This article was first published on Bisnis.com, ladder (3/1/2022). with the title “I Solusi Asuransi Penyakit Kritis”
Liga Asuransi – Bisnis.com, JAKARTA — Critical illness insurance requires a waiting period before it can be claimed when a policyholder falls ill. This is because certain prerequisites must be confirmed by the insurance company first.
Insurance observer Azuarini Diah Parwati stated that health insurance consists of two types: pure health insurance and unit-linked insurance followed by riders. She mentioned that protection against critical illnesses is usually offered as an additional coverage (rider) that requires a waiting period. “Why is there a waiting period? The standard logic is that when a policyholder is affected by a severe illness, it won’t manifest immediately, but there will be preliminary symptoms. When policyholders experience this, they have a choice, whether to undergo treatment or not, sometimes policyholders underestimate this,” Azuarini said to Bisnis on Tuesday (3/1/2022).
The waiting period is a mandatory period that policyholders/insured individuals must go through before they can file an insurance claim. This provision is generally applied by insurance companies as a way to monitor and assess the risk level of prospective policyholders. For the insured, this waiting period is useful in facilitating the initial application so that a medical check-up is not required first. Azuarini explained that critical illnesses usually require further treatment, including medications and therapies.
This is why insurance companies always require a waiting period for critical illnesses. “Sometimes people buy insurance when they are already sick, and when filling out the SPAJ or statement form, they do not honestly disclose that they have been diagnosed with a disease. This [dishonest SPAJ data] can be one of the reasons why a claim cannot be processed,” said Azuarini. READ ALSO Symptoms and Causes of Brain Hemorrhage, as Experienced by Indra Bekti After Vietnam, Insurance Startup Fuse Ensures Expansion in Southeast Asia Update on Wanaartha Life and Kresna Life’s Failed Payment Cases from OJK, Circular RUPS Azuarini, who is also the Vice Chair of the Insurance Writers Community (Kupasi), shared tips to prevent policyholders from having their claims rejected, namely purchasing health insurance when the body is still healthy.
She mentioned the phenomenon of policyholders considering themselves healthy, whereas the opposite may be true. This will have an impact when a claim is made, including when there is a history of consuming medications for critical illnesses, making the claim not covered. Rini, who is also active in the Indonesian Insurance Council (DAI), encourages pure health insurance, a type of insurance product that only provides health protection. She also advises purchasing health insurance when young, when the body is relatively healthier. “At least buy insurance at the age of 25-30 so that you can still get a cheap premium and sufficient coverage. Because if you are over 50, the coverage tends to decrease.
Lastly, don’t forget to read the policy,” said Azuarini. Critical illness insurance has come under scrutiny following the news that artist Indra Bekti could not fully claim his policy due to not yet passing the waiting period.
Critical illness insurance is a type of insurance coverage that provides a lump sum payment to the policyholder in the event they are diagnosed with a specified critical illness or medical condition. The purpose of critical illness insurance is to offer financial support to the insured individual during a challenging time, helping cover medical expenses, living expenses, or other financial obligations that may arise due to the illness.
Understanding Critical Illness Insurance
Key features of critical illness insurance typically include:
Covered Illnesses:
Policies specify a list of critical illnesses or medical conditions that are covered. Common examples include cancer, heart attack, stroke, organ transplants, and other severe illnesses.
Lump Sum Payout:
If the policyholder is diagnosed with a covered illness and survives a waiting period (as mentioned in the previous conversation), the insurance company pays out a lump sum amount. This payment is made regardless of the actual medical expenses incurred.
Waiting Period:
There is usually a waiting period from the time the policy is purchased until the coverage becomes effective. During this waiting period, the policyholder is not eligible to make a claim.
No Requirement for Medical Bills:
Unlike traditional health insurance, critical illness insurance does not require the policyholder to submit medical bills or receipts for reimbursement. The payout is made as a lump sum, and the insured can use the funds as needed.
Freedom to Use Payout:
The policyholder has the flexibility to use the lump sum payout for various purposes, such as covering medical treatments, paying for living expenses, settling debts, or making necessary lifestyle adjustments.
Coverage Duration:
Critical illness insurance policies are typically for a specified term, and coverage ceases at the end of the policy term. Some policies may also offer renewable or convertible options.
Premiums:
Policyholders pay regular premiums to maintain coverage. Premium amounts are determined based on factors such as age, health status, coverage amount, and the term of the policy.
It’s important for individuals considering critical illness insurance to carefully review policy terms and conditions, understand the list of covered illnesses, and be aware of any exclusions or limitations. Additionally, purchasing such insurance is often recommended when individuals are relatively healthy, as pre-existing conditions may affect coverage eligibility. As with any insurance product, consulting with a financial advisor or insurance professional can help individuals make informed decisions based on their specific needs and circumstances.
Conclusion
Navigating the complexities of health challenges requires not just medical attention but also a robust financial safety net. Critical illness insurance stands as a formidable solution, providing a shield against the unforeseen burdens of severe medical conditions. By understanding the importance of early consideration, transparent disclosure, and strategic planning, individuals can proactively safeguard their well-being and financial stability.
As you embark on your journey towards a secure and resilient future, remember that the right critical illness insurance serves as a powerful ally, offering peace of mind and a steadfast defense against life’s uncertainties. Make informed choices, prioritize your health, and embrace the protection that critical illness insurance brings to ensure a brighter and more secure tomorrow.”
This article is part of the book “BANGKITNYA ASURANSI KAMI” with keynote speaker Professor Muhammad Eddi Purnawan, Member of the OJK Supervisory Board. February 2024. ISBN, IPB Press Publishers.
The price of this book is IDR 155,000 and can be ordered through ligasuransi.com.
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Irvan Rahardjo
Lebih dari 40 tahun berkecimpung di dunia asuransi dimulai dari asuransi joint venture hingga pernah menjadi Direksi Asuransi BUMN ; Komisaris Independen AJB Bumiputera 1912 dan Asuransi SOMPO Indonesia. Saat ini menjabat sebagai Komisaris Utama di L&G Risk Insurance Broker.
