Cashless health insurance is one of types of insurance products in Indonesia. This is because the claim process is very easy, without cash, where you only need to show your membership card at the partner hospital.
Plus, you don't have to pay for it first. The insurance company will immediately pay your bill to the hospital.
So, what is the procedure for claiming cashless insurance? What are the advantages? Does cashless health insurance have higher or lower premiums? Who is it suitable for? Instead of being curious, let's read the complete information from the newbie below!
How to Claim Cashless Health Insurance
For partner hospitals abroad, you can check here .
What are the Benefits of Cashless Insurance?
In short, cashless insurance is more profitable than reimbursement insurance because:
Plus, you don't have to pay for it first. The insurance company will immediately pay your bill to the hospital.
So, what is the procedure for claiming cashless insurance? What are the advantages? Does cashless health insurance have higher or lower premiums? Who is it suitable for? Instead of being curious, let's read the complete information from the newbie below!
How to Claim Cashless Health Insurance
health insurance intends to make it easier for you when paying hospital bills. You don't need to worry about the cost because you can only show your health card when taking care of administration, and fill out the personal data form.
Usually there is a third party who then takes care of the administration between the insurance company (the newbie by Sequis Online and Sequis Life) and the partner hospital. In our case, this third party is called AdMedika, which has a network of partner hospitals of more than 4000 hospitals. This is the nearest hospital .
The following is more or less the procedure for cashless insurance:
Usually there is a third party who then takes care of the administration between the insurance company (the newbie by Sequis Online and Sequis Life) and the partner hospital. In our case, this third party is called AdMedika, which has a network of partner hospitals of more than 4000 hospitals. This is the nearest hospital .
The following is more or less the procedure for cashless insurance:
- You bring your health card and ID to verify your membership.
- Fill in the medical service form at the partner hospital.
- The partner hospital will send the form and medical report to AdMedika.
- AdMedika will provide a guarantee letter (if inpatient) to the partner hospital so that you can carry out the treatment process.
- AdMedika will take care of the settlement of the bill to Sequis through claims.
- If the final bill exceeds the coverage limit of your insurance policy, Sequis will charge you the excess fee.
For partner hospitals abroad, you can check here .
What are the Benefits of Cashless Insurance?
In short, cashless insurance is more profitable than reimbursement insurance because:
- Easy & fast process . You do not need to prepare various types of documents. Just fill out the form and the rest will be taken care of by the hospital and AdMedika.
- No need to spend money first . Usually when you are hospitalized, you need to spend money first to pay the bill, then there will be a replacement by insurance after the claim. In the case of cashless insurance, you don't need to spend money because the company will take care of it immediately.
- The service is quite extensive . Cashless insurance products, especially the newbie cashless insurance, provide a wide range of services. Starting from inpatient, outpatient, to laboratory checks and therapy.
- Can fit the bill . In general, cashless insurance provides a cashless feature to match existing hospital bills. Of course, you also need to pay attention to the maximum limit of the insurance benefits.
- It doesn't have to be expensive . Although most cashless insurance products are expensive, the newbie is not. health insurance products Super Well (10 critical illness risks according to the bill, max. IDR 1M per year) and Super Care (accident risk and 30+ infectious disease risks according to bill, max. IDR 50 million per case).
What You Need to Pay Attention to from Cashless Insurance
Before buying cashless insurance, you need to pay attention to the terms of the product first. You can get this information from the Product Information Summary, as well the Insurance Policy when you have purchased.
Here's the information you really need to know before deciding to buy a cashless health insurance product.
1. Product Terms
Make sure you know the insurance product is okay for anyone. In general, you can check this by finding out the age of entry (who can register) and the age of coverage (how long it can be covered).
In addition, insurance products may also have certain conditions. For example, a health statement that you are not sick to prevent insurance fraud cases where the customer has been sick before registering for insurance. Some insurance products also have an insurance period (long time after registering to claim).
The following is an example of information for the newbie Care products (accident risk insurance and 30+ infectious diseases including COVID):
- Entry age: 30 days — 70 years
- Age of coverage: Up to a max age of 75 years old
- Health requirements: Not currently suffering from or suspected of suffering from COVID-19 (specifically the plan that covers COVID), no physical disability, and does not have a high-risk job
- Insurance period: None (risk of infectious disease) and 30 days (risk of accident)
2. Maximum Coverage Value
Indeed, cashless insurance products fit the bill. However, insurance products also have a maximum limit value. Usually the maximum limit has been set in such a way that it is neither too high nor too low.
Therefore, make sure the maximum coverage limit is suitable for your needs. Usually this limit can be yearly, or per case of disease.
The following is an example of the maximum limit for the newbie cashless insurance:
- Super Well (10 critical illnesses): Up to IDR 1M per year
- Super Care (30+ infectious diseases and accidents): Up to IDR 50 million per case of illness or accident, as well as several other benefits such as surgical costs, therapy, and assistive devices for accidents.
3. Can't Double Claim
Because cashless insurance benefits are billed, you can't do this insurance product to double claim with other cashless insurance. So, what if it turns out that your insurance benefits are insufficient?
Take it easy, you can usually still make a double claim with a reimbursement insurance product. Cashless insurance is generally compatible with daily inpatient cash benefit-based insurance such as My Hospital.
For example, you use cancer treatment with Super Well. The maximum coverage is IDR 1M per year. Then you need to undergo treatment for 60 days. Meanwhile, the bill has reached its limit.
If you have My Hospital Gold Plus too, you can get daily cash compensation of IDR 500,000. This means that you will get a total compensation of IDR 30 million for 60 days of hospitalization. That way, you can also pay for the extra maintenance fees that are charged to you.
4. Partner Hospital
Cashless insurance can only be used at partner hospitals. Therefore, make sure you find out in advance whether Sequis partner hospitals are available around your area or city.
5. There are Exceptions
Like insurance products in general, cashless insurance usually has some exceptions. Each insurance product has different exceptions. Therefore, make sure you check your insurance policy or Product Information Summary.
In general, cashless insurance products do not cover:
- Pre-existing conditions . This means that you must be in good health and have no symptoms or have been diagnosed with a disease when you register for insurance.
- Risk of pregnancy and childbirth . Usually cashless health insurance does not cover the risk of pregnancy and childbirth, unless it is a special birth insurance .
- Caused by a mental condition or dependence . For example, attempted suicide, eating or sleeping disorders, to alcohol and drug dependence.
- Deliberate action . For example, attempted suicide or self-harm on purpose.
This is an explanation of cashless health insurance. Come on, also read the importance of health insurance for outpatient .
Don't forget to buy your cashless health insurance at the newbie. Affordable premiums. Fast and easy process.
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