BCA - Dental Care Plan

Other Provisions

Advantages

Ease of cashless treatment at hundreds of hospitals and dental clinics in the Innova Care network in more than 50 cities throughout Indonesia.
Provide dental plan benefit up to Rp10,000,000 per year
Benefits up to 100%* for:

Emergency dental treatments
Regular dental visit
Preventive dental treatment, such as prophylaxis (dental cleaning)
X-ray, such as ¬panoramic X-ray

Benefits up to 80%* for:

Fillings and extractions
Root canal treatment

Fixed premium and no grouping based on age

Access to Our Network

The Insured is entitled to preferential treatment coverage for services and procedures when visiting our Network Member Provider. To access the benefits, the Insured must call the Insurer at 0-800-1-333-111. The Insured is required to read the Policy Schedule to obtain further information about the benefits, treatment and procedures covered by this Policy.

Tabel Premi dan Manfaat

Premium	Plan 1		Plan 2		Plan 3		Plan 4
Premium	In-Network Provider	Out-of-Network Provider	In-Network Provider	Out-of-Network Provider	In-Network Provider	Out-of-Network Provider	In-Network Provider	Out-of-Network Provider
Premi bulanan	IDR 148,000		IDR 166,000		IDR 191,000		IDR 211,000

BENEFITS		Plan A		Plan B		Plan C		Plan D
BENEFITS		In-Network Provider	Out-of-Network Provider	In-Network Provider	Out-of-Network Provider	In-Network Provider	Out-of-Network Provider	In-Network Provider	Out-of-Network Provider
Visit	Emergency dental treatments	80% Guarantee	50% Guarantee	100% Guarantee	70% Guarantee	80% Guarantee	50% Guarantee	100% Guarantee	70% Guarantee
Visit	Emergency palliative care and minor procedures	80% Guarantee	50% Guarantee	100% Guarantee	70% Guarantee	80% Guarantee	50% Guarantee	100% Guarantee	70% Guarantee
Preventive	Prophylaxis (dental cleaning) / scaling and cleaning/fluoride application (cleaning not included)	80% Guarantee, 1 visit per year	50% Guarantee, 1 visit per year	100% Guarantee, 1 visit per year	70% Guarantee, 1 visit per year	80% Guarantee, 1 visit per year	50% Guarantee, 1 visit per year	100% Guarantee, 1 visit per year	70% Guarantee, 1 visit per year
X-ray	Dental Radiology (panoramic x-ray)	80% Guarantee, 1 visit per year	50% Guarantee, 1 visit per year	100% Guarantee,1 visit per year	70% Guarantee,1 visit per year	80% Guarantee, 1 visit per year	50% Guarantee, 1 visit per year	100% Guarantee, 1 visit per year	70% Guarantee, 1 visit per year
Conservation	Fillings (amalgam or composite/resin)	80% Guarantee up to 2 teeth per year	50% Guarantee, up to 2 teeth per year	80% Guarantee, up to 2 teeth per year	50% Guarantee, up to 2 teeth per year	80% Guarantee, up to 3 teeth per year	50% Guarantee, up to 3 teeth per year	80% Guarantee, up to 3 teeth per year	50% Guarantee, up to 3 teeth per year
Extraction	Simple extraction – erupted tooth or exposed root	80% Guarantee up to 2 teeth per year	50% Guarantee, up to 2 teeth per year	80% Guarantee, up to 2 teeth per year	50% Guarantee, up to 2 teeth per year	80% Guarantee, up to 3 teeth per year	50% Guarantee, up to 3 teeth per year	80% Guarantee, up to 3 teeth per year	50% Guarantee, up to 3 teeth per year
Extraction	Complicated extraction– partially bony teeth or root	80% Guarantee up to 2 teeth per year	50% Guarantee, up to 2 teeth per year	80% Guarantee, up to 2 teeth per year	50% Guarantee, up to 2 teeth per year	80% Guarantee, up to 3 teeth per year	50% Guarantee, up to 3 teeth per year	80% Guarantee, up to 3 teeth per year	50% Guarantee, up to 3 teeth per year
Endodontic	Root canal, 1 canal (including x-ray fee)	Access to In-Network Provider and Special Price	No benefit	Access to In-Network Provider and Special Price	No benefit	80% Guarantee, 1 treatment per year	50% Guarantee, 1 treatment per year	80% Guarantee, 1 treatment per year	50% Guarantee, 1 treatment per year
	Root canal, 2 canals (including x-ray fee)
	Root canal, 3 canals (including x-ray fee)
Maximum Coverage per Year		IDR 10,000,000		IDR 10,000,000		IDR 10,000,000		IDR 10,000,000
Waiting Period (except for emergency palliative care and minor procedures)		90 Days		90 Days		90 Days		90 Days

OJK Disclaimer

OJK Disclaimer:

Dental Care Plan is an Insurance Product marketed specifically based on the collaboration between PT Chubb General Insurance (Chubb) and PT Bank Central Asia (BCA)
The Insurance Product is not a product and responsibility of the Bank, thus is not included in the guarantee program, and the Bank shall not be responsible for any information issued by Chubb
PT Chubb General Insurance and PT Bank Central Asia Tbk is licensed and supervised by Financial Services Authority (Otoritas Jasa Keuangan)