What is a health insurance deductible — and should you choose one?

How the deductible works

The deductible works annually: within each policy year, you bear eligible costs up to your chosen deductible amount, and eligible claims above it are paid according to your plan. On Plan Extra and Plan Premier you can choose between deductible options starting from Rp6 million a year — the deductible tempers routine claims, which is one of the ways the product keeps the cost of care, and therefore future repricing, in check.

Your advisor will show you the available options side by side, including what each does to your premium, before you choose.

The deductible options

Both Plan Extra and Plan Premier offer two deductible options, and the amount that applies depends on where you are treated — Preferred Network hospitals carry the lowest deductible.

*Asia excluding Singapore, Hong Kong and Japan. The category on the first date of service applies; if care in one policy year spans categories, the highest applicable deductible governs. Once you have met the full deductible in a policy year, later eligible claims that year are paid in full.

When the deductible does not apply

No deductible is charged for outpatient services, for emergencies caused by an accident or force majeure, for HIV/AIDS care, or for critical illness within the palliative-care benefit. For emergencies, the waiver applies while care is purely the initial handling to stabilise you — once you are stable, continued care is subject to the deductible. Plan Standard carries no deductible at all, and under OJK transparency rules a no-deductible plan is always shown alongside the deductible plans so you can compare the benefit differences before deciding.

The separate deductible for Special Diseases

Claims arising from the policy’s 15 listed Special Diseases carry their own temporary deductible: Rp100 million per policy year, applying for the six months after the Special-Disease waiting period ends in your first policy year. From the second policy year onward, Special-Disease claims are charged the ordinary deductible for the hospital category you use. The list includes condition groups such as heart and vascular disease, kidney and urinary stones, cataract, benign tumours, diabetes, hypertension and hernia — the full list is on our FAQ page.

How a deductible affects your premium

Choosing a deductible lowers your premium and supports flatter, more predictable premium adjustments over time — it does not make premiums fixed. Premiums still rise with the insured’s age and can be repriced at renewal, and the deductible amount itself may be revised to reflect health-cost inflation, effective only at a policy anniversary.