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Health Insurance Agreement

Health Insurance Agreement Template for Indonesia

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Key Requirements PROMPT example:

Health Insurance Agreement

"I need a Health Insurance Agreement for a tech company with 500 employees in Jakarta, including international coverage for senior executives and special provisions for remote telehealth services, to be effective from March 1, 2025."

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Document background
This Health Insurance Agreement serves as the primary contractual document establishing health insurance coverage in Indonesia. It is essential for both individual and corporate policyholders seeking to secure healthcare benefits through private insurance. The agreement complies with Indonesian insurance regulations, including Law No. 40 of 2014 and OJK directives, while providing comprehensive coverage terms, premium structures, and claims procedures. It can be used for various scenarios including individual coverage, family plans, and corporate group policies. The document includes detailed provisions for medical benefits, network healthcare providers, exclusions, and administrative procedures, ensuring clarity in coverage terms while protecting both insurer and policyholder interests under Indonesian law.
Suggested Sections

1. Parties: Identification of the insurance provider and the policyholder/insured person

2. Background: Context of the agreement and general purpose of the health insurance coverage

3. Definitions: Detailed definitions of key terms used throughout the agreement

4. Scope of Coverage: Overview of health insurance coverage, including general inclusions and exclusions

5. Premium Payment Terms: Details of premium amounts, payment schedules, and payment methods

6. Claims Procedure: Process for submitting and handling insurance claims

7. Rights and Obligations: Detailed responsibilities and rights of both the insurer and the insured

8. Waiting Periods: Specified periods before certain coverage benefits become effective

9. Exclusions: Detailed list of conditions, treatments, and circumstances not covered by the insurance

10. Term and Renewal: Duration of the policy and conditions for renewal

11. Termination: Conditions and procedures for terminating the insurance coverage

12. Dispute Resolution: Procedures for handling disputes between parties

13. Governing Law: Specification of Indonesian law as governing law and relevant jurisdictions

Optional Sections

1. Network Hospitals: Used when the insurer has specific hospital networks - lists participating healthcare providers and special arrangements

2. International Coverage: Include when the policy offers coverage for treatment outside Indonesia

3. Family Coverage Terms: Required when the policy extends to family members

4. Pre-existing Conditions: Detailed section needed when covering pre-existing conditions with special terms

5. Corporate Group Terms: Include for corporate group insurance policies

6. Digital Services: Include when offering digital claim submissions or online services

7. Wellness Benefits: Used when the policy includes preventive care or wellness programs

8. Premium Financing: Include when offering premium payment installations or financing options

Suggested Schedules

1. Schedule A - Benefits Table: Detailed breakdown of coverage limits, sub-limits, and benefits for different medical services

2. Schedule B - Premium Schedule: Detailed premium calculations, including factors affecting premium rates

3. Schedule C - Network Healthcare Providers: List of approved hospitals, clinics, and healthcare providers

4. Schedule D - Claim Forms: Standard forms and documentation required for claim submission

5. Appendix 1 - Pre-approval Procedures: List of treatments requiring pre-approval and related procedures

6. Appendix 2 - Excluded Treatments: Comprehensive list of excluded medical procedures and treatments

7. Appendix 3 - Emergency Procedures: Guidelines for emergency treatment and related claims procedures

8. Appendix 4 - Privacy Policy: Detailed privacy and data protection policies

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok成人版 | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co
Relevant legal definitions





















































Clauses



































Relevant Industries

Insurance

Healthcare

Banking and Financial Services

Human Resources Services

Healthcare Technology

Legal Services

Corporate Services

Employee Benefits

Medical Tourism

Pharmaceutical

Relevant Teams

Legal

Human Resources

Risk Management

Compliance

Operations

Finance

Employee Benefits

Insurance Administration

Claims Processing

Customer Service

Healthcare Relations

Policy Administration

Relevant Roles

Insurance Underwriter

Claims Manager

Legal Counsel

HR Director

Benefits Administrator

Risk Manager

Compliance Officer

Insurance Agent

Healthcare Administrator

Corporate Secretary

Chief Financial Officer

Employee Benefits Manager

Insurance Operations Manager

Policy Administration Officer

Healthcare Relations Manager

Industries







Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks, 聽Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination, 聽Severance Pay, Governing Law, Entire Agreemen

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