BCA - 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

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.

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.

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.

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.

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.

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.

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

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

Other Provisions

Advantages

Ease of cashless treatment at hundreds of hospitals and dental clinics in the Innova Care network in more than 50 cities throughout Indonesia.
Provide dental plan benefit up to Rp10,000,000 per year
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

Benefits up to 80%* for:

Fillings and extractions
Root canal treatment

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
Premium	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
BENEFITS		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
Visit	Emergency palliative care and minor procedures	80% Guarantee	50% Guarantee	100% Guarantee	70% Guarantee	80% Guarantee	50% Guarantee	100% Guarantee	70% Guarantee
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
Extraction	Complicated extraction– partially bony teeth or 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
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:

Insurance companies may reject your application if it does not meet the applicable requirements and regulations.
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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