Maestro Elite Care - Benefit Table Benefits Platinum Plan Gold Plan Silver Plan Please note: benefit values are per person each year unless otherwise specified and are reduced each time you claim only by the net amount (less any deductible, excess or co-insurance) we Area of cover Worldwide excluding USA Asia excluding HK and China Indonesia Yearly maximum up to IDR 16,500,000,000 IDR 6,600,000,000 IDR 3,300,000,000 Per medical condition maximum up to N.A. IDR 1,800,000,000 IDR900,000,000 Outside area of cover Emergency treatment only (maximum 90 days stay outside area of cover) Level of reimbursement Reasonable and customary (R&C) charges In-patient and daycare treatment (including surgery, consultations, organ transplants, consumables, surgical implants etc.) Daily accommodation charges Included – Standard Single room Included - 2-bedded room (Applicable inside and outside Indonesia) Daily accommodation charges Included – Standard Single room Included – Standard Single room Included – 2 bedded room or upgrade to (Applicable inside Indonesia) or daily room up to maximum IDR or daily room up to maximum Standard Single room or daily room up 1,200,000/night IDR 800,000/night to maximum IDR 400,000/night Parent accommodation up to Psychological counselling up to Cash benefit (when not claimed from AXA) In-patient direct billing Applicable in-patient direct billing network Level of cover Out-patient treatment Computerized tomography, magnetic resonance imaging, positron emission tomography, x-rays and gait scans Pre and post hospitalisation out-patient treatment up to Radiotherapy, chemotherapy, Kidney Dialysis treatment Surgical procedures received as an outpatient Other benefits Home nursing (subject to pre-authorisation) Ambulance transport International Emergency Medical Assistance Accidental damage to teeth Pre and post-natal complications New Born Accommodation Other features: 1. 5-2-2 Moratorium Underwriting (No medical questions on application IDR1,400,000 per night IDR 3,000,000 IDR 950,000 per night No benefit Included Global directory of hospitals 100% of reasonable and customary (R&C) charges up to the R&B entitlement Included No benefit IDR2,000,000 No benefit Included Included Included No benefit Included Included Included Included – available only after 12 months membership Included No benefit No benefit
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