KEHAMILAN, PERSALINAN & NIFASMANFAA

KEHAMILAN, PERSALINAN & NIFAS
MANFAAT
1. Melahirkan Normal / Abnormal
2. Tambahan untuk Melahirkan Abnormal
3. Melahirkan dengan Pembedahan
4. Keguguran
5. Sebelum & Sesudah Melahirkan
6. Komplikasi Kehamilan
Penggantian biaya perawatan melahirkan termasuk biaya kamar, Dokter Ahli Kandungan, perawat,
bidan, ruang persalinan, obat-obatan dan biaya lain yang berhubungan dengan proses melahirkan.
PENGECUALIAN
1. Peserta Wanita dengan umur dibawah 16 tahun atau lebih dari 45 tahun.
2. Perawatan yang berhubungan dengan aborsi ilegal, sterilisasi, pemeriksaan kesuburan dan
perawatan yang berkaitan dengan kemandulan.
3. Peserta dalam keadaan telah hamil sebelum tanggal efektif Peserta diikutsertakan dalam
Asuransi Tambahan Perawatan Kehamilan dan Melahirkan ini.

RAWAT JALAN

MANFAAT
1. Konsultasi Dokter Umum
2. Konsultasi Dokter Spesialis
3. Obat-obatan
4. Pemeriksaan Diagnostik
5. Fisioterapi
6. Imunisasi Dasar
Terdiri dari :
- Imunisasi Dasar : BCG 1x, DPT 3x, Polio 3x, Campak 1x bagi anak berusia dibawah 1 tahun
- Hepatitis B 3x bagi anak dibawah 5 tahun
7. Keluarga Berencana
Terdiri dari konsultasi dan pelayanan Keluarga Berencana, termasuk pemasangan IUD, suntik, pil
dan susuk.

PENGECUALIAN
Sama dengan Rawat Inap

KO ASURANSI*
Ada pilihan ko asuransi yang dapat disesuaikan dengan kebutuhan perusahaan
Pilihan ko asuransi 0%, 5%, 10%, 15% atau 20%

RAWAT JALAN

MANFAAT
1. Konsultasi Dokter Umum
2. Konsultasi Dokter Spesialis
3. Obat-obatan
4. Pemeriksaan Diagnostik
5. Fisioterapi
6. Imunisasi Dasar
Terdiri dari :
- Imunisasi Dasar : BCG 1x, DPT 3x, Polio 3x, Campak 1x bagi anak berusia dibawah 1 tahun
- Hepatitis B 3x bagi anak dibawah 5 tahun
7. Keluarga Berencana
Terdiri dari konsultasi dan pelayanan Keluarga Berencana, termasuk pemasangan IUD, suntik, pil
dan susuk.

PENGECUALIAN
Sama dengan Rawat Inap

KO ASURANSI*
Ada pilihan ko asuransi yang dapat disesuaikan dengan kebutuhan perusahaan
Pilihan ko asuransi 0%, 5%, 10%, 15% atau 20%


RAWAT GIGI

MANFAAT
1. Pencegahan
Pembersihan karang gigi (scaling), fluoridasi dan pit & fissure sealant
2. Perawatan Gigi Dasar
Penambalan gigi dengan amalgam, composite, glass ionomer, compomer baik dengan atau tanpa
light curing (teknik penyinaran), penambalan gigi sementara, pemolesan setelah penambalan gigi,
pencabutan gigi (tanpa pembedahan), rongent gigi Dental dan panoramik (untuk Odontektomi),
perawatan periodontal (dengan kuretase), perawatan syaraf (saluran akar gigi), pengobatan pada
infeksi (seperti abses, periodontitis, operculitis, gingivitis) secara intra oral.
3. Perawatan Gigi Kompleks
Pencabutan gigi (dengan pembedahan dan pembiusan local), termasuk odontektomi dan
operculectomy, perawatan abses dengan pembedahan, dan apeks reseksi.
4. Gigi Palsu
Gigi tiruan lepas (sebagian, penuh) dan gigi tiruan cekat (crown/mahkota, bridge/gigi tiruan
jembatan, inlay, onlay).

PENGECUALIAN
1. Perawatan dan pengobatan orthodontik (cekat/lepasan).
2. Semua tindakan bedah mulut kecuali Odontektomi dan Operkulektomi.
3. Perawatan dan pengobatan kelainan sendi Temporo Mandibula.
4. Semua perawatan gigi dengan pembiusan umum.

KO ASURANSI*
Ada pilihan ko asuransi yang dapat disesuaikan dengan kebutuhan perusahaan
Pilihan ko asuransi 0%, 5%, 10%, 15% atau 20%

KACAMATA

MANFAAT
1. Pemeriksaan Mata
2. Bingkai
3. Lensa / Contact Lens
PENGECUALIAN
Manfaat Kacamata ini tidak berlaku atas biaya Lensa Intra ocular dan pemasangannya.
KO ASURANSI*
Ada pilihan ko asuransi yang dapat disesuaikan dengan kebutuhan perusahaan.
Pilihan ko asuransi 0%, 5%, 10%, 15% atau 20%

PROSEDUR KLAIM

Pada prinsipnya, program ini memberikan dua bentuk sistem klaim yaitu :
1. Sistem Reimbursement
Peserta dapat bebas memilih Rumah Sakit manapun, dimana biaya perawatan ditanggulangi
terlebih dahulu oleh Peserta.
2. Sistem “Cashless” *
a. RS/Klinik Jaringan Allianz
Peserta dapat masuk ke RS/Klinik Jaringan Allianz dengan hanya menunjukkan Kartu
Peserta yang akan diberikan pada setiap Peserta.
Dengan sistem ”Cashless” ini perawatan dan/atau pengobatan dengan menggunakan
RS/Klinik Jaringan Allianz dengan biaya yang dibayarkan terlebih dahulu oleh Allianz. Apabila
terjadi ”Excess of Claim” akan dibayarkan dulu oleh Allianz dan selanjutnya Allianz akan
menagihkan kepada Pemegang Polis.
Berlaku untuk Rawat Inap, Melahirkan, Rawat Jalan dan Rawat Gigi. Khusus untuk
Kacamata berlaku dengan sistem ”Reimbursement”.
b. RS/Klinik Jaringan Allianz-AdMedika (Swipe Card)
Peserta dapat masuk ke RS/Klinik Jaringan Allianz-AdMedika dengan hanya menunjukkan
Kartu Peserta Allianz-AdMedika yang akan diberikan pada setiap Peserta.
Dengan sistem ”Cashless” ini perawatan dan/atau pengobatan dengan menggunakan
RS/Klinik Jaringan Alianz-AdMedika di mana bila ada selisih biaya atau ”Excess of Claim”
yang terjadi melebihi hak Peserta, maka Peserta harus membayar ”Excess of Claim”
tersebut di RS/Klinik Jaringan

Hasil (Inggris) 1:

PREGNANCY, CHILDBIRTH & PARTURITIONBENEFITS1. give birth to Normal/Abnormal2. in addition to the Birth of Abnormal3. Delivery with surgery4. Miscarriage5. Before & After Childbirth6. pregnancy complicationsReimbursement of expenses including the cost of delivery care room, Doctor, nurse, Content Expertmidwife, birthing room, medications and other costs related to the process of childbirth.EXCEPTION1. Participants women with age under 16 years or over 45 years.2. Treatment related to illegal abortions, sterilization, fertility and examinationtreatment-related infertility.3. participants in the State have been pregnant before the effective date of participants included in theAdditional Care Insurance pregnancy and giving birth to it.OUTPATIENTBENEFITS1. Consulting a general practitioner2. Consulting a specialist3. medical supplies4. Diagnostic Examination5. Physiotherapy6. Basic ImmunizationConsists of:-Basic Immunization: BCG, DPT 3 x 1 x, 1 x, 3 x, measles Polio for children aged under 1 year-Hepatitis B 3 x for children under 5 years old7. family planningComprises consultations and family planning services, including fitting of IUD, injection, pilland pegs.EXCEPTIONSame as InpatientKO INSURANCE *There are options that can be customized insurance ko with company needsChoice ko insurance 0%, 5%, 10%, 15% or 20%OUTPATIENTBENEFITS1. Consulting a general practitioner2. Consulting a specialist3. medical supplies4. Diagnostic Examination5. Physiotherapy6. Basic ImmunizationConsists of:-Basic Immunization: BCG, DPT 3 x 1 x, 1 x, 3 x, measles Polio for children aged under 1 year-Hepatitis B 3 x for children under 5 years old7. family planningComprises consultations and family planning services, including fitting of IUD, injection, pilland pegs.EXCEPTIONSame as InpatientKO INSURANCE *There are options that can be customized insurance ko with company needsChoice ko insurance 0%, 5%, 10%, 15% or 20%DENTAL CAREBENEFITS1. PreventionCleaning of tartar (scaling), fluoridasi and pit & fissure sealant2. Basic dental careDental amalgam with patching, composite, glass ionomer, compomer either with or withoutlight curing (technique shines), dental while patching, patching after Polishing teeth,removal of teeth (without surgery), dental rongent Dental and panoramic (to Odontektomi),periodontal treatments (with curettage), neurological care (dental root canal) treatment oninfection (such as abscesses, periodontitis, gingivitis, operculitis) for intra oral.3. dental care ComplexRemoval of teeth (with local anesthesia and surgery), including odontektomi andoperculectomy, abscess treatment with surgery, and apical resection.4. false teethLoose dentures (partial, full) and cekat dentures (crowns, crown/bridge/denturesthe bridge, inlay, onlay).EXCEPTION1. the care and treatment of orthodontik (cekat/loose).2. all acts of oral surgery except for Odontektomi and Operkulektomi.3. the care and treatment of Temporo Mandibular Joint disorders.4. All dental care with General anesthesia.KO INSURANCE *There are options that can be customized insurance ko with company needsChoice ko insurance 0%, 5%, 10%, 15% or 20%EYEGLASSESBENEFITS1. examination of the eye2. frame3. Lenses/Contact LensEXCEPTIONThe benefits of these glasses are not applicable over the cost of the Intra ocular Lenses and installation.KO INSURANCE *There is the option of insurance which can ko adapted to the needs of the company.Choice ko insurance 0%, 5%, 10%, 15% or 20%CLAIMS PROCEDUREIn principle, the program provides two forms of the system claim that:1. Reimbursement SystemParticipants can freely choose any Hospital, where care costs be solvedin advance by attendees.2. the "Cashless" System *a. RS/Clinic network of AllianzParticipants can enter the RS/Clinic Network shows only Cards with AllianzParticipants will be given to each participant.With a system of "Cashless" this care and/or treatment with useRS/Clinic Network Allianz with fees paid in advance by Allianz. Whencase "Excess of Claim" will be paid first by Allianz and Allianz willcharge to Policyholders.Apply to Inpatient, Outpatient and childbirth, Dental Care. Specifically forGlasses effect with a system of "Reimbursement".b. RS/Clinic network, Allianz-AdMedika signing ceremony (Swipe Card)Participants can enter the RS/Clinic Network Allianz-AdMedika signing ceremony with only showsAllianz-AdMedika signing ceremony Participants cards that will be given to each participant.With a system of "Cashless" this care and/or treatment with useRS/Alianz Network-Clinic AdMedika signing ceremony where if there is a difference in cost or "Excess of Claim"going beyond the rights of Participants, the Participants must pay the "Excess of Claim"the RS/Clinic Network

Hasil (Inggris) 2:

PREGNANCY, LABOR & POSTPARTUM
BENEFITS
1. Childbirth Normal / Abnormal
2. Supplement for Childbirth Abnormal
3. Surgery gave birth to
4. Miscarriage
5. Before & After Childbirth
6. Pregnancy Complications
Replacement cost of care delivery including the cost of the room, Obstetricians, nurses,
midwives, labor room, medicines and other costs associated with childbirth.
EXCEPTION
1. Women participants under the age of 16 years or more than 45 years.
2. Care related to illegal abortions, sterilization, fertility examination and
treatment relating to infertility.
3. Participants in the state have been pregnant before the effective date of Participants included in the
Additional Insurance Pregnancy and Childbirth Care this. OUTPATIENT BENEFITS 1. Public Consultation 2. Consultation Specialist 3. Drugs 4. Diagnostic Examination 5. Physiotherapy 6. Primary immunization consists of: - Basic Immunization: BCG 1x, 3x DPT, Polio 3x, 1x measles for children under 1 year - Hepatitis B 3x for children under 5 years 7. Family Planning consists of consultation and family planning services, including IUD insertion, injections, pills and implants. EXCLUSION Same as Inpatient KO INSURANCE * There is a choice of insurance co that can be tailored to the needs of companies of insurance co Option 0%, 5%, 10%, 15% or 20% OUTPATIENT BENEFITS 1. Public Consultation 2. Consultation Specialist 3. Drugs 4. Diagnostic Examination 5. Physiotherapy 6. Primary immunization consists of: - Basic Immunization: BCG 1x, 3x DPT, Polio 3x, 1x measles for children under 1 year - Hepatitis B 3x for children under 5 years 7. Family Planning consists of consultation and family planning services, including IUD insertion, injections, pills and implants. EXCLUSION Same as Inpatient KO INSURANCE * There is a choice of insurance co that can be tailored to the needs of companies of insurance co Option 0%, 5%, 10%, 15% or 20% HOSPITAL DENTAL BENEFITS 1. Prevention of tartar cleaning (scaling), fluoridation and pit & fissure sealant 2. Basic Dental Care dental fillings with amalgam, composite, glass ionomer, compomer either with or without light curing (irradiation technique), while dental fillings, polishing after dental fillings, tooth extractions (without surgery), Dental and panoramic dental rongent (for Odontektomi) , periodontal treatment (with curettage), nerve treatment (root canal) treatment of infection (such as abscesses, periodontitis, operculitis, gingivitis) intra-oral. 3. Dental Care Complex Lifting gear (with surgery and local anesthesia), including odontektomi and operculectomy, abscess treatment with surgery, and the apex of the resection. 4. Dentures Denture off (partial, full) and fixed denture (crown / crown, bridge / denture bridges, inlays, onlays). EXCEPTION 1. Care and orthodontic treatment (fixed / removable). 2. All except oral surgery and Operkulektomi Odontektomi. 3. Care and treatment of Temporo Mandibular joint disorder. 4. All dental treatment with general anesthesia. KO INSURANCE * There is a choice of co insurance that can be tailored to the needs of companies of insurance co Option 0%, 5%, 10%, 15% or 20% GLASSES BENEFITS 1. Eye Examination 2. Frame 3. Lenses / Contact Lens EXCLUSION Benefits These glasses do not apply to the cost of Intra ocular lens and installation. KO INSURANCE * There is a choice of insurance co that can be tailored to the needs of companies. The choice of insurance co 0%, 5%, 10%, 15% or 20% PROCEDURE CLAIMS In principle, the program provides two forms of the claims system are: 1. Reimbursement System Participants can freely choose any Hospital, where the cost of care be addressed first by the Participant. 2. System "Cashless" * a. Hospital / Clinic Allianz Network Participants can enter the hospital / clinic Allianz network by simply showing Card Participants will be given to each participant. With the system "Cashless" The care and / or treatment using hospital / clinic Allianz Network with fees paid in advance by Allianz. If the case "Excess of Claim" will be paid out by Allianz and Allianz will subsequently billed to the policyholder. Valid for Inpatient, Maternity, Outpatient and Dental Care. Especially for Glasses apply to a system of "Reimbursement". b. Hospital / Clinic-AdMedika Allianz Network (Swipe Card) Participants can enter the hospital / clinic-Allianz Network AdMedika by simply showing participants Allianz-AdMedika Card which will be given to each participant. With the system "Cashless" The care and / or treatment using a Hospital / Clinic Network Alianz-AdMedika where when there is difference in cost or "excess of Claim" which occurs in excess of the Participant, the Participant must pay "Excess of Claim" in the RS / Clinic Network