Comprehensive Health Insurance
for You and Your Loved Ones,

Falling ill and having hospitalized will be the last thing you will be expected moreover with the current increasing of hospital expenses. Due to this matter, as part of our protection concept, Standard Chartered Bank together with PT. Asuransi Allianz Life Indonesia provide Smart Health Maxi Care.

Smart Health Maxi Care is the comprehensive health insurance which covers inpatient, outpatient, dental, maternity and daily cash benefit that can be used worldwide.

The benefits of Smart Health Maxi Care :

No Claim Bonus * If there is no claim there will be 20% discount of your next year's insurance premium.
More plan such as Inpatient, Dental and Maternity.
Convenient payment of claim : Reimbursement or Cashless - Using your Allianz-Admedika Hospital Network.
5% discount on premium if you include your family members.
Daily cash benefit plan available for your additional benefit.
Unlimited Annual Claim per year subject to the maximum limit for each benefit.

Beside the benefit above, Smart Health Maxi Care also gives more benefit for International Medical Evacuation services such as

Emergency Medical Evacuation up to USD 500,000.
Repatriation up to USD 15,000
Health Recovery Benefit up to USD 1,000
24 Hours Medical Assistance and Information Services plus other benefit

*)No Claim Bonus only available if the insurance policy is renewed.

SMART HEALTH MAXI CARE TABLE BENEFIT

Inpatient only:
Rupiah

Inpatient (Rp)	Maximum Limit	A	B	C	D
Room & Board	per day-180 days/year	350,000	500,000	750,000	1,000,000
ICU Room	per day - 15 days per year	550,000	700,000	1,000,000	1,300,000
Physician Fee	per day-180 days/year	112,500	150,000	215,000	300,000
Specialist Fee	per day-180 days/year	137,500	175,000	250,000	350,000
Surgical :
- Complex	per hospitalization period	58,000,000	82,000,000	120,000,000	160,000,000
- Major	per hospitalization period	37,700,000	53,300,000	78,000,000	104,000,000
- Intermediate	per hospitalization period	26,100,000	36,900,000	54,000,000	72,000,000
- Minor	per hospitalization period	14,500,000	20,500,000	30,000,000	40,000,000
Miscellaneous	per hospitalization period	6,250,000	8,500,000	12,500,000	16,000,000
Pre & Post Hospitalization	per hospitalization period 30 days after and prior	1,400,000	2,000,000	3,000,000	4,000,000
Home nursing	per day-180 days/year	175,000	250,000	375,000	500,000
Ambulance	per hospitalization period	275,000	350,000	500,000	650,000
Emergency Accidental Outpatient and Dental	per event within 14 days	3,500,000	5,000,000	7,500,000	10,000,000
Death Benefit		4,500,000	6,000,000	8,500,000	11,500,000

US Dollar

Inpatient (US$)	Maximum Limit	A	B	C	D
Room & Board	per day-180 days per year	400	500	800	1,000
ICU Room	per day - 15 days per year	800	1,000	1,600	2,000
Physician Fee	per day-180 days per year	80	85	100	120
Specialist Fee	per day-180 days per year	150	175	220	250
Surgical :
- Complex	per hospitalization period	27,500	35,000	47,500	50,000
- Major	per hospitalization period	17,875	22,750	30,875	32,500
- Intermediate	per hospitalization period	12,375	15,750	21,375	22,500
- Minor	per hospitalization period	6,875	8,750	11,875	12,500
Miscellaneous	per hospitalization period	3,000	3,500	5,000	7,000
Pre & Post Hospitalization	per hospitalization period 30 days after and prior	400	450	600	750
Home nursing	per day-180 days per year	40	50	80	100
Ambulance	per hospitalization period	60	70	100	120
Emergency Accidental Outpatient and Dental	per event within 14 days	1,800	2,100	2,600	2,750
Death Benefit		550	750	1,200	1,500

Notes :

Cashless could be used for hospital under Alllianz-Admedika hospital network
Miscellaneous will include pharmacy, laboratory and diagnostic services
Pre & Hospitalization will include doctor’s consultancy fee as well as medicine and other chechup within 30 days before and after hospitalization

Inpatient + Outpatient
Rupiah

Inpatient (Rp)	Maximum Limit	A	B	C	D
Room & Board	per day - 180days per year	350,000	500,000	750,000	1,000,000
ICU Room	per day - 15 days per year	550,000	700,000	1,000,000	1,300,000
Physician Fee	per day - 180days per year	112,500	150,000	215,000	300,000
Specialist Fee	per day - 180days per year	137,500	175,000	250,000	350,000
Surgical :
- Complex	per hospitalization period	58,000,000	82,000,000	120,000,000	160,000,000
- Major	per hospitalization period	37,700,000	53,300,000	78,000,000	104,000,000
- Intermediate	per hospitalization period	26,100,000	36,900,000	54,000,000	72,000,000
- Minor	per hospitalization period	14,500,000	20,500,000	30,000,000	40,000,000
Miscellaneous	per hospitalization period	6,250,000	8,500,000	12,500,000	16,000,000
Home nursing	per day - 180days per year	175,000	250,000	375,000	500,000
Ambulance	per hospitalization period	275,000	350,000	500,000	650,000
Death Benefit		4,500,000	6,000,000	8,500,000	11,500,000
Outpatient* (Rp)	Maximum Limit
GP Consultation Fee	per visit	87,500	125,000	185,000	250,000
Specialist Fee**	per visit	200,000	275,000	555,000	750,000
Prescribed Medicine	per year	3,400,000	4,700,000	8,800,000	12,000,000
Diagnostic Test	per year	1,850,000	2,600,000	4,400,000	6,000,000
Physiotherapy	per visit	87,500	125,000	185,000	250,000
Co Share***	20%
Annual Limit	Unlimited
Coverage	Worldwide

US Dollar

Inpatient (US$)	Maximum Limit	A	B	C	D
Room & Board	per day - 180 days per year	400	500	800	1,000
ICU Room	per day - 15 days per year	800	1,000	1,600	2,000
Physician Fee	per day - 180 days per year	80	85	100	120
Specialist Fee	per day - 180 days per year	150	175	220	250
Surgical :
- Complex	per hospitalization period	27,500	35,000	47,500	50,000
- Major	per hospitalization period	17,875	22,750	30,875	32,500
- Intermediate	per hospitalization period	12,375	15,750	21,375	22,500
- Minor	per hospitalization period	6,875	8,750	11,875	12,500
Miscellaneous	per hospitalization period	3,000	3,500	5,000	7,000
Home Nursing	per day - 180 days per year	40	50	80	100
Ambulance	per hospitalization period	60	70	100	120
Death Benefit		550	750	1,200	1,500
Outpatient* (US$)	Maximum Limit
GP Consultation Fee	per visit	40	50	80	100
Specialist Fee**	per visit	120	150	240	300
Prescribed Medicine	per year	1,000	1,250	2,000	2,500
Diagnostic Test	per year	400	500	800	1,000
Physiotherapy	per visit	40	50	80	100
Co Share***	20%
Annual Limit	Unlimited
Coverage	Worldwide

* Outpatient including coverage for Pre&Post Hospitalization and Emergency Accidental OP &
Den. Co-Share 20% applied
** Valid for Outpatient only

Maternity
Rupiah

Maternity (Rp)	Maximum Limit	A	B	C	D
Normal delivery	per pregnancy	3,500,000	5,000,000	7,500,000	10,000,000
Additional Benefit (abnormal)	per pregnancy	1,750,000	2,500,000	3,750,000	5,000,000
S-caesarea	per pregnancy	7,000,000	10,000,000	15,000,000	20,000,000
Miscarriage / Legal Abortus	per pregnancy	1,750,000	2,500,000	3,750,000	5,000,000
Pre & Post Natal	per year	1,750,000	2,500,000	3,750,000	5,000,000
Annual Limit	Unlimited
Coverage	Worldwide

US Dollar

Maternity (US$)	Maximum Limit	A	B	C	D
Normal delivery	per pregnancy	4,000	5,000	8,000	10,000
Additional Benefit (abnormal)	per pregnancy	2,000	2,500	4,000	5,000
S-caesarea	per pregnancy	8,000	10,000	16,000	20,000
Miscarriage / Legal Abortus	per pregnancy	2,000	2,500	4,000	5,000
Pre & Post Natal	per year	2,000	2,500	4,000	5,000
Annual Limit	Unlimited
Coverage	Worldwide

Notes :

Cashless system can be used for delivery except for Pre&Post Natal which must use reimbursement.

Dental
Rupiah

Dental (Rp)	Maximum Limit	A	B	C	D
Preventive Care	per visit 2 visit per year	87,500	125,000	185,000	250,000
Basic Dental	per year	950,000	1,250,000	3,375,000	4,500,000
Complex Dental	per year	1,125,000	1,500,000	3,750,000	5,000,000
Dentures	per year	1,125,000	1,500,000	3,750,000	5,000,000
Co Share	20%
Annual Limit	Unlimited
Coverage	Worldwide

US Dollar

Dental (US$)	Maximum Limit	A	B	C	D
Preventive Care	per visit 2 visit per year	100	100	155	175
Basic Dental	per year	800	1,000	1,300	1,400
Complex Dental	per year	900	1,050	1,350	1,450
Dentures	per year	1,200	1,400	1,700	2,000
Co Share	20%
Annual Limit	Unlimited
Coverage	Worldwide

Notes :

Co-share 20% applied
Uses Reimbursement System

Daily Cash
Rupiah

Rp	Maximum Limit	A	B	C	D
Daily Cash	per day	350,000	500,000	750,000	1,000,000

US Dollar

USD	Maximum Limit	A	B	C	D
Daily Cash	per day	40	50	80	100

Notes :

Uses Reimbursement System

More information about SmartHealth-Maxi Care:

Q:	Who can join SmartHealth-Maxi Care?
A:	Anyone from age 15 days up to 60 years (over 60 only for extended policies).

Q:	What is the benefit of joining SmartHealth-Maxi Care health insurance?
A:	The policy holder will obtain the benefits of health insurance according to your needs, 24 hour, 365 day access to Allianz Medical Hotline to fulfill your medical needs and also additional benefits of international medical services (medical evacuation).

Q:	How do I obtain health services?
A:	For Inpatient and maternity, you can enjoy the benefit of cashless facilities using your card under Allianz-AdMedika hospital coverage. By presenting your insurance card, Allianz will cover your health expenses according to your benefit. The insured person may be expected to pay any charges in excess of the benefit, and must pay all remaining costs. You are free to choose the hospital or clinic you desire, then process your healthcare claim using the reimbursement system.

Q:	What is a No Claim Bonus?
A:	If there's no claim within the policy period and you renew your policy, you obtain a 20% discount on your next premium.

Q:	Should I invite my family to join and what do you mean by Family Discount?
A:	You are welcome to include your family members in this program, for which you will receive a 5% premium discount.

Q:	Is there any grace period before we can obtain the benefits of SmartHealth-Maxi Care?
A:	No, with the exception of pregnancy, maternity and post maternity.

Q:	How do I pay my insurance premium?
A:	Payments may be made by bank transfer, cash, cheque or credit card.

Q:	How do I make a claim and when do I receive my reimbursement?
A:	Ask the doctor to fill in and sign your claim form, along with the original copy of your receipt and all other documents. Send these to Allianz within 30 days of the health services date. Allianz will pay your claim within 14 working days after receiving all necessary documents.

Q:	What happens if I don't claim within 30 days or for any other reason?
A:	Allianz reserves the right to not pay the claim.

Q:	How to renew my policy?
A:	One month before the renewal deadline, Allianz will send you Renewal Notice by mail. If we receive don't receive any, then the policy will automatically expire. You can reactivate your policy within 3 months after expiry date by paying your policy fully (including any policy changes due to age). Your policy will be reactivated upon receipt of confirmation or payment from Allianz, whichever the latest. Pre-existing disease and other diseases claims will no longer be valid. Claim after policy expires up to policy renewal will not be processed.

This insurance product is not a bank product and is not included within the saving guarantee program by Saving Guarantee Department (Lembaga Penjamin Simpanan). Standard Chartered Bank only act as a distributing party and cannot be held responsible for any risk that might occur from this insurance product. This product is not an investment product (not a Unit Link insurance product)

Managed by: PT. Asuransi Allianz Life Indonesia Founded in August 16, 1996 with more than 10.000 agents. Currently, PT Asuransi Allianz Life Indonesia has 80 marketing offices and outlets located in 43 cities across Indonesia, starting from Banda Aceh up to Jayapura (Papua). It also operates an Allianz Center in Jakarta, Surabaya, Bandung and Denpasar. The usage of any bank logo or attribute inside this brochure does not necessarily mean that Smart Health Maxi Care is a bank product.

Comprehensive Health Insurance for You and Your Loved Ones,

Comprehensive Health Insurance
for You and Your Loved Ones,