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AIA Optima Medical Care

AIA Optima Medical Care

About


Optima Medical Care is an insurance product for Daily Hospital and Surgical Cash Benefit issued by PT AIA FINANCIAL

Optima Medical Care also offers Return of Premium benefits when no claim has been raised within 1 year.

Protection Benefits


Daily Cash Benefit

Daily Cash Benefit is payable according to the Benefit Plan of Optima Medical Care that has been selected during the Insurance Period, and Policy is in force, and passes the Waiting Period based on a doctor’s diagnosis, in the event that the Insured and/or Additional Insured(s) (if any) must undergo hospitalization treatment due to illness or injury, under the following conditions:

  1. Hospitalization is a medically necessary treatment
  2. Daily Cash Benefit is subject to maximum of 200 (two hundred) days for all illnesses or injuries in 1 (one) policy year
  3. Daily Cash Benefit does not apply to Outpatient Surgery

Additional Daily ICU Cash Benefit

Additional Daily ICU Cash Benefit is payable according to the Benefit Plan of Optima Medical Care that has been selected during the Insurance Period, and Policy is in force, and passes the Waiting Period based on a doctor’s diagnosis, in the event that the Insured and/or Additional Insured(s) (if any) must undergo hospitalization treatment due to illness or injury, under the following conditions:

  1. Daily Cash Benefit is paid
  2. Additional Daily ICU Cash Benefit will be paid a maximum of 30 (thirty) days for all illnesses or injuries in 1 (one) policy year.

Surgical Benefit

Surgical Benefit is payable according to the invoice issued by the Hospital which includes the costs of surgeon, assistant operator, anesthesiologist, operating room, recovery room, and medicines, which are carried out in accordance with generally accepted and standard procedures, during the Insurance Period, and Policy is in force, and passes the Waiting Period based on a doctor’s diagnosis, in the event that the Insured and/or Additional Insured(s) (if any) must undergo Surgery or Outpatient Surgery, under the following conditions:

  1. Surgery or Outpatient Surgery is a medically necessary treatment based upon usual, customary, and reasonable charges;
  2. Surgical Treatment is carried out due to illnesses or injuries, which leads to the hospitalization or outpatient surgery of the Insured and/or Additional Insured(s) (if any) approved by the Insurer; and
  3. In the event that surgery is performed for organ transplant, the Insurer does not pay the cost for the purchase of the organ.

Medical Expenses Benefit

Medical Expenses Benefit is payable according to the invoice issued during the Insurance Period, and Policy is in force, and passes the Waiting Period based on a doctor’s diagnosis, in the event that the Insured and/or Additional Insured(s) (if any) must undergo hospitalization due to illnesses or injuries, which includes the costs of doctor’s visit, ambulance service, and various medically necessary treatment based upon usual, customary, and reasonable charges.

Death Benefit

Death Benefit is payable provided that during the Insurance Period, Policy is still in force, and passes the Waiting Period:

  1. The Insured passes away, the Insurer will pay the Death Benefit according to the selected Insurance Plan and subsequently the Policy expires.
  2. Additional Insured(s) (if any) passes away during the Insurance Period, the Insurer will pay the Death Benefit according to the selected Insurance Plan and Policy remains in force.

No Claim Bonus

No Claim Bonus is payable 25% (twenty five percent) of the premiums paid within 6 (six) business days after all the following requirements have been satisfied:

  1. Premiums have been paid in full for 12 (twelve) consecutive months in the previous Policy Year (“Evaluation Period”) and no claim has been raised for such Period.
  2. Insurer has received and approved all provided documents.
No Benefit/s Description Plan
1 2 3 4
1 Daily Cash Benefit Per day (maximum of 200 days per Policy Year) 250,000 500,000 750,000 1,000,000
2 Additional Daily ICU Cash Benefit Per day (maximum of 30 days per Policy Year) 250,000 500,000 750,000 1,000,000
3 Surgical - According to invoice
4 Benefit According to invoice
Total Annula Limit* - 50 million 100 million 150 million 200 million
5 Death Benefit - 2,500,000 5,000,000 7,500,000 10,000,000
6 No Claim Bonus per Policy Year 25% of the premiums paid, No Claim Benefit is payable if the premiums have been paid in full, Policy is still in force, and no claim has been raised during the Evaluation Period
Age of the Insured/ Additional Insured (years) Monthly Premium
Plan 1 (250,000) Plan 2 (500,000) Plan 3 (750,000) Plan 4 (1,000,000)
5-17 287,000 349,000 431,000 500,000
18-24 305,000 369,000 458,000 550,000
25-30 335,000 405,000 501,000 572,000
31-40 428,000 519,000 642,000 733,000
41-50 525,000 637,000 788,000 899,000
51-60 705,000 855,000 1,057,000 1,208,000
61-64 981,000 1,191,000 1,471,000 1,681,000

Terms and Conditions:

  • Entry Age of policyholder: 18 – 60 years old (policy holder must be the same as the Insured).
  • Entry Age of Additional Insured (spouse): 18 – 60 years.
  • Entry Age of Additional Insured (children): 5 – 17 years old.
  • Payment Method: BCA Credit Card monthly auto-debit

Other Provisions


Protection with comprehensive health solutions

  1. Issuer: PT AIA Financial
  2. Product Name: Optima Medical Care
  3. Currency: Rupiah
  4. Product Type: Health
  5. Product Description:
    • Daily Inpatient Cash Benefit
    • Daily ICU Cash Benefit
    • Surgical and Medical Expenses Benefit
    • Death Benefit
    • Daily cash benefit starting from Rp250 thousand until Rp1 million
    • Return of Premium Benefit payable within 1 year if no claim has been raised
    • Eligible for BCA Credit Card holder
    • This product is offered through BCA Telemarketing
  6. Important definitions:
    • The policyholder is the individual whose name an insurance policy is written, as the party who enters into an insurance agreement, hereinafter referred to as “You”.
    • The Insured is the individual whose life is covered by this Policy.
  7. Procedures, Methods, and Terms:
    • Claim Submissions
      1. The payment of the Insurance Benefit will be processed if our Head Office has received all the required documents, completely and correctly.
      2. The Insurance Benefit is payable after premiums have been fully paid for the risks of insurance coverage that occur during the Grace Period and other obligations (if any) are satisfied.
      3. We are not responsible for the costs incurred to complete the requirements for the Insurance Benefit payment request.
      4. All documents and/or supporting evidence for a request for payment of Insurance Benefit must be submitted in Indonesian and/or English.
      5. The letter issued regarding the payment of Insurance Benefits is valid proof that such payment has been made pursuant to the prevailing provisions of the Policy.
    • Policy Cancellation during Freelook Period

If you do not agree to the terms and conditions set forth in this Policy for any reason, you can cancel the insurance protection, by:

      1. Submit a Policy Cancellation Application Form which has been filled out completely and signed by you and sent to our Head; or
      2. Call our customer care to cancel your policy, where, in this case, you agree that the conversation regarding the Policy cancellation will be recorded;
      3. Within 14 (fourteen) calendar days after you receive the Policy (“Free Look Period”). On that matter, the Policy is treated as void by default from the Policy Effective Date and we are not liable for any insurance protection to you, the Insured, and/or Additional Insureds (if any). All of the premium received will be refunded.

Disclaimer (important):

  1. Insurance companies may reject your application if it does not meet the applicable requirements and regulations.
  2. Please read the Summary of Product and Service Information carefully and you have the right to ask the Insurance Company employees questions related to this Product Summary.

Disclaimer (OJK)

  • Optima Medical Care is an insurance product marketed specifically in collaboration between PT AIA Financial (AIA) and PT Bank Central Asia Tbk (BCA)
  • This Insurance Product is not a product and responsibility of the Bank, thus is not included in the guarantee program, and the Bank shall not be responsible for any information issued by AIA
  • PT AIA Financial and PT Bank Central Asia Tbk are registered with and overseen by the OJK

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