Company Profile
PT.A.J.Central Asia Raya was established on
30 April 1975, by Notarial Deed of Ridwan
Suselo No.357. Since the establishment, all off
the shareholders board of commissioners, and
board of directors put their commitment to
make this company one of the life insurance
companies has passes through three decades
and continues to grow. This has been proven
by having assets of more than Rp.3.821
trillion, risk based capital ( RBC ) is 216% and
the only and the first life insurance company to
achieved Platinum Award form Infobank
magazine with “Excelent” rating for 10 years
consecutively (1999 to 2008 )
Shareholder support is very
important especially in terms
of capital, and it is proven
that the shareholder
approved the increase paid
up capital to Rp. 100 billion
in 2008. Total paid up capital
is in compliance with
government regulation for
insurance industry prior to
the issuance of regulation. It
is very important that the
company had anticipated
regulatory changes in the
insurance industry. Kantor Pusat Central Asia Raya
Wisma Asia Lt 11
Shareholders have always Jl Letjen S.Parman Kav 79
commited to maintain capital Jakarta Barat
adequacy for the operation,
the development, and the
solvency of the company. In 2012
capital/stockholders equity of the company
was more than Rp. 1.27 trillion and is
expected to continue to grow in accordance
with its development.
Innovative products which will give benefits
for customers are launched, ranging from
individual life insurance product, including :
life Insurance, individual health insurance,
critical illness, personal accident, unit-
linked;meanwhile for group ; group life
insurance, mortgage, health insurance for
employees and even as a management of
pension funds through Financial Institutions
Pension Fund ( DPLK CAR ). In 2012, the
company was launched personal health
insurance product- Prevensia Premier. And
this innovation will continue to grow in the
coming years.
The hard work of staff and
agents ( marketing
agencies ) proves that there
is no problem that can not be
resolved. The key is to unite
in facing all the problems.
Creativity is encouraged.
Many activities are created
from creativity by holding on
hard work and togetherness.
Extensive sales channel
distribution is shareholders
and management obsession
to preserve company growth
and to reach and serve
customers. Company has 84
sales offices supported by 47
customer servives offices
spreading in cities in 33
provinces. Expanding our sales channel
distribution, we also collaborate with banks
(bancassurance) & insurance supporting
companies/insurance broker.
 TE VALUE & STRENGTH

A. FINANCIAL

Financial strength reported at the end of 2012;

Total Assets : IDR 3,821 Triliun.
Capital : IDR 1,271 Triliun
Risk Based Capital (RBC) : 216 %.

B. ACHIEVEMENT

Platinum Award,
Central Asia Raya, PT recently has become the one and only life insurance company and the
first or as a pioneer insurance company which has been rewarded for several years as “the
best life insurance company” (based on “Infobank” and “Investor magazines”) 10 times

Golden award
Golden award for “excellent performance” reward for 5 years in a row (Infobank magazine
version)

C. OPERATION

In a daily routine operational for maintain and provide excellent services for all the customers
and policy holders, PT. Central Asia Raya provide services through;
• more than 700 employees and 1300 consultants
• 8 regional offices, 47 servicing office and 76 marketing offices spreading all over the
country.

Recently, PT. Central Asia Raya has been serving more than 800.000 policy holders all over
the country

D. PRODUCT RE-ASSURED

To support and maintain excellent products quality and the liquidity guarantee of liabilities to all
the policy holders, all the assurances products form CAR has been re-assured to several
insurers
 TE PREVENSIA

Several reasons why should be “PREVENSIA”

a. 38 years of experiences in organizing and developing excellent insurance products and

excellent services for the policy holders and customers has made CAR become an
excellent and professional insurance company
b. Simply flexible and easy for each insured member to choose any Hospitals, clinics, doctors,
pharmacy and labs according to their own need
c. No physical exam necessary to all members (except if there are other requirements has
been arranged in endorsement policy)
d. Medical cost of guarantee that PREVENSIA ensured the coverage for all the medical costs
occurred whether it is a sickness or bodily injury 24 hours and worldwide coverage.
e. In a very efficient premium rate, can be provided a coverage limitation of medical costs
effectively during a year period of insurance.
f. This program mechanism will help policy holder / company in monitoring discipline and
efficiency of using medical benefits and evaluating the health condition level of each
employee (insured member).
g. CAR Provide more than 600 Networked Hospitals facilities spreading all over in Indonesia
& several in Malaysia & Singapore
h. The program are also included death allowance and total permanent disability benefit.
i. 24 hours call centre / hotline service for ensure all the participants will be immediately
handled wherever and whenever they required hospitalization guarantee or any others
medical situation.
j. Competency and commitment in claim reimbursement payment due to our bench marked
process is approximately within maximum 10 days
k. Profit Sharing will be given to policy holder by the end of coverage period (for certain
premium amount) with the calculation formula as mentioned below;
25 % ((65% x Total premium / year) – Total claim occurred per-year)
l. Premium Refunding will be given to policy holder for any outgoing/ resignation membership
in the middle of insured period (without any claim occurred)
m. Policy holder is in title to ask insurer for claim paid reports whenever it is needed
n. Claims Pick Up service (if it is necessary)

TEBENEFITS

In general, all the benefits of PREVENSIA is to indemnify medical expenses of all Insured
persons as declared, caused by sickness and/or accident occurred during the period of
Insurance Cover.

Variety of benefit program can be selected according to company needs, as:

1. Hospitalization/inpatient, including surgical Benefits (Main benefits)

2. Outpatient benefits (rider benefits)
3. Dental benefits (rider Benefit)
4. Maternity, incl. delivery, miscarriages and pre post delivery (rider Benefit)

Nb : for more details benefit items see attachment

 CLAIM PROCEDURESTE

1. INPATIENT

Inpatient treatment or hospitalization is needed when a participant has to be treated for

sickness or injury for more than one day in the hospitals.
This treatment is only entitle provide by registered hospital or in an emergency situation at
some remote area with appropriate facilities as a hospital.

Claim procedures applied based on both Network Hospital system and/or reimbursement

Network/Provider Hospital System:

Procedures for Inpatient treatment in a networked hospital will be;

1. Participant register and show his/her “Prevensia” member card at admission section in a
referral networking hospital (based on update hospital referral list issued by CAR)
2. Participant must indicate or attach a photocopy of personal identity such as; citizen ID,
driving licensed or other personal identity
3. The hospital will inform the insurer (CAR) for providing a guarantee letter for the participant
(after a validity verification)
4. Participant will be treated in a room accommodation along with all the facilities in
accordance with the provisions of the benefits/plan, he/she entitle in.
5. Guarantee letter for hospitalization will still be given for a room upgrading if only in a
condition of fully boarded room (within 20% of plan upgrading), but when the room
upgrading is more than 20% of plan, provider system could not be applied anymore instead
a member should pay all the inpatient expenses occurred for he/she might reimburse it to
CAR (reimbursement)
6. In term of a situation that a participant could not show his/her member card to be registered
due to left at home, or the card is lost, or the card is still in the process in CAR underwriting
dept. he/she should immediately contact the Insurer (CAR) cq. Claims Department to be
checked his/her member validity and in order to obtain a letter of guarantee.
Reimbursment System:

Reimbursement system will be applied in term of condition such as a participant is treated in

non-networked/provider hospital or a participant is treated in a networked/ provider hospital but
in a room which higher than his/her maximum benefit plan entitle.
On those situation a participant/insured member should pay in advanced all the inpatient
expenses occurred for he/she might reimburse it to insurer (claim dept-CAR)

To reimburse all the expenses occurred during the treatment, a participant/member should
submit several authentic documents, as mentioned below;
• All the original bills and receipt from hospital
• Detail description of each treatment bills
• Detail information regarding drugs or medication used during the treatment
• Copies of laboratory or diagnostic test result.
• Medical record/medical resume, which inform all the anamneses (early diagnose),
medication and treatment, final diagnose.
• “Attending Physician statement” form filled up by the treating doctor.
• Refer to a “pre and post hospitalization treatment” condition, there should be information
which indicate it is a related treatment to the hospitalization treatment and the diagnose has
to be similar as it before.

All those documents usually might be obtained from the hospital cashier when checking out
and paying the bills.

The participant should submit those documents to HRD of his/her company as policy holder for
they can be collected and administratively checked and recorded at HRD,
And then HRD might forward all the claim documents to insurer (CAR) to be processed.

2. OUTPATIENT
In a standard term, outpatient claim procedures is can be applied as reimbursement system
only, as the participants able to choose their own doctors, pharmacies, clinics, etc for they just
simply reimburse all the treatment and medication expenses occurred to insurer (CAR).

Several authentic documents should be submitted as outpatient claim, such as;

• Original billings and receipts from the doctors at private practice or at clinics or at hospitals
• Original billings and receipts of drugs and medicines bought from pharmacy along with the
copy of medicines recipe
• Diagnose information of the illness filled up by the treating doctor in the “diagnose form”
provided by insurer (CAR) or on doctor memo or on the billings receipt
• For laboratory or diagnostic test/examinations, the recommendation from treating doctor
has to be attached along with the test result.

3. DENTAL TREATMENT
All procedures regarding claim for dental treatment is remain the same as in outpatient.

4. MATERNITY
All procedures regarding claim for Maternity is remain the same as Hospitalization/inpatient
procedures.
5. DEATH BENEFIT
If there is any participant/member dies during the period of coverage, the authentic documents
for death claim are needed such as;
• Official proposal from policy holder which inform the death
• Official letter from treating doctors which inform caused of death or the disease (die at
hospitals, clinics) or forensic examination (if necessary)
• Letter of death chronology which explain the death made by his/her family (die at home)
• “Prevensia” member card and copies of other personal ID, such as KTP, KK, etc
• Official statement letter from local police department in charged (die by traffic accident)

The participant should submit those claim documents mentioned above to HRD of company as
the policy holder for they can be administratively collected, checked and recorded at HRD,
And then HRD might forward all the claim documents to insurer (CAR) to be processed.

All the documents are expected to be received by the insurer (CAR-claim dept.) within 30 days,
other wised they might be considered as expired and invalid documents and can not be
proceed and paid to insured members.

Insurer will process all the claim documents which are considered valid and complete for the
payment can be received by policy holders within 14 working days.
 EXCLUSIONE
The Insurer shall have no obligation to pay insurance benefits in the following cases :
SELF-INFLICTED/SELF-INDUCED INJURY
Due to suicide attempts or Injury caused by
acts of the participant carried out intentionally
in full awareness or otherwise.
VIOLATION OF THE LAW:
Due to violation or infringement of official laws
or regulations.
RADIATION
Radiation due to experiments or contamination
by radioactivity from any type of nuclear fuel or
nuclear waste produced from the process of
nuclear fission or from any material used in
nuclear weapons.
COSMETIC SURGERY
Cosmectic surgery or treatment, except those
considered necessary to repair physical Injury
or defect due to an accident which occurred
while the Policy was valid.
PERSONAL DEVICES
The use of a prosthesis, heart pacemaker,
eyeglasses, hearing aid, except when the
defect requiring such aid is due to an accident
which must be proven by written certification
from a doctor and which occurred while the
Policy was valid.
CONGENITAL AND HEREDITARY DEFECTS
PSYCHOLOGICAL
Disturbances due to a mental condition,
including drugs related to the said mental
condition.
FAMILY PLANNING DEVICES :
Contraceptive devices, sterilization and
treatment or diagnosis or medication to
achieve fertility.
PREGNANCY
All matters related to the process of
pregnancy, including abortion, pregnancy
examinations, treatment for pregnancy
complications, and both normal and abnormal
childbirth.
INFECTIOUS DISEASES OF GENITAL
ORGANS DUE TO ANY CAUSE
Treatment of infectious diseases of genital
organs which is cause by sexual relations or
not caused by sexual relation.
HIV INFECTION, AIDS ( Acquired Immuno
Deficiency Syndrome) and ARC ( AIDS
Realted Complex )
CHECK-UP :
Routine medical check-up or examination that
is not related to the treatment or diagnosis of a
disease covered by the insurance Policy, and
immunization/ inoculations.
DENTAL CARE:
-All types of dental surgery, with
hospitalization or as out patient
-Dental care and treatment except:
Any care treatment deemed necessary
because of injury or damaged caused by an
accident to the natural and healthy teeth that
occurred while the Policy was still inforce
The dental care or treatment included in the
paragraph on General Dental Care
LABORATORY EXAMINATION
/DIAGNOSIS AND
UNNECESSARY TREATMENT
Laboratory examination/Diagnosis Treatment
or medication that is not medically required or
has no relation to the treatment of a disease or
injure.
DRUG ABUSE :
Disease or injure caused by the abuse or
misuse of narcotics, alcohol, psychotropic
drugs or other prohibited drugs.
DANGEROUS SPORTS :
Disease or Injury as the result of training for
the use of aqua-lungs or scuba diving, cliff
climbing or rock climbing that requires the use
of thick ropes or special equipment, hot poling,
parachute jumping, hang gliding, professional
sport or races/ competition such as automobile
racing, horse racing, para-gliding, sailing, or
swimming in open sea, mountain climbing,
boxing, wrestling and other sport which
contain an element of danger and carry high
risk.
DRUGS :
Drugs that can be purchased freely over the
counter (OTC) without and/ or with a doctor’s
prescription in a dispensary / pharmacy or
drugs which are not appropriate for the
disease or Injury suffered.
MODIALYSIS :
Hemodialisis or purification of the blood,
including all the related costs.
PRE – EXISTING CONDITION :
Pre-existing conditions shall not be covered
prior to the passing of a 12 month (twelve)
month period, commencing the date the
Health insurance Policy becomes effective for
the participant concerend.
CIRCUMCISION :
Circumcision carried out for any reason.
TRANSPLANTATION of BODY ORGANS :
Surgery to transplant body organs including
bone marrow transplantation or neurological
transplantation and all the related costs.
LEUCORRHOEA :
Any kind of leucorrhoea due to any causes
whatsoever.
ABNORMALITIES IN EYE REFRACTION :
Examination and treatment for abnormalities in
eye refraction due to any causes whatsoever.
PT.A.J.CENTRAL ASIA RAYA
REINSURANCE