VALMET

BENEFIT DETAIL NO. GHP.000.581

In-Patient
HS Hospitalization & Surgical Benefits Direktur Staff
HS 750 HS 500 HS 500 HS 350
HS1 Room & Board, per day Rp 750,000 Rp 500,000 Rp 500,000 Rp 350,000
HS2 Intensive Care Unit (ICU), per day Rp 1,500,000 Rp 1,000,000 Rp 1,000,000 Rp 700,000
HS3 Private Nurse, per day Rp 310,000 Rp 210,000 Rp 210,000 Rp 150,000
HS4 In-Hospital Physician,s Visits, per day Rp 310,000 Rp 210,000 Rp 210,000 Rp 150,000
Pre Hospital and In-Hospital Specialist Consultations, per
HS5 Rp 1,500,000 Rp 1,000,000 Rp 1,000,000 Rp 700,000
confinement
HS6 Miscellaneous Hospital Supplies, per confinement Rp 23,250,000 Rp 15,750,000 Rp 15,750,000 Rp 11,250,000
HS7 Ambulance Service, per confinement Rp 460,000 Rp 310,000 Rp 310,000 Rp 220,000
HS8 Surgery, per operation
HS8.1 Complex Rp 30,015,000 Rp 23,500,000 Rp 23,500,000 Rp 20,650,000
HS8.2 Major Rp 15,020,000 Rp 11,750,000 Rp 11,750,000 Rp 10,325,000
HS8.3 Intermediate Rp 7,510,000 Rp 5,875,000 Rp 5,875,000 Rp 5,150,000
HS8.4 Minor Rp 3,755,000 Rp 2,950,000 Rp 2,950,000 Rp 2,575,000
HS9 Anesthesia (% of surgical limits), per operation 40% 40% 40% 40%
HS10 Operating Theather (% of surgical limits), per operation 40% 40% 40% 40%
HS11 Emergency Out-Patient Treatment, per policy year Rp 4,500,000 Rp 3,000,000 Rp 3,000,000 Rp 2,100,000
HS12 Emergency Dental Treatment,per policy year Rp 3,000,000 Rp 2,000,000 Rp 2,000,000 Rp 1,400,000
HS13 Post-Hospital Specialist Consultations, per confinement Rp 1,500,000 Rp 1,000,000 Rp 1,000,000 Rp 700,000
OL Overall Limit, per policy year Rp 300,000,000 Rp 200,000,000 Rp 200,000,000 Rp 140,000,000

TL Death Benefit
T25 T25 T25 T25

Employee Rp 2,500,000 n.a Rp 2,500,000 n.a

Dependent n.a Rp 2,500,000 n.a Rp 2,500,000