Business Model to Adira Multifinance

Report
Presentation to:
Local protection, global connection
Who We Are…..
2
The Generali Group is a leading player in the global insurance
and financial markets
•68 countries worldwide
•60 million clients
•Over 70 billion Euro of premiums
•85,000 employees
•Over 1.3 billion Euro of net profit
It all began in 1831 in Trieste where Assicurazioni Generali S.p.A. was founded.
Today Assicurazioni Generali S.p.A. is::
 1st insurer in Italy
 The biggest Life Insurer in Europe
 It has strong financial rating: S&P AA-
Geographic Expansion: Continental Europe and Asia
Indonesia
Spain
4.7%
French
7.6%
Germany
8.7%
Italy
24.9%
Austria
15%
Switzerland
4.7%
CEE
6.9%
China
5.8%
What we offer
What do they say about us….
5
Fortune Global 500 – Year 2010: Worldwide Insurance Ranking
AXA
ING Group
126,012
GENERALI
Generali
Allianz
AIG
Aviva
Prudential
Munich Re
Nippon Life
Zurich Financial Services
CNP Assurance
China Life
Based on Revenue (in USD Bio)
40,000
80,000
120,000
160,000
Forbes Global 2000 – Year 2010: Worldwide Insurance Ranking
AXA
Allianz
123.14
GENERALI
Generali
Aviva
Prudential
Zurich Financial Services
Munich Re
CNP Assurances
Manulife Financial
Prudential Financial
Travelers Cos
China Life Insurance
Based on Sales (in USD Bio)
20.00 40.00 60.00 80.00 100.00 120.00 140.00 160.00
Global Employee Benefit Market Share
30.00%
19.61%
20.00%
23.57%
23.13%
25.00%
25.70%
19.19%
GENERALI
15.00%
10.00%
5.00%
0.00%
2005
Column4
2006
Column3
2007
Column2
Source: Ernst & Young 2009 Market share survey
2008
GENERALI
2009
Column1
What we offer
Generali Indonesia
9
Head Office
PT. Asuransi Jiwa Generali Indonesia
Cyber 2 Tower 30th Floor
Jl. H.R. Rasuna Said Blok X - 5 /13
Jakarta 12950
Key Development Milestone
• 570 hospitals in Indonesia
• 30 international hospitals (REVIEWED)
• 90 employee (4 doctors)
• 153 companies (world best known)
• Over 50,000 member
Strong Risk Based Capital
(481% per Juni 2010)
• Started Operations in January 2009
Active Members
49,600
50,000
45,000
40,000
34,545
35,000
30,000
25,000
20,000
15,000
10,000
5,000
-
2,442
Our Business Model
Healthier
and Productive
Employees
(1)
Customized
Solutions
Group
Medical
QUALITY
OF
SERVICE
(3)
Proactive Claim
Management
(2)
Speed
Processing
Long Term
Relationship
Capacity
Group
Term Life
GEB
Support
+
Free Cover Limit
Serving you better…
1. Easy and Convenience
Claim Process
Speed
Processing
3. Easy Tracking Process
2. Easy and Faster
Registration Process
Easy and Convenience Claim Process
Provider Network
Cashless
Swipe Card
Non Provider Network
Customer
Paid to Hospital
Reimbursement to
Generali Indonesia
Claim Business Process
Patient
Hospital/Clinic
Hospital/Clinic
Verify ID card &
Swipe the card
Admission Process
Provide
Medical Services
Claim Business Process
Hospital/Clinic
Generali Indonesia
Generali Indonesia
Submit the
complete
documents
Verify documents
Payment Process
14 Working Days
14 Working Days
Easy and Faster Registration & Tracking Process
Regional
Office
Common
Practice
Regional
Office
HO
Insurance
Company
Regional
Office
Regional
Office
Generali
Indonesia
Regional
Office
Regional
Office
CLICK
DIRECT REGISTRATION
(Through Generali Indonesia Web - CLICK)
Serving you better…
POLICY
User id
CLAIM
Generali CLICK
Password BILLINGxxxxxxxx
CLICK
ACCEPTED
CASH
Regional
Office
Generali
Indonesia
Regional
Office
Regional
Office
CLICK
DIRECT REGISTRATION
(Through Generali Indonesia Web - CLICK)
Serving you better…
POLICY
Policy Inquiry
Member
Registration
CLAIM
Claim Inquiry
Claim History
BILLING
Billing Due Date
Billing Tracking
CASH
Payment Status
Cash Receipt
CLICK
Serving you better…
Regional Processing
Center
7x24 Hour Call center &
Emergency Mobile Phone
Wide provider network
Service
Claim & Payment Status
email to member
Wider Provider Network (570 local and 30 overseas)
 Singapore : 8 Provider (Review)
 Malaysia
 Riau /Batam : 15 Provider
 NAD
: 1 Provider
 Other Sumatera
 Jabotabek
 Kalimantan
: 16 Provider
: 22 Provider (Review)
 Maluku
: 2 Provider
 Sulawesi
: 10 Provider
 Papua
: 1 Provider
: 18 Provider
: 260 Provider
 Bali/NTT/NTB : 25 Provider
 West Java
: 55 Provider
 East Java
 Middle java
: 64 Provider
: 45 Provider
MANFAAT RAWAT INAP & PEMBEDAHAN
NO
BENEFIT
1
Biaya kamar Rumah Sakit per hari (Maks 365 hari)
2
3
Biaya Unit Perawatan Intensif (Maks 180 hari)
Biaya Pembedahan
- Pembedahan A
- Pembedahan B
- Pembedahan C
- Pembedahan D
PLAN 1
250
250,000
PLAN 2
350
350,000
PLAN 3
500
500,000
PLAN 4
1350
1,350,000
500,000
700,000
1,000,000
2,650,000
22,000,000
11,000,000
5,600,000
2,800,000
29,000,000
14,000,000
7,500,000
3,630,000
40,000,000
18,000,000
9,000,000
4,500,000
80,000,000
52,000,000
25,000,000
12,500,000
6,250,000
8,750,000
12,500,000
30,000,000
4
Biaya Perawatan Rumah Sakit lainnya (obat-obatan, x-ray, lab)
5
kunjungan dokter di rumah sakit per hari (Maks 365 hari)
200,000
280,000
400,000
600,000
6
Biaya konsultasi dokter spesialis di rumah sakit (Maks 365 hari)
300,000
320,000
500,000
1,000,000
7
8
9
Perawatan Gawat Darurat per ketidakmampuan
Biaya perawat pribadi (Maks 90 hari)
Biaya Ambulan per kasus
2,000,000
150,000
200,000
3,000,000
200,000
280,000
4,000,000
300,000
400,000
10,000,000
600,000
1,000,000
750,000
1,050,000
1,500,000
3,500,000
10 Biaya sebelum (30 hari) & setelah (30 hari) perawatan
Batasan Tahunan
11 Santunan kematian
Tidak terbatasTidak terbatas Tidak terbatas Tidak terbatas
2,500,000
2,500,000
2,500,000
2,500,000
MANFAAT PERSALINAN
NO
MANFAAT
1
Persalinan normal
2
Persalinan dengan Pembedahan
3
Komplikasi kehamilan
4
Perawatan sebelum & sesudah melahirkan
PLAN 1
PLAN 2
PLAN 3
PLAN 4
2,500
3,500
5,000
8,000
2,500,000 3,500,000 5,000,000 8,000,000
3,125,000 4,500,000 6,500,000 10,000,000
1,700,000 2,500,000 3,500,000 5,500,000
500,000
700,000
1,000,000 1,600,000
MANFAAT RAWAT JALAN
NO
MANFAAT
1
Biaya konsultasi Dokter Umum (per kunjungan/hari)
2
PLAN 1
PLAN 2
PLAN 3
PLAN 4
40,000
50,000
70,000
150,000
Biaya konsultasi Dokter Spesialis (per kunjungan/hari)
120,000
150,000
210,000
450,000
3
Biaya obat-obatan sesuai resep dokter / tahun
900,000
1,250,000
1,400,000
3,250,000
4
Biaya Diagnostik/laboratorium / tahun
675,000
825,000
1,200,000
2,325,000
5
Biaya Fisioterapi per tahun
200,000
300,000
500,000
600,000
3,500,000
100%
4,250,000
100%
BATAS TAHUNAN PER ORANG
PENGGANTIAN
5,900,000 12,000,000
100%
100%
MANFAAT RAWAT GIGI
NO
MANFAAT
PLAN 1
PLAN 2
PLAN 3
P-LAN 4
1 Perawatan dasar (per tahun)
400,000
500,000
700,000
1,000,000
2 Perawatan pencegahan (per tahun)
200,000
250,000
350,000
500,000
3 Perawatan kompleks (per tahun)
600,000
750,000
1,050,000
1,500,000
4 Gigi palsu (per tahun)
400,000
500,000
700,000
1,000,000
1,600,000
100%
2,000,000
100%
2,800,000
100%
4,000,000
100%
BATAS TAHUNAN PER ORANG
PENGGANTIAN
MANFAAT KACA MATA
NO
MANFAAT
PLAN 1
PLAN 2
PLAN 3
P-LAN 4
a. Frame (batas dua tahunan)
210,000
300,000
600,000
700,000
b. Lensa atau lensa kontak (batas tahunan)
140,000
200,000
400,000
500,000
35,000
50,000
100,000
200,000
100%
100%
100%
1 Penggantian Kacamata
2 Biaya Dokter Mata per tahun
PENGGANTIAN
100%
Kelebihan Program Asuransi Kesehatan Rawat Inap &
Rawat Jalan, Persalinan & Kacamata dari Generali
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Limit Tahunan Rawat Inap “Tidak terbatas” dengan Biaya Rawat Inap, Kunjungan Dokter, Konsultasi
Dokter Spesialist dicover sampai 365 hari, Biaya Unit perwatan intensif dicover sampai 180 hari
Perawatan gawat darurat rawat jalan dan gigi dijadikan satu, dan disediakan per ketidakmampuan, bukan
per tahun.
Biaya operasi : dokter bedah, dokter anestesi, & kamar operasi dijadikan satu
Biaya Fisioterapi di Rawat Jalan terpisah dari biaya dokter spesialis.
Untuk rawat jalan langsung ke dokter spesialis tanpa rujukan dari dokter umum.
Tidak ada masa tunggu untuk PRE-EXISTING CONDITION.
Untuk rawat jalan penggantian bisa 100% untuk reimbursement.
Pada program Persalinan, penggantian biaya dokter dan bidan sama besar.
Pada program Persalinan, biaya perawatan sebelum & sesudah melahirkan terpisah.
Biaya pemeriksaan dokter mata pada program kacamata terpisah dari biaya pembelian kacamata dan
bingkai.
Proses klaim reimbursement adalah 14 hari kerja (dibayarkan ke rekening karyawan/perusahaan)
29
Mengapa memilih Generali Indonesia ?
1.
2.
Kekuatan keuangan :
a. Bagian dari Generali Group, terbesar di Itali, 3 terbesar di Eropa, 30 besar di Dunia
b. RBC 481% (per Juni 2010)
Registrasi dan Inquiry :
Sistem IT yang teruji : Sistem Click
a. Policy inquiry : Melihat informasi data peserta aktif
b. Claim inquiry : Melihat informasi detail claim status klaim reimbursement/provider
c. Billing inquiry : Melihat informasi tagihan/pengembalian premi/ekses klaim
d. Form Changes : Penambahan/pengurangan/perubahan Data Peserta
3.
Standar kepatuhan :
Etika Bisnis, Acuan Perlindungan Data.
4.
Jaringan Provider Rawat Inap dan Rawat Jalan dengan teknologi terkini :
a. Teknologi swipe card
b. Jaringan provider yang sangat luas
- 570 Rumah Sakit rawat inap & Klinik rawat jalan
- 24 jam, Worldwide coverage
5.
Pengembalian Premi (Profit Sharing) :
Minimum Premi Rp. 15,000,000 dan Jumlah karyawan 25 orang
50% (60% Premi – Klaim – 1,500,000), apabila polis diperbarui untuk tahun berikutnya
6.
Customer Service :
a. 7 x 24 jam
: (021) 57933290
b. Emergency Mobile Phone : 081586401117
c. Customer service
: (021) 29963737 (Office Hour)
31

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