Lecturing of Basic of Health Insurance - Stikes Indonesia Maju (STIKIM)

1. Risky Kusuma Hartono
1
Sekolah Tinggi Ilmu Kesehatan Indonesia Maju

2. Definition of Contract
§Agreement of 2 people/ parties
§Voluntary
§Should be written
§Binding
2

3. Insurance Contract
§Agreement between insurer and
policy holder (insured)
§insurer agree to give compensation
or benefit to policy holder after
premium payment to the insurer
§All of the terms about the rights and
obligations are written in the policy
3

4. Basic Element of Contract
1. Consideration
2. Meeting of the minds
3. Capacity to contract
4. Offer and acceptance
4

5. Consideration
§The action of one party is reciprocal
from the other party
§prospective policy holders: submit
applications and pay premiums
§Insurer: promises to pay benefits based
on the policy provision
5

6. Meeting of the Minds
§ Both parties must have the same
understanding of the agreement contents
and the rights and obligations each other
§ They must have good faith
§ Without good faith it will not be reached
meeting of the minds à CANCEL CONTRACTS
6

7. Capacity to Contract
§Both parties must be able to understand
the contents of the contract
§Without the capacity it WILL NOT REACH a
meeting of the minds
§Children & insane people are considered
unable to make contracts
7

8. Offer and Acceptance
§One party makes an offer and the other
party accepts the offer
§Prospective policy holders make an offer
by submitting an application and paying
a premium
§Insurer accepts the offer by issuing the
policy
8

9. Special Characteristics of
Insurance Contracts
1. Unilateral contracts
2. Conditional contracts
3. Aleatory contracts
4. Contracts of adhesion
9

10. Unilateral Contracts
§Only one party makes an appointment
§Insurer promised to pay benefit
§Policy holders do not promise to pay
the premiums
10

11. Conditional Contracts
§Insurer will pay the benefits IF
ONLY the risk of insured occurs
§The contract requires to cover
the loss
11

12. Aleatory Contracts
§The value obtained by one party
(insurer or policy holder) can be
bigger or smaller than its
obligations
12

13. Contracts of Adhesion
§Contracts are offered based on the
principle of take-it-or-leave-it by the
insurer who have more knowledge
than policy holders who have limited
resources and little expertise
13

14. Policy
§ Written agreement between insurer and policy
holder
§ Explaining all of the terms including rights and
obligations of 2 parties
§ Containing (SPA, Illustration, ID, proof of payment,
rights and obligations)
§ Is there any forms of insurance contracts besides
policies form?
14

15. Policy Clause
§ The day and date of the insurance agreement
§ Insured's name
§ Clearly insured description
§ Amount insured
§ danger / event / perils that are covered by the insurer
§ Start and end of the coverage
§ Insurance premium
§ Disclaimer
15

16. General Provision
§ Entire Contract
§ Validity of Statement
§ Age statement error
§ Administrative error
§ Record Keeping
§ Proof of Loss
§ Assignment Benefit
16

17. Other Provision
§Effective date
§Information Required Policy Holder
§Premium payment
§Grace Period
§Experience Refund
§Termination
17

18. Provisions Related to Insured
§ Eligibility
§ Benefit
§ Pre-exiting condition
§ Insuring clause
§ Coordination of Benefit
§ Renewal Provision
§ Non cancellable
§ Guaranteed renewable
§ Optionally renewable
18

19. risky_kusuma@yahoo.com
19