CONFIDENTIAL

PROPOSAL
GROUP Health INSURANCE program
FOR
PT. ISTANA KARANG LAUT
Prepared by:
EMPLOYEE BENEFITS I!ISION
PT. "#ll#$ I%&o%e$#a
26th Floor, Wisma Keiai
Jl. Jend. Sdirman Ka!. "#$
Ja%arta &'22'
(el. 2)2$*"'' # Fa+. 2)2$*"),
Website: ---.-illis..om ---.-illis..om
2/ September 2'&"

CONFIDENTIALITY
This Proposal contains information which is confdential to both PT Istana
!aran" La#t and
PT $illis Indonesia
Accordin"l%& we tr#st %o# will #nderstand this Proposal is "i'en to PT
Istana !aran" la#t and their o(cers and emplo%ees in confdence and ma%
not be reprod#ced in an% form or comm#nicated to an% other person& frm
or compan% witho#t the prior appro'al of PT $illis Indonesia
TABLE OF CONTENTS
&. 01023(450 S366AR7..................................................................................2
2. 48S3RA820 9080RAL 38:0RWR4(489 A8: S0R5420S 2O6PAR4SO8..........*
". 48S3RA820 ;080F4( 2O6PAR4SO8............................................................&&
$. :06O9RAP<42 606;0R............................................................................&)
*. A883AL 384( PR06436 =4:R>?..................................................................2&
6. PR06436 2O6PAR4SO8?............................................................................26
/. (O(AL 836;0R OF PL3S PO48(S...............................................................2/
,. W4LL4S S2OP0 OF S0R5420S ,. W4LL4S S2OP0 OF S0R5420S ....................................................................... 2/

'. E(ECUTI!E SUMMARY
We -old li%e to than% P(. 4stana Karan@ Lat Aor this opportnity to sbmit or Proposal Aor
<ealth 4nsran.e pro@ram.
On ') September 2'&", P(. Willis 4ndonesia -as @i!en an opportnity by P(. 4stana Karan@ lat to
obtain Botations Arom the 4nsran.e mar%et, on behalA oA the 2ompany.
4t has been noted that the 2ompanyCs medi.al pro@ram is .rrently selA#insred and no- is
loo%in@ Aor the possibility to transAer the ris% onto the 4nsran.e pro@ram.
)* BENEFIT ESIGN
(his insran.e pro@ram is desi@ned based on the medi.al selA#insred beneDts .rrently
implemented by P(. 4stana Karan@ Lat. (he inAormation -as re.ei!ed Arom yo on && September
2'&".
(he 6edi.al Plan is di!ided into the Aollo-in@ .ate@ories:
Plan &: :ire.tor E 6ana@er
Plan 2: Sper!isor E StaF
Plan ": 8on#StaF
Plan $: 2ontra.t 0mployee?
*Not quoted since there is no member data is received under this Plan.
)* BETTERMENT
(he betterment 4npatient ;eneDt .onditions are hi@hli@hted as belo-:
48PA(408(
&. Post <ospitaliGation treatment is .o!ered
2. 0mer@en.y Otpatient treatment de to a..ident is .o!ered
". 0mer@en.y :ental treatment de to a..ident is .o!ered
$. O!erall Limit is @i!en nlimited, instead oA .apped by limit
*. <ospitaliGation de to .ompli.ations oA pre@nan.y is .o!ered nder 4npatient ;eneDt
Pro@ram
6. :eath beneDt de to si.%ness and a..ident Aor 0mployee and :ependents is .o!ered
)* CLAIM INFORMATION
8o selA#insred 6edi.al .laim inAormation re.ei!ed Arom P(. 4stana Karan@ Lat at this sta@e. (hs
-e are nable to analyGe Arther Aor the .ost impa.t oA the .rrent .ost !s premim oFered.
)* INSURERS APPROACHE
Willis has approa.hed the Aollo-in@ 4nsrers -ho are listed in the Willis 6ar%et Se.rity Appro!ed
List and also re!ie- the mar%et to ensre yor insran.e .o!er maintains its hi@h le!el Bality
and beneDts at an HaFordable pri.eI.
2

We approa.hed D!e =*> 4nsran.e 2ompanies, they are:
&> P(. Asransi AllianG LiAe 4ndonesia? : a Joint 5entre 4nsran.e 2ompany
2> P(. Asransi A545A 4ndonesia : a Joint 5entre 4nsran.e 2ompany
"> P(. Asransi A1A 4ndonesia : a Joint 5entre 4nsran.e 2ompany
$> P(. Asransi Ji-a 6anliAe 4ndonesia : a Joint 5entre 4nsran.e 2ompany
*> P(. Asransi Relian.e 4ndonesia : a Lo.al 8ational 4nsran.e 2ompany
*PT. Asuransi Allianz Life Indonesia is unable to support Willis because you have approached
them directly unless the
Letter of Appointment is issued to PT. Willis Indonesia.
)* CONCLUSION
A545A pro!ides the hi@hest nmber oA pls points =yello-#mar%ed> .ompared -ith other
Botin@ 4nsrers.
(he most .ompetiti!e premim is oFered by R0L4A820. 4A yo -ish to e+.lde 5ision
pro@ram, A1ACs premim -ill be the most .ompetiti!e.
2omparin@ to yor medi.al .ost =selA#insred> e+perien.e the total premim=s> oFered
by the 4nsrers may .ost hi@her. <o-e!er -ith the ad!anta@e oA bein@ insred, -e
re.ommend P(. 4stana Karan@ Lat to pr.hase 4npatient, Otpatient, :ental and
6aternity medi.al 4nsran.e and 5ision to remain selA#insred. We .an sele.t 4nsrers to
be in or short#listed and ne@otiate Arther in the Dnal sta@e.
:etailed belo- is an analysis oA some oA the ad!anta@es and disad!anta@es oA ea.h:
Alter%at#+e A&+a%tage$ #$a&+a%tage$

SELF, INSURE
0!erythin@ is mana@ed
internally # no need to Aa.e
.han@es
Ris% borne by 2ompany &''J
<@e administration in!ol!ed
;d@et n.ertainly
0+posre to a maKor .atastrophi.
Loss
INSURANCE
Ris% transAerred to the 4nsrer
2ompany .an .ontrol .osts L
bd@et eFe.ti!ely
Opportnity to ed.ate
employees on health .are
0liminate Arad .laims
Red.es administration .osts
<ospital Pro!idersM2ashless
Aa.ility is pro!ided
Represents a .han@e to e+istin@
arran@ements
0mployees may be rel.tant to
a..ept .han@e
Poor ser!i.e by poorly ed.ated
8et-or%
6is.ommni.ation
Possibility .omplaints

Frthermore, please see Bi.% .omparison nder se.tion H9eneral 4nsran.e 3nder-ritin@ L
Ser!i.e 2omparisonI and H4nsran.e ;eneDt 2omparisonI.
(his smmary has been prepared by P(. Willis 4ndonesia and to assist P(. 4stana Karan@ lat in
e!alatin@ the beneDts pro!ided by the Botin@ 4nsrers. We hi@hli@ht only the %ey items Arom
the terms and .onditions applied by ea.h 4nsrer. For .omplete details oA plan beneDts,
.onditions, limitations and e+.lsions, P(. 4stana Karan@ lat shold reAer to the poli.y -ordin@,
.opy oA -hi.h -ill be pro!ided pon reBest.
3

2o!era@e that is .learly better =pls points> is identiDed in yello-.
We loo% Aor-ard to hearin@ Arom yo and shold yo need Arther details, please do not hesitate
to .onta.t or oN.e.
Ja%arta, 2/ September 2'&"
Emplo-ee Be%e.t$ Team
R#/a -ah Ta%t# Ma&el#%e Le$ma%a
Assistant 2lient 0+e.ti!e 2lient 6ana@er
4

0. INSURANCE GENERAL UNER"RITING AN
SER!ICES COMPARISON
Co'era"e that is clearl% better is identifed in %ellow
UNER"RITING
UNER"RITING 1 SER!ICES
RELIANCE MANULIFE A!I!A A(A
INSURER PROFILE A Lo.al 8ational
4nsran.e 2ompany
A Joint 5entre 4nsran.e 2ompany
AGE LIMITS
0mployee and
spose are .o!ered
p to 6* years old.
=SbKe.t to loadin@
premim Aor a@e
abo!e ** years old>
0mployee and Female spose are .o!ered p to 6* years old.
2hild .o!ered Arom
' day p to 2"
years old
=&* days iA
prematre deli!ery
=OP"/ -ee%s> L
-ei@ht OP 2,*''
@ram>
=sbKe.t to All#time
stdents,
nemployed,
nmarried and
Dnan.ially
spported by
0mployee>
6a+. " .hildren
2hild is .o!ered Arom ' day p to 2* years old.
=sbKe.t to All#time stdents, nemployed, nmarried and
Dnan.ially spported by 0mployee>
6a+. " .hildren
GEOGRAPHICAL AREA World-ide, "6* days, 2$ hors
AUTOMATIC AITION
AN ELETION
MEMBERS
6a+imm "' days Arom reportin@ date
PREMIUM CALCULATION
FOR AITION 1
ELETION MEMBER
Prorate basis
!eletion*" prorate
premium # claims
*$ormula %
&'()*Premium
after !iscount+ *
&Number of !ays
that has not been
passed, Number of
!ays the Periods of
Insurance+# -laims
paid
Prorate basis
re.ardless claims have occurred
Prorate basis
No premium refund
if claims have
occurred
5

UNER"RITING
UNER"RITING 1 SER!ICES
RELIANCE MANULIFE A!I!A A(A
FULL ANNUAL LIMIT
FOR AITION
MEMBERS
4npatient L
6aternity:
Fll limit
Otpatient, :ental
and 5ision :
Fll Limit
4npatient L
6aternity:
Fll limit
Otpatient, :ental
and 5ision :
Prorate Limit
4npatient L 6aternity:
Fll limit
Otpatient, :ental and 5ision :
Fll Limit
PRE,E(ISTING MEICAL
CONITION2S*
Atomati.ally .o!ered
"AITING PERIO
4npatient, Otpatient, :ental, 5ision:
8one
6aternity:
8one
4npatient,
Otpatient, :ental,
5ision:
8one
6aternity:
, 6onths Waitin@
Period
4npatient,
Otpatient, :ental,
5ision:
8one
6aternity:
8one
ORGAN
TRANSPLANTATION
2o!ered
=e+.ldin@ the .ost oA or@an>
HAEMOIALYSIS 2o!ered
CHEMOTHERAPY 2o!ered
ENOMETROSIS 2o!ered
CRITICAL
ILLNESS3CHRONIC
CONITIONS
2o!ered
HEART SURGERY 2o!ered
CIRCUMCISSION
2RELATE TO MEICAL
INICATION ONLY*
2o!ered p to ma+
* years old
2o!ered 2o!ered p to ma+
* years old
2o!ered
IMPLANT PROSTHESES 2o!ered
!ITAMIN 2CURATI!E
TREATMENT4 RELATE
TO IAGNOSE AN
RECOMMENE BY
OCTOR*
2o!ered
/ther vitamins 0hich are not related to dia.nose and recommended by !octor are not
covered
FOO SUPLEMENT
2RELATE TO IAGNOSE
AN RECOMMENE BY
OCTOR*
2o!ered
/ther food supplement 0hich are not related to dia.nose and recommended by !octor
are not covered
6

UNER"RITING
UNER"RITING 1 SER!ICES
RELIANCE MANULIFE A!I!A A(A
!ALIITY CLAIM
REIMBURSEMENT
SUBMISSION
4nitial 2laim:
4npatient and
6aternity
6' :ays
Otpatient, :ental
and 5ision:
6' :ays
Re#2laim:
"' :ays
&from the /ri.inal
1eceipt2s !ate+
4nitial 2laim:
4npatient and
6aternity
)' :ays
Otpatient, :ental
and 5ision:
"' :ays
Re#2laim:
"' :ays
&from the /ri.inal
1eceipt2s !ate+
4nitial 2laim:
4npatient and 6aternity
6' :ays
Otpatient, :ental and 5ision:
6' :ays
Re#2laim:
"' :ays
&from the /ri.inal 1eceipt2s !ate+
CLAIM REIMBURSEMENT
SETTLEMENT
&' Wor%in@ :ays
=SbKe.t to 2laim :o.ments re.ei!ed in 2ompletely>
Payment is transAerred to 0mployeeCs ;an% A..ont
&$ Wor%in@ :ays
=SbKe.t to 2laim
:o.ments re.ei!ed
in 2ompletely>
Payment is
transAerred to
0mployeeCs ;an%
A..ont
NET"ORK
HOSPITALS3CLINICS
"ITHIN REPUBLIC OF
INONESIA
2CASHLESS FACILITY*
7es
Pro!ided appro+.
*$6
Pro!ider 8et-or%s
arran@ed by
R0L4A820#Ad6edi%a
7es
Pro!ided appro+.
$6,
Pro!ider 8et-or%s
arran@ed by AJ64#
Ad6edi%a
7es
Pro!ided appro+.
*,&
Pro!ider 8et-or%s
arran@ed by A545A#
Ad6edi%a
7es
Pro!ided appro+."&&
Pro!ider 8et-or%s
arran@ed by A1A#
Ad6edi%a
CASHLESS FACILITY
STILL APPLIE AT
HOSPITAL NET"ORK
REGARLESS MEMBER
TAKING HIGHER ROOM
AN BOAR UE ANY
REASONS
Flly O..piedM8ot
A!ailable:
6ember .an ha!e
their preAeren.e to
lo-er RL; or not.
8o .ertain
per.enta@e
.ondition on
9arantee Letter
issed =.ashless
Aa.ility -ill still
apply>
3p@rade RL; by
o-n reBest:
Reimbrsement
system -ill apply
Flly O..piedM8ot A!ailableM 3p@rade RL;
by o-n reBest:
6ember .an ha!e their preAeren.e to lo-er
RL; or not. 8o .ertain per.enta@e
.ondition on 9arantee Letter issed
=.ashless Aa.ility -ill still apply>
Flly O..piedM8ot
A!ailable:
6ember .an ha!e
their preAeren.e to
lo-er RL; or not.
8o .ertain
per.enta@e
.ondition on
9arantee Letter
issed =.ashless
Aa.ility -ill still
apply>
3p@rade RL; by
o-n reBest:
Reimbrsement
system -ill apply
E(CESS CLAIM AT
NET"ORK
HOSPITALS3CLINICS
4npatient, Otpatient, :entalL 6aternity:
Settled pon dis.har@ed
7

UNER"RITING
UNER"RITING 1 SER!ICES
RELIANCE MANULIFE A!I!A A(A
CONTINUITY OF
HOSPITALI5ATION
AFTER THE POLICY
ISCONTINUE 2SUB6ECT
THE BENEFIT LIMIT IS
A!AILABLE*
7es
3a*imum 45 days
from the policy
e*piry
e*cludin. post
hospitalization
bene6t
7es
e*cludin. post hospitalization bene6t
PROFIT SHARING
2SUB6ECT THE POLICY IS
RENE"E AN MINIMUM
PREMIUM IS FULFILLE.
GI!EN 7 MONTHS AFTER
RENE"AL*
7es, Aormla :
*'J + =6'J
premim Q .laim
paid> #loss in the
last year Aor poli.y
period @reater than
& year
7es, Aormla:
*'J + R=6'J
Premim> Q 2laimS
7es, Aormla:
*'J + R=/"J
Premim> Q 2laimS
7es, 9ood 2laim
:is.ont # Aormla:
&'J dis.ont Arom
e+istin@ premim iA
.laim O *'J and
*J dis.ont Arom
e+istin@ premim iA
.laim *'J#6'J
PREMIUM PAYMENT
METHO
Annally
MEMBERSHIP CAR Printed Aor ea.h 6ember
MEMBERSHIP
HANBOOK
:istribted to ea.h 0mployee member
INPATIENT P)O*)A+
INPATIENT TYPE OF
PROGRAM
4nner Limit
REINSTATEMENT
BENEFIT
2PER ISABILITY*
&$ days
SEMI ICU3
ISOLATION3
INTERMEIATE ROOM
2o!ered nder 4ntensi!e 2are 3nit =423> beneDt
INPATIENT MINIMUM
HOUR2S*
, hors
as lon. as the
7ospital char.ed
1oom 8 9oard
6 hors
as lon. as the 7ospital char.ed 1oom 8
9oard
8one
as lon. as the
7ospital char.ed
1oom 8 9oard
PRE 1 POST
HOSPITALI5ATION
2o!ered nder 4npatient pro@ram
:( days before and :( days after hospitalization
ONE AY SURGERY 2o!ered
HOSPITALI5ATION UE
TO COMPLICATIONS
URING PREGNANCY
2OCTOR
RECOMMENATION*
2o!ered
&durin. pre.nancy
and after childbirth+
2o!ered
=drin@ pre@nan.y only>
8ot 2o!ered
8

UNER"RITING
UNER"RITING 1 SER!ICES
RELIANCE MANULIFE A!I!A A(A
EMERGENCY
OUTPATIENT 1 ENTAL
TREATMENT 2"ITHIN
0(08 HOURS*
2o!ered
=Within &+2$ hors>
2o!ered
=Within 2+2$ hors>
2o!ered
=Within &+2$ hors>
INPATIENT ROOM 1
BOAR TOLERANCE IF
FULLY OCCUPIE 3 NOT
A!AILABLE
Flly O..pied:
3p@rade *'J or 4:R
/*,''' =-hi.he!er
is lesser> Arom
hisMher entitlement
Plan -ith no
limitation days
8ot A!ailable:
3p@rade *'J or 4:R
/*,''' =-hi.he!er
is lesser> Arom
hisMher entitlement
Plan -ith no
limitation days
Other beneDts -ill
be .o!ered as per
S.hedle oA ;eneDts
Flly O..pied:
3p@rade 4:R *','''
hi@her Arom hisMher
entitlement Plan
-ith no limitation
days
8ot A!ailable:
3p@rade 4:R *','''
hi@her Arom hisMher
entitlement Plan
-ith no limitation
days
Other beneDts -ill
be .o!ered as per
S.hedle oA ;eneDts
Flly O..pied:
3p@rade *'J or 4:R
/*,''' =-hi.he!er
is lesser> Arom
hisMher entitlement
Plan -ith no
limitation days
8ot A!ailable:
3p@rade *'J or 4:R
/*,''' =-hi.he!er
is lesser> Arom
hisMher entitlement
Plan -ith no
limitation days
Other beneDts -ill
be .o!ered as per
S.hedle oA ;eneDts
Flly O..pied:
3p@rade 4:R *','''
hi@her Arom hisMher
entitlement Plan
-ith no limitation
days
8ot A!ailable:
3p@rade 4:R *','''
hi@her Arom hisMher
entitlement Plan
-ith no limitation
days
Other beneDts -ill
be .o!ered as per
S.hedle oA ;eneDts
EATH BENEFIT
BECAUSE OF ACCIENT
OR SICKNESS
2o!ered Aor all 6embers
as lon. as not fall into policy e*clusions
2o!ered Aor all
6embers
3in ; months 8 3a*
;5 years old
as lon. as not fall
into policy
e*clusions
O,TPATIENT AND DENTAL P)O*)A+
OUTPATIENT TYPE OF
PROGRAM
4nner Limit
OUTPATIENT IRECT TO
ALL SPECIALITS
7es
ACUPUNCTURE
TREATMENT PERFORME
BY A REGISTERE
LICENSE OCTOR
2ONLY THE OCTOR FEE*
2o!ered
AMINISTRATION FEE
2o!ered nder do.torCs limit 2o!ered -ith
separate limit
2o!ered nder
do.torCs limit
+ATE)NITY P)O*)A+
MATERNITY TYPE OF
PROUCT
Limit per pa.%a@e
AGE LIMITS
6a+ $* years old
6a+imm " .hildren =$
th
.hild 4s not .o!ered>
9

UNER"RITING
UNER"RITING 1 SER!ICES
RELIANCE MANULIFE A!I!A A(A
PRE 1 POST NATAL 89
AYS 2MATERNITY*
CONSULTATION
2o!ered
durin. pre.nancy and :( days after delivery
-I.ION P)O*)A+
!ISION TYPE OF
PROGRAM
Pa.%a@e limit
ELIGIBILITY 0mployee Only
LENS FOR E!ERY YEAR 7es
FRAME FOR E!ERY T"O
YEARS
7es 8o, per year
TOTAL PLUS POINTS
2YELLO",MARKE*
: POINTS '0 POINTS '; POINTS '9 POINTS
10

7. INSURANCE BENEFIT COMPARISON

Co'era"e that is clearl% better is identifed in %ellow
INPATIENT
BENEFITS
INPATIENT 2IR*
RELIANCE MANULIFE A!I!A A(A
HOSPITAL ROOM 1 BOAR
2R1B*
*'','''
$'','''
"'','''
Per day
INTENSI!E CARE UNIT
2ICU*
,'','''
,'','''
6'','''
Per day 3a*.<(
days per disability
,'','''
,'','''
6'','''
Per day
&,''','''
,'','''
6'','''
Per day
,'','''
,'','''
6'','''
Per day
PRI!ATE NURSING CARE
&2','''
&'','''
,','''
Per day 3a*.:(
days per disability
&2','''
&'','''
,','''
Per day
&2','''
&'','''
,','''
Per day 3a*.:(
days per disability
&2','''
&'','''
,','''
Per day
IN,HOSPITAL PHYSICIAN
!ISIT
2'','''
&/','''
&/','''
Per day
2'','''
&/','''
&"','''
Per day
22*,'''
&,','''
&"*,'''
Per day 3a*.4 visit
per day
IN,HOSPITAL SPECIALIST
CONSULTATION
,'','''
6'','''
$*','''
Per day 3a*.:(
days per disability
,'','''
6'','''
$*','''
Per day
,'','''
6'','''
$*','''
Per day 3a*.4 visit
per day
MISCELLANEOUS HOSPITAL
SUPPLIES
6,''','''
$,''','''
",*'','''
Per disability
AMBULANCE SER!ICE
$'','''
&"','''
&"','''
Per disability
"&','''
&"','''
&"','''
Per disability
$'','''
&"','''
&"','''
Per disability
11

BENEFITS
INPATIENT 2IR*
RELIANCE MANULIFE A!I!A A(A
SURGERY4 ANESTHESIA4
OPERATING THEATRE
S<rger-=
2omple+:
2*,''','''
&/,''','''
&$,''','''
6aKor:
&',''','''
/,&'','''
6,$'','''

4ntermediate:
/,''','''
$,,'','''
$,''','''
6inor:
$,''','''
2,&'','''
&,/'','''
A%e$the$#a=
$'J oA Sr@ery
Limit abo!e
Operat#%g
Theatre=
$'J oA Sr@ery
Limit abo!e
Per disability
S<rger-4
A%e$the$#a4 a%&
operat#%g
theatre=
2omple+:
$*,''','''
"',6'','''
2*,2'','''
6aKor:
&,,''','''
&2,/,','''
&&,*2','''
4ntermediate:
&2,6'','''
,,6$','''
/,2'','''
6inor:
/,2'','''
",/,','''
",'6','''
Per disability
S<rger-4
A%e$the$#a4 a%&
operat#%g
theatre=
2omple+:
6',''','''
$,,''','''
"6,''','''
6aKor:
$',''','''
"2,''','''
2$,''','''
4ntermediate:
"',''','''
2$,''','''
&,,''','''
6inor:
&*,''','''
&2,''','''
),''','''
Per disability
S<rger-4
A%e$the$#a4 a%&
operat#%g
theatre=
2omple+:
$*,''','''
"',6'','''
2*,2'','''
6aKor:
&,,''','''
&2,/,','''
&&,*2','''
4ntermediate:
&2,6'','''
,,6$','''
/,2'','''
6inor:
/,2'','''
",/,','''
",'6','''
Per disability
EMERGENCY OUTPATIENT
TREATMENT UE TO
ACCIENT
&,,,','''
&,,,','''
&,,,','''
Per disability
2,*'','''
2,''','''
&,*'','''
Per disability
",''','''
2,$'','''
&,,'','''
Per year &,''','''
,'','''
6'','''
Per disability
EMERGENCY ENTAL
TREATMENT UE TO
ACCIENT
)$','''
)$','''
)$','''
Per disability
2,''','''
&,6'','''
&,2'','''
Per year
PRE 1 POST
HOSPITALI5ATION
Pre
/ospitali0ation
,'','''
6'','''
$*','''
Post
/ospitali0ation
,'','''
6'','''
$*','''
Per disability
Pre and Post /ospitali0ation1
&,6'','''
&,2'','''
)'','''
Per disability
Pre
/ospitali0ation
,'','''
6'','''
$*','''
Post
/ospitali0ation
,'','''
6'','''
$*','''
Per disability
12

BENEFITS
INPATIENT 2IR*
RELIANCE MANULIFE A!I!A A(A
ONE AY SURGERY
/,2'','''
",/,','''
",'6','''
Per year
2o!ered in Sr@i.al beneDt limit
Per disability
CHEMOTERAPY AN
HAEMOIALYSIS >
HOSPITALI5ATION
&2,''','''
,,''','''
/,''','''
Per year
2o!ered in 6is.ellaneos 4npatient beneDt limit
Per disability
CHEMOTERAPY AN
HAEMOIALYSIS >
OUTPATIENT
2o!ered in Pres.ription dr@s Otpatient
beneDt limit
Per year
&2,''','''
,,''','''
/,''','''
Per year
2o!ered in
Pres.ription dr@s
Otpatient beneDt
limit
Per year
HOSPITALI5ATION UE TO
COMPLICATIONS URING
PREGNANCY
&2,''','''
,,''','''
/,''','''
Per year
&&,''','''
,,,'','''
6,6'','''
Per year
2o!ered nder
4npatient s.hedle
oA beneDts
8ot 2o!ered
O!ERALL LIMIT PER
PERSON PER POLICY YEAR
3nlimited
EATH BENEFIT UE TO
SICKNESS AN ACCIENT
&',''','''
All members
TOTAL PLUS POINTS
2YELLO",MARKE*
? POINTS ; POINTS '9 POINTS @ POINTS
MATERNITY
BENEFITS
MATERNITY 2IR*
RELIANCE MANULIFE A!I!A A(A
NORMAL ELI!ERY
2PHYSICIAN3MI"IFE*
$,''','''
2,&'','''
&,/'','''
13

BENEFITS
MATERNITY 2IR*
RELIANCE MANULIFE A!I!A A(A
CAESAREAN ELI!ERY
&',''','''
/,&'','''
6,$'','''
,,''','''
$,&'','''
",$'','''
&',''','''
/,&'','''
6,$'','''
MISCARRIAGE
&,2'','''
6"','''
*&','''
8ot 2o!ered &,2'','''
6"','''
*&','''
PRE 1 POST NATAL
,'','''
$2','''
"$','''
TOTAL PLUS POINTS
2YELLO",MARKE*
0 POINTS ' POINT ' POINT 0 POINTS
14

OUTPATIENT
BENEFITS
OUTPATIENT 2IR*
RELIANCE MANULIFE A!I!A A(A
OUTPATIENT GENERAL
PRACTITIONER
,','''
,','''
*','''
Per visit 3a* 4 visit
per day
,','''
,','''
*','''
Per =isit
,','''
,','''
*','''
Per day
,','''
,','''
*','''
Per visit 3a* 4 visit
per day
OUTPATIENT SPECIALIST
CONSULTATION
2'','''
2'','''
&*','''
Per visit 3a* 4 visit
per day
2'','''
2'','''
&*','''
Per =isit
2'','''
2'','''
&*','''
Per day
2'','''
2'','''
&*','''
Per visit 3a* 4 visit
per day
PHYSIOTHERAPY
2'','''
2'','''
&*','''
Per visit 3a* 4 visit
per day
2,''','''
2,''','''
&,*'','''
Per year
2'','''
2'','''
&*','''
Per day
2'','''
2'','''
&*','''
Per visit 3a* 4 visit
per day
OUTPATIENT IAGNOSTIC
LABORATORY SER!ICES
INCLUING (,RAY
2,*'','''
2,*'','''
2,''','''
Per year
&,)&2,*''
&,)&2,*''
&,2"/,*''
Per year
2,*'','''
2,*'','''
2,''','''
Per year
OUTPATIENT OCTORAS
TREATMENT PACKAGES
As per do.tor and
pres.ription dr@s
beneDtsC limit
&2','''
&2','''
/*,'''
Per =isit
As per do.tor and pres.ription dr@s
beneDtsC limit
OUTPATIENT
PRESCRIPTION RUGS
",''','''
",''','''
2,*'','''
Per year
",''','''
",''','''
2,''','''
Per year
",''','''
",''','''
2,*'','''
Per year
AMINISTRATION As per do.tor beneDt limit $','''
$','''
$','''
Per day
As per do.tor
beneDt limit
O!ERALL LIMIT PER
PERSON PER POLICY YEAR
6,''','''
6,''','''
*,''','''
15

BENEFITS
OUTPATIENT 2IR*
RELIANCE MANULIFE A!I!A A(A
TOTAL PLUS POINTS
2YELLO",MARKE*
0 POINTS 8 POINTS ' POINT 0 POINTS
16

ENTAL
BENEFITS
ENTAL 2IR*
RELIANCE MANULIFE A!I!A A(A
BASIC TREATMENTS
As 2har@ed
&,*'','''
&,2*','''
&,''','''
Per year
As 2har@ed
PRE!ENTI!E TREATMENTS
As 2har@ed As 2har@ed As .har@ed
3a* < visits per
year
REHABILITATION
TREATMENTS
As 2har@ed
3a*. 4 visit per day
As 2har@ed As .har@ed
3a* 4 visit per day
GUM TREATMENTS As 2har@ed As 2har@ed As .har@ed
3a* < visits per
year
COMPLE( TREATMENTS As 2har@ed
3a*. 4 visit per day
ENTURE TREATMENTS As 2har@ed
O!ERALL LIMIT PER
PERSON PER POLICY YEAR
&,*'','''
&,2*','''
&,''','''
TOTAL PLUS POINTS
2YELLO",MARKE*
8 POINTS 9 POINT 8 POINTS 8 POINTS
17

!ISION
BENEFITS
!ISION 2IR*
RELIANCE MANULIFE A!I!A A(A
FRAME
$'','''
$'','''
$'','''
/nce every < years
$'','''
$'','''
$'','''
Per year
/'','''
/'','''
/'','''
Per year
LENS
"'','''
"'','''
"'','''
3a* 4 time per year
"'','''
"'','''
"'','''
Per year
TOTAL PLUS POINTS
2YELLO",MARKE*
9 POINT ' POINT ' POINT ' POINT
18

8. EMOGRAPHIC MEMBER
As re.ei!ed Arom P(. 4stana Karan@ Lat on ) September 2'&"
INPATIENT4 OUTPATIENT4 ENTAL 2MANULIFE4 A(A4 A!I!A*)
CATEGORY
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
MALE &/ *& &&
FEMALE &$ *' &'
CHIL 2" // &,
SUB TOTAL ?8 ';@ 7:
TOTAL
PARTICIPANTS
0;'

*Premium is calculated based on 3ale $emale -hild. There are > members are not eli.ible to be re.istered due
to over a.e. They are 9amban. La?sono &'4 years old+ and spouse and. 9a?rie abdullah &;; years old+ and
spouse.
INPATIENT4 OUTPATIENT4 ENTAL 2RELIANCE*)
CATEGORY
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
MALE &* *& &&
MALE 2 ?E,E9* & ' '
MALE 2 E',E? * & ' '
FEMALE &$ *' &'
CHIL 2" // &,
SUB TOTAL ?8 ';@ 7:
TOTAL
PARTICIPANTS
0;'

*Premium is calculated based on 3ale $emale -hild. There are > members are not eli.ible to be re.istered due
to over a.e. They are 9amban. La?sono &'4 years old+ and spouse and 9a?rie abdullah &;; years old+ and
spouse. 3embers for a.e above 55 years old are sub@ect to loadin. premium.
!ISION)
CATEGORY
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
EMPLOYEE &, ** &&
19

TOTAL
PARTICIPANTS
@8
* Ali.ible for employee only.9amban. La?sono and 9a?rie Abdullah are not eli.ible to be re.istered due to over
a.e.
MATERNITY)
CATEGORY
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
FEMALE MARRIE &2 $" &'
TOTAL
PARTICIPANTS
E?

)Ali.ible female married is ma* >5 years old. There are 44 members 0ho are not eli.ible for maternity bene6ts.
4. Bin.le" Plan 4" !ian Lusiana $aluzi
Plan <" Theresia Bhinta $.3 3einer 9 Litary 3amara Ardiata$lora !0i !
<. A.e above >5" Plan 4" -ut Culia B9a?ri Abdullah spouse
Plan <" 9amban. la?sono spouse 7i?mayah A 3imi B Boezi Boezana
20

?. ANNUAL UNIT PREMIUM 2IR*)
PREMIUM UNIT PER PERSON AN PER YEAR
PT.ASURANSI RELIANCE INONESIA
INPATIENT
INPATIENT
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
MALE ,/$,)'' 6*/,)'' *$/,)''
MALE 2 ?E,E9* &,"&2,"*' ),6,,*' ,2&,,*'
MALE 2 E',E? * &,/$),,'' &,"&*,,'' &,')*,,''
FEMALE &,'$2,,'' /,2,*'' 6*',$''
CHIL /'6,)'' *"",$'' $$*,"''

O,TPATIENT
OUTPATIENT
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
MALE &,",),$'' &,",),$'' &,&/",6''
MALE 2 ?E,E9* 2,',$,&'' 2,',$,&'' &,/6',$''
MALE 2 E',E? * 2,//,,,'' 2,//,,,'' 2,"$/,2''
FEMALE &,66&,"'' &,66&,"'' &,$'2,$''
CHIL &,&&/,6'' &,&&/,6'' )$$,)''

DENTAL
ENTAL
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
MALE 2)2,&'' 2$",$'' &)$,/''
MALE 2 ?E,E9* $",,&*' "6*,&'' 2)2,'*'
MALE 2 E',E? * *,$,2'' $,6,,'' ",),$''
FEMALE "*',*'' 2)2,&'' 2"",/''
CHIL "*',*'' 2)2,&'' 2"",/''
-I.ION
21

!ISION
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
EMPLOYEE 2"2,"'' 2"2,"'' 2"2,"''
+ATE)NITY
MATERNITY
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
FEMALE MARRIE &,2,',*'' /)',/'' 6,&,,''
22

PT.ASURANSI MANULIFE INONESIA
INPATIENT
INPATIENT
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
MALE )/6,*'' /&$,2'' *)$,'''
FEMALE &,*2&,,'' &,&"*,&'' )&",6''
CHIL /&&,/'' *22,&'' $2,,&''

O,TPATIENT
OUTPATIENT
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
MALE 2,''6,)'' 2,''6,)'' &,6"2,'''
FEMALE 2,,,6,"'' 2,,,6,"'' 2,"$/,,''
CHIL 2,$/$,2'' 2,$/$,2'' 2,'&$,$''

DENTAL
ENTAL
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
MALE $&,,"'' "$,,6'' 2/,,)''
FEMALE /"&,''' 6'),2'' $,/,"''
CHIL &/6,"'' &$6,)'' &&/,6''
-I.ION
!ISION
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
EMPLOYEE ""$,*'' ""$,*'' "&6,)''
+ATE)NITY
MATERNITY
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
FEMALE MARRIE &,$6",2'' )"&,*'' ,&&,/''
23

PT.ASURANSI A!I!A INONESIA
INPATIENT
INPATIENT
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
MALE &,,)",''' &,2)',''' ))),'''
FEMALE &,)&/,''' &,*),,''' &,"2&,'''
CHIL )&&,''' 6)",''' */),'''

O,TPATIENT
OUTPATIENT
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
MALE 2,&'*,''' 2,&),,''' &,*$",'''
FEMALE 2,*"$,''' 2,/$*,''' &,)"*,'''
CHIL &,*"*,''' &,*"*,''' &,&'",'''

DENTAL
ENTAL
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
MALE $,6,''' $&6,''' "/2,'''
FEMALE 6&&,''' *22,''' $6,,'''
CHIL $$6,''' ",',''' "$&,'''
-I.ION
!ISION
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
EMPLOYEE $&&,''' $&&,''' $&&,'''
+ATE)NITY
MATERNITY
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
FEMALE MARRIE )",,''' *),,''' $,$,'''
24

PT.ASURANSI A(A INONESIA
INPATIENT
INPATIENT
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
MALE &,6'),''' &,2*,,''' )/*,'''
FEMALE &,,*',''' &,$$6,''' &,&2&,'''
CHIL &,*6),''' &,226,''' )*','''

O,TPATIENT
OUTPATIENT
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
MALE ,/&,''' ,/&,''' 6/$,'''
FEMALE &,''&,''' &,''&,''' //*,'''
CHIL ,$),''' ,$),''' 6*/,'''

DENTAL
ENTAL
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
MALE &)$,''' &,/,''' &,&,'''
FEMALE 22$,''' 2&6,''' 2',,'''
CHIL &)',''' &,",''' &/6,'''
-I.ION
!ISION
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
EMPLOYEE &,"&2,''' &,"&2,''' &,"&2,'''
+ATE)NITY
MATERNITY
Pla% '
2#reBtor C
Ma%ager*
Pla% 0
2S<per+#$or C
StaD*
Pla% 7
2No%,StaD*
FEMALE MARRIE 6&),''' ""6,''' 2/2,'''
25

E. PREMIUM COMPARISON)
TOTAL ANNUAL PREMIUM
TOTAL ANNUAL
PREMIUM
ANNUAL PREMIUM 2IR*
RELIANCE MANULIFE A!I!A A(A
INPATIENT &,&,""),**' 2&&,'"&,*'' "&",6$$,''' "*),2"*,'''
OUTPATIENT "*,,*,,,"'' 6$6,"'&,6'' *"',2,6,''' 2"*,&,2,'''
MATERNITY *6,&,$,&'' 6*,/2),)'' $&,,&',''' 2$,*)6,'''
ENTAL /6,*6/,/*' )&,''/,6'' &&,,*6',''' *2,$/&,'''
!ISION &),*&",2'' 2/,)'$,$'' "$,*2$,''' &&',2',,'''
TOTAL ANNUAL
PREMIUM
E:04':04:99 '498'4:;?4999 '497@4@084999 ;@'4E:04999
* Notes"
&. (he abo!e premims are e+.ldin@ poli.y .ost iA any.
2. (he abo!e premims to be re.al.lated pon re.ei!in@ .onDrmation oA Dnal nmber oA members to be
.o!ered.
". (he abo!e annal premim is Ally paid p Aront. (here -ill be additional loadin@ Aor Semi#Annal and
Tarterly payment.
$. (he abo!e est. premims are !alid Aor "' days Arom proposal date.
*. R0L4A820 -ill .har@ed loadin@ premim Aor parti.ipant *6#6* years old and premim Aor .hildren 2"#2*
years old -ill be .har@ed as an adlt premim.
6. (here are $ members are not eli@ible to be re@istered de to o!er a@e. (hey are ;amban@ La%sono =/&
years old> and spose, and. ;a%rie abdllah =66 years old> and spose.
26

;. TOTAL NUMBER OF PLUS POINTS
NUMBER OF PLUS
POINTS
PLUS POINTS
RELIANCE MANULIFE A!I!A A(A
UNER"RITING 1
SER!ICES
COMPARISON
) &2 &/ &'
BENEFIT
COMPARISON

&" &" &/ &/
PREMIUM
COMPARISON
" ' ' "
TOTAL NUMBER OF
PLUS POINTS
2YELLO",MARKE*
0? POINTS 0? POINTS 78 POINTS 79 POINTS
27

@. "ILLIS SCOPE OF SER!ICES
RE!IE" 1 ASSESSMENT 2an!ass 4nsran.e mar%et
Feasibility stdyU .rrent !erss Atre pro@ram
Re#desi@n or impro!ement on e+istin@ beneDts
INSURANCE PLACEMENT
SER!ICES
Rene-al ne@otiatin@
2an!ass 4nsran.e mar%etU obtainin@ Botations,
.omparin@ .ompetiti!e terms oA .o!era@e and pri.in@
Presentin@ proposal on beneDts, .osts .omparison
EMPLOYEE
COMMUNICATIONS
;rieDn@ sessions on .han@es =iA any>, beneDts .o!era@e
Re!ie- membership handboo%
Re!ie- meetin@ -ith <R re@larly
:ay#to#day enBiries

GENERAL
AMINISTRATION
6ana@e member data
2he.%in@ poli.y, endorsements Aor a..ra.y
2he.%in@ member data, membership .ards Aor a..ra.y
2he.%in@ premim in!oi.es Aor a..ra.y
CLAIMS AMINISTRATION
1 A6UICATION
A.%no-led@e re.ei!e and notiAy the 4nsrer
Ad!i.e on do.ments to spport .laims
Wor% -ith the 4nsrer to ensre .laims trnarond time
Re!ie- .laims report pro!ided by the 4nsrer
Pro!ide .laims report Barterly

28