesia is actually operating at a loss. Every year, they run a deficit.