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Dental Care Plan

Dental Care Plan

About

Dental Care Plan is an insurance product marketed by PT Chubb General Insurance Indonesia (‘’Chubb’’) that offers complete dental and oral protection.


Benefits

  1. Emergency Dental Treatment Benefit
    In the event that the Insured suffers a Dental Emergency, which based on a diagnosis certified by a Dentist requires Emergency Dental Treatment, the Insurer shall:
    • Pay the costs incurred for palliative treatment services performed by an In-Network Provider directly to said In-Network Provider.
    • Indemnify the Insured for Palliative Treatment performed by an Out-of-Network Provider according to the usual, customary, and reasonable charges, arising from Emergency Dental Treatment under the Maximum Allowable Benefit for one (1) Insurance Period specified in the Policy Schedule at the time of such treatment.
  2. Regular Dental Visit Benefit
    In the event that the Insured needs to make regular visits to a Dentist for Dental Treatment, the Insurer shall:
    • Pay the costs incurred for treatment services performed by an In-Network Provider directly to said In-Network Provider if the Insured has notified the Insurer via telephone via telephone before such treatment.
    • Indemnify the Insured for treatment services performed by an Out-of-Network Dentist or In-Network Dentist according to the usual, customary, and reasonable charges if the Insurer is not notified before such treatment,
      • for one (1) visit during each Insurance Period and
      • under the Maximum Allowable Benefit specified in the Policy Schedule.
  3. Preventive Benefit
    The Insurer shall:
    • Pay the costs incurred for preventive treatment services performed by an In-Network Dentist directly to said In-Network Provider if the Insured has notified the Insurer via telephone before a treatment; or
    • Indemnify the Insured for Dental Services by an Out-of-Network Dentist or In-Network Dentist according to the usual, customary, and reasonable charges if the Insurer is not notified before such treatment, limited to a maximum of one (1) visit during the Insurance Period.
  4. X-ray Benefit
    The Insurer shall:
    • Pay the costs incurred for dental x-ray services performed by an In-Network Dentist at a Dental Clinic, Medical Center or Hospital, directly to said In-Network Provider if the Insured has notified the Insurer via telephone before such treatment; or
    • Indemnify the Insured for dental x-ray services performed by an Out-of-Network Dentist or In-Network Dentist at a Dental Clinic, Medical Center or according to the usual, customary, and reasonable charges if the Insurer is not notified before such treatment, for:
      • up to a maximum of three (3) sets of intraoral bitewing films during the Insurance Period; or 
      • one (1) set of survey x-ray for the posterior, anterior, lateral views of the skull or facial bones view, during the Insurance Period; or
      • one (1) set of panoramic x-rays during the Insurance Period.

Up to a maximum of one (1) set of x-ray procedures as described above during one (1) Insurance Period.

  1. Dental Conservation Benefit
    The Insurer shall:
    • Pay the costs incurred for dental conservation treatments that are medically necessary and performed by an In-Network Dentist at a Dental Clinic, Medical Center or Hospital, directly to said In-Network Provider if the Insured has notified the Insurer via telephone before such treatment; or
    • Indemnify the Insured for dental conservation treatments that are medically necessary and performed by an Out-of-Network Dentist or In-Network Dentist at a Dental Clinic, Medical Center or according to the usual, customary, and reasonable charges if the Insurer is not notified before a treatment that is limited to:
    • Permanent amalgam,
    • Permanent composite/resin, and
    • tooth sealants (only for kids),

but adheres to the same limit provisions applicable to amalgam and composite/resin fillings, until the maximum allowed fillings specified in the Policy Schedule for each (1) Insurance Period.

  1. Extraction Benefit
    The Insurer shall:
    • Pay the costs incurred for extractions performed by an In-Network Dentist at a Dental Clinic, Medical Center or Hospital, directly to said In-Network Provider if the Insured has notified the Insurer via telephone before such treatment; or
    • Indemnify the Insured for extractions performed by an Out-of-Network Dentist or In-Network Dentist at a Dental Clinic, Medical Center or according to the usual, customary, and reasonable charges if the Insurer is not notified before a treatment that is limited to:
    • Simple extraction due to erupted tooth or exposed root; or 
    • Complicated extraction due to partially bony teeth or root, up to a maximum of two (2) teeth during one (1) Insurance Period. 
  2. Root Canal Treatment Benefit
    The Insurer shall:
    • Pay the costs incurred for endodontic treatments performed by an In-Network Dentist at a Dental Clinic, Medical Center or Hospital, directly to said In-Network Provider if the Insured has notified the Insurer via telephone before such treatment; or
    • Indemnify the Insured for endodontic treatments performed by an Out-of-Network Dentist or In-Network Dentist at a Dental Clinic, Medical Center or according to the usual, customary, and reasonable charges if the Insurer is not notified before a treatment that is limited to: 
    • root canal (including x-ray costs), and
    • therapeutic pulpotomy (excluding final restoration)

up to a maximum of one (1) endodontic treatment during one (1) Insurance Period.


Terms and Conditions

  1. Main Insured age between 21-60 years old (renewable up to 65 years old)
  2. Pre-existing condition within 12 months 
  3. Auto approval
  4. A waiting period of 90 days from the policy effective date (except for Emergency Dental Treatment)
  5. BCA customers with BCA credit cards auto-debit payment

Other Provisions

Advantages

  1. Ease of cashless treatment at hundreds of hospitals and dental clinics in the Innova Care network in more than 50 cities throughout Indonesia.
  2. Provide dental plan benefit up to Rp10,000,000 per year
  3. Benefits up to 100%* for:
    • Emergency dental treatments 
    • Regular dental visit 
    • Preventive dental treatment, such as prophylaxis (dental cleaning)
    • X-ray, such as ¬panoramic X-ray
  4. Benefits up to 80%* for:
    • Fillings and extractions
    • Root canal treatment
  5. Fixed premium and no grouping based on age

Access to Our Network

The Insured is entitled to preferential treatment coverage for services and procedures when visiting our Network Member Provider. To access the benefits, the Insured must call the Insurer at 0-800-1-333-111. The Insured is required to read the Policy Schedule to obtain further information about the benefits, treatment and procedures covered by this Policy.

Tabel Premi dan Manfaat

Premium Plan 1 Plan 2 Plan 3 Plan 4
In-Network Provider Out-of-Network Provider In-Network Provider Out-of-Network Provider In-Network Provider Out-of-Network Provider In-Network Provider Out-of-Network Provider
Premi bulanan IDR 148,000 IDR 166,000 IDR 191,000 IDR 211,000

BENEFITS

Plan A

Plan B

Plan C

Plan D

In-Network Provider

Out-of-Network Provider

In-Network Provider

Out-of-Network Provider

In-Network Provider

Out-of-Network Provider

In-Network Provider

Out-of-Network Provider

Visit

Emergency dental treatments

80% Guarantee

50% Guarantee

100% Guarantee

70% Guarantee

80% Guarantee

50% Guarantee

100% Guarantee

70% Guarantee

Emergency palliative care and minor procedures

Preventive

Prophylaxis (dental cleaning) / scaling and cleaning/fluoride application (cleaning not included)

80% Guarantee, 1 visit per year

50% Guarantee, 1 visit per year

100% Guarantee, 1 visit per year

70% Guarantee, 1 visit per year

80% Guarantee, 1 visit per year

50% Guarantee, 1 visit per year

100% Guarantee, 1 visit per year

70% Guarantee, 1 visit per year

X-ray

Dental Radiology (panoramic x-ray)

80% Guarantee, 1 visit per year

50% Guarantee, 1 visit per year

100% Guarantee,1 visit per year

70% Guarantee,1 visit per year

80% Guarantee, 1 visit per year

50% Guarantee, 1 visit per year

100% Guarantee, 1 visit per year

70% Guarantee, 1 visit per year

Conservation

Fillings (amalgam or composite/resin)

80% Guarantee up to 2 teeth per year

50% Guarantee, up to 2 teeth per year

80% Guarantee, up to 2 teeth per year

50% Guarantee, up to 2 teeth per year

80% Guarantee, up to 3 teeth per year

50% Guarantee, up to 3 teeth per year

80% Guarantee, up to 3 teeth per year

50% Guarantee, up to 3 teeth per year

Extraction

Simple extraction – erupted tooth or exposed root

80% Guarantee up to 2 teeth per year

50% Guarantee, up to 2 teeth per year

80% Guarantee, up to 2 teeth per year

50% Guarantee, up to 2 teeth per year

80% Guarantee, up to 3 teeth per year

50% Guarantee, up to 3 teeth per year

80% Guarantee, up to 3 teeth per year

50% Guarantee, up to 3 teeth per year

Complicated extraction– partially bony teeth or root

Endodontic

Root canal, 1 canal (including x-ray fee)

Access to In-Network Provider and Special Price

No benefit

Access to In-Network Provider and Special Price

No benefit

80% Guarantee, 1 treatment per year

50% Guarantee, 1 treatment per year

80% Guarantee, 1 treatment per year

50% Guarantee, 1 treatment per year

Root canal, 2 canals (including x-ray fee)

Root canal, 3 canals (including x-ray fee)

Maximum Coverage per Year

IDR 10,000,000

IDR 10,000,000

IDR 10,000,000

IDR 10,000,000

Waiting Period
(except for emergency palliative care and minor procedures)

90 Days

90 Days

90 Days

90 Days

Disclaimer

Disclaimer:

  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.

OJK Disclaimer

OJK Disclaimer:

  • Dental Care Plan is an Insurance Product marketed specifically based on the collaboration between PT Chubb General Insurance (Chubb) and PT Bank Central Asia (BCA)
  • The 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 Chubb
  • PT Chubb General Insurance and PT Bank Central Asia Tbk are registered with and overseen by the OJK

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