Here's the Difference Between Employee and Individual Health Insurance You Need to Know!

Having health insurance is mandatory for you because this insurance can help with many things when you must deal with unwanted conditions. But in fact, there are still many who are confused about individual health insurance and employee health insurance provided by the office as a facility.

Perhaps one of the most basic questions about these two things is: if you already have one of these health insurances, do you still need another health insurance?

Well, to answer questions related to individual and employee health insurance, you can look at the explanation in this article. Hopefully, you can get further insight into the two health insurances, ranging from benefits, payments, how to claim, and so on.

Also read: 2 Types of Car Insurance and Its Benefits You Should Know

Individual Health Insurance vs Employee Health Insurance

The first difference is in the understanding or definition. Individual health insurance is coverage that you can purchase on your own and is a product that offers health insurance in the form of protection and fulfillment of medical expenses during the grace period and benefit limits set in the insurance policy terms and conditions.

The costs covered generally start with doctor consultations, outpatient costs, hospitalization costs, childbirth costs, medicine costs, surgical costs, and other coverage costs in the insurance policy. Then what about employee health insurance?

Specifically, this insurance product is intended for employees who are facilitated by the company. Because it is provided by the company, employees do not need to 'buy' this insurance with the money they have received as benefits from the company.

Premium payments can be borne by your company or not fully borne by you but will be assisted by the distribution agreed upon by the company and you as an employee. Later, the insurance provider and the product chosen will depend on the options provided by the company.

Differences between Individual and Employee Health Insurance

After understanding the differences in general, let's explore further the differences between these two insurances. Equally useful to help and guarantee health facilities that may be used in the future, here are the differences between the two.

1. Payment Process

Employee insurance premiums will be paid directly by the employer each month, and if cost sharing is required, it will be deducted from the employee's compensation. The amount is a proportion of the overall compensation plus a percentage of the company's payment. However, certain companies include insurance premium payments as one of the advantages they offer to their employees. As an insurance policy holder, you must pay for personal insurance directly.

2. Benefits Provided

The second point is about the benefits provided by these two types of insurance. You, as an individual insurance holder, can, at the beginning of purchasing insurance, determine what benefits you will be able to get. But generally, the benefits provided are inpatient and outpatient. The amount of benefits obtained will affect the amount of premium paid each month and will be clearly written in the insurance contract.

Unlike employee health insurance, the benefits provided are more diverse and uniform between one person and another. Starting from the benefits of hospitalization, outpatient care, dental care, childbirth, and glasses. This is because the parties who make up the agreement are companies and insurance product providers.

Also read: Get To Know The 5 Benefits of Insurance in General and Their Types

3. How to Claim?

The way claims are made is also quite different. Individual health insurance is generally claimed with a reimbursement system, such as completing some specific conditions, according to what was agreed upon at the beginning of the purchase of insurance products. Starting from a claim form that has been filled out completely, a complete medical resume filled out by the treating doctor, original receipts and details of treatment costs and drug prescriptions, photocopies of lab examination results, photocopies of identity, original power of attorney for requests for medical data to the hospital, photocopies of driver's licenses and investigation reports from the local police if an accident occurs, an original statement letter with details of claim payments from other insurance, an original receipt for overpayment of maintenance, and a statement letter of guarantee by BPJS. However, there are some individual health insurance plans that also have a cashless method.

For employee insurance, the way to claim is through cashless and reimbursement methods. The cashless method will be easier because you only need to swipe the insurance card you have from the office. While the process with the reimbursement method is carried out in long stages, starting from reading all benefits and benefits, looking at the annual limit, checking the exclusion provisions, submitting a claim as soon as possible, and completing the required documents.

If You Already Have Employee Health Insurance, Do You Need To Have Individual Health Insurance?

Now it's clear: what are the differences between employee health insurance and individual health insurance? There are pluses and minuses to each of these insurances, and of course, all the benefits will be much more complete when you have both.

The question in this subheading can easily be answered with a positive sentence: You do need individual insurance to complete insurance from the office.

The points that you can make your main consideration are as follows:

• Guarantee is limited to office insurance that can be provided by a benefit coordination program with individual insurance. In general, at the time of treatment, you must opt to use insurance as the first guarantee. Furthermore, you can apply to the office for the remaining cost of treatment that is not guaranteed by the first guarantor to individual health insurance / health insurance. Of course, the guarantee will be based on the policy's terms and circumstances.
• Not all offices cover family members with the health insurance solutions they provide.
• In general, the services offered by office insurance are usually at a regular level, and do not give outstanding service when needed.
• Office insurance coverage is plainly related to job status; essentially, when you resign, the advantages received will also be gone.

So basically, the existence of individual health insurance will be the perfect complement to the benefits provided by office insurance and can provide optimal protection for each family member at the same time.

Also read: Understand What Insurance Is, the Different Types, and the Top 5 Reasons Why You Should Have the Right Insurance

Having a reliable health insurance product from the office is obviously an advantage in itself. But having an optimal individual health insurance product will be the ace you have to deal with various unwanted conditions. Therefore then AXA Insurance Indonesia offers SmartCare Executive Health Insurance Individual with very abundant benefits. In addition to helping you deal with unwanted health situations from the financial side, you can also protect family members with this insurance. So, immediately complete the insurance you have from the office with reliable products from AXA Insurance right now!

* Promo code is valid for direct purchase on AXA myPage until December 31, 2023

Source: 

• https://www.gooddoctor.co.id/program-kesehatan-karyawan/asuransi-karyawan/cara-klaim-asuransi-kesehatan/
• https://axa.co.id/-/cara-mudah-ajukan-klaim-asuransi-kesehatan-dari-kantor
• https://easysunday.co.id/blog/id/ketahui-perbedaan-asuransi-kesehatan-pribadi-dan-asuransi-karyawan/#:~:text=Asuransi%20karyawan%20menetapkan%20preminya%20sama,pula%20premi%20yang%20harus%20dibayarkan.
• https://axa-mandiri.co.id/-/apakah-perlu-melengkapi-asuransi-kesehatan-dari-kantor-dengan-asuransi-pribadi
• https://sikapiuangmu.ojk.go.id/FrontEnd/CMS/Article/40788
• https://mypage.axa.co.id/news/tata-cara-pengajuan-klaim