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Three critical illnesses, namely cancer, stroke, and heart attack, are among the leading causes of premature death and long-term disability in Indonesia. Their impact is not only on physical health, but also on family finances because treatment costs can continue to run, even for BPJS Kesehatan participants. This article discusses the differences between critical illness insurance and regular health insurance, the benefits of protection, and how to choose the right policy.
Data from the Indonesian Ministry of Health shows that non-communicable diseases such as cancer, heart disease, stroke, and diabetes have now become the leading causes of death in Indonesia, surpassing infectious diseases. More than 400,000 new cancer cases are diagnosed every year in Indonesia, while the five-year survival rate is still far below the average of high-income countries.
From a financial perspective, the risks also need to be taken seriously. The cost of treating critical illnesses can become a major burden for families, especially if the patient requires repeated treatment, long-term rehabilitation, or access to private health facilities.
As an illustration, chemotherapy costs for stage two breast cancer can reach IDR 50 million to IDR 150 million per cycle, depending on the treatment regimen and the health facility used. Stroke that requires long-term rehabilitation can also result in physiotherapy and care costs of around IDR 10 million to IDR 30 million per month. Meanwhile, heart bypass surgery at a private hospital can range from IDR 100 million to IDR 250 million.
BPJS Kesehatan can help cover part of the treatment costs, but it still has a number of limitations that need to be understood. Some of these include long queues at referral health facilities, drug options that follow the national formulary, and limitations for experimental therapies or the latest-generation treatments.
For patients who need faster access, broader treatment options, or follow-up care outside standard coverage, the cost difference that must be paid out of pocket can be very large.
This is where critical illness insurance plays a role. Unlike health insurance, which reimburses actual medical expenses, critical illness insurance provides a lump-sum cash benefit when the insured is diagnosed with an illness listed in the policy, without having to wait for hospital bills.
This cash benefit can be used for various needs, including treatment costs, income replacement during recovery, the family’s daily needs, or other supporting costs that are not always covered by regular health insurance.
To understand relevant health risks, you can read Oona’s guide on common types of cancer in Indonesia, including cancer types that often occur and factors that can increase the risk. In addition, the article about causes of stroke that often go unnoticed can help you assess whether critical illness protection is suitable for your family’s health condition and financial needs.
Before comparing products or calculating protection needs, it is important to first understand what critical illness insurance is, how its benefits are paid, and why this product is different from regular health insurance.
Critical illness insurance is an insurance product that provides a benefit in the form of a lump-sum cash payment when the insured is diagnosed with a critical illness covered in the policy. The illnesses covered usually include serious conditions such as cancer, stroke, heart attack, kidney failure, and other critical illnesses, depending on the terms of each product.
Unlike regular health insurance, critical illness insurance benefits do not always depend on the amount of hospital bills. If the claim is approved according to the policy terms, the insured will receive the sum insured according to the benefit value selected when purchasing the policy.
This cash benefit can help families deal with the financial impact that arises after a critical illness diagnosis. The funds can be used for various needs, such as treatment costs, follow-up consultations, medicines, recovery, transportation to health facilities, the family’s daily needs, or temporary income replacement while the insured is unable to work.
After understanding how critical illness insurance works, the next step is to look at how it differs from health insurance. This comparison is important because the two are often considered the same, even though their functions, claim methods, and benefit uses are different.
Aspect |
Critical Illness Insurance |
Health Insurance or BPJS |
|---|---|---|
Benefit Payment Mechanism |
Paid as a lump sum after the diagnosis of a covered critical illness and the claim is approved |
Reimburses or pays medical treatment costs according to bills and benefit terms |
Basis of Payment |
Based on the diagnosis of an illness listed in the policy |
Based on eligible actual medical expenses |
Use of Benefits |
More flexible, including for treatment, living expenses, recovery, or family needs |
Generally limited to medical costs recognized in the policy or health insurance program |
Benefit Amount |
Fixed according to the selected sum insured |
Follows actual costs, benefit limits, annual limits, treatment class, or program terms |
Waiting Period |
Usually subject to a certain waiting period from when the policy becomes active |
Varies depending on the product, program, and type of service |
Disease Coverage |
Refers to the list of specific critical illnesses in the policy |
Broader for general health services, but still follows coverage terms and exclusions |
Disclaimer: Benefits, waiting periods, exclusions, critical illness definitions, claim requirements, and the list of covered illnesses may differ between products and insurance companies. Always read the product information summary, policy, and claim terms in full before buying.
In other words, health insurance helps pay for medical treatment costs, while critical illness insurance helps provide additional financial support when the diagnosis of a serious illness begins to affect income, savings, and family needs.
This protection can be a complement, not a replacement, for BPJS Kesehatan or health insurance. For some people, a combination of BPJS, health insurance, and critical illness insurance can help create more comprehensive protection against medical costs and the risk of losing income due to serious illness.
Because each product’s coverage can differ, prospective customers need to see which illnesses are truly covered in the policy. For Oona Critical Illness Insurance, protection is focused on three major health risks that are of great concern to many families in Indonesia.
Oona Critical Illness Insurance is designed to provide financial protection against three major critical illnesses, namely cancer, heart attack, and stroke. These three conditions are serious illnesses that can require high treatment costs, long recovery periods, and affect a person’s ability to work and meet family needs.
Unlike some other critical illness insurance products that may cover dozens of types of illnesses, Oona Critical Illness Insurance focuses on protection against three major health risks that are often the main concern of families in Indonesia.
It is important to understand that not every diagnosis automatically qualifies for a claim. Each illness has medical definitions, severity levels, waiting periods, exclusions, and claim terms that must be fulfilled according to the policy.
Critical Illness |
General Explanation |
|---|---|
Cancer |
Protection is provided for cancer that meets the definitions and terms in the policy, including certain types of cancer according to the applicable claim requirements |
Heart Attack |
Protection is provided if the insured experiences a heart attack that meets the medical criteria and policy terms |
Stroke |
Protection is provided for stroke that meets the medical definition, severity level, and claim requirements according to the policy |
Disclaimer: Oona Critical Illness Insurance only covers the critical illnesses mentioned in the policy, namely cancer, heart attack, and stroke. Benefits, illness definitions, waiting periods, exclusions, and claim requirements follow the applicable policy terms.
The protection focus on cancer, heart attack, and stroke makes this product easier to understand for prospective customers who want to protect their families from major critical illness risks. However, before buying, it is important to read the product information summary and policy in full so that you understand the illnesses covered, waiting periods, exclusions, and documents needed when making a claim.
One question that often arises is whether someone still needs critical illness insurance if they already have BPJS Kesehatan. The answer depends on protection needs, financial condition, choice of health facilities, and the family’s ability to face additional costs when a serious illness occurs.
BPJS Kesehatan provides important access to health services for the Indonesian public. This program can help cover many medical needs according to service pathways, referral requirements, and applicable benefits. However, patients still need to understand the existence of tiered referral procedures, service availability, health facility options, and the list of drugs that follow program requirements.
Private health insurance can complement BPJS with more flexible access to certain hospitals, more comfortable room options, and different service processes depending on the product. However, health insurance generally still focuses on paying eligible actual medical costs. This product does not always provide income replacement if the insured is unable to work during treatment or recovery.
Critical illness insurance fills a different need. This product provides a lump-sum cash benefit when the insured is diagnosed with a covered critical illness and the claim is approved according to the policy terms. The funds can be used more flexibly to help with treatment costs, household needs, transportation, patient companions, recovery, or temporary income replacement.
Type of Protection |
Main Function |
Advantages |
Things to Understand |
|---|---|---|---|
BPJS Kesehatan |
Helps provide access to health services according to the national insurance program |
Important as basic protection and can be used by many Indonesian people |
Follows referral pathways, health facility requirements, and program benefits |
Private Health Insurance |
Helps pay actual medical costs according to the policy |
Can provide additional access to certain hospitals, rooms, and services |
Benefits usually follow medical bills, limits, exclusions, and policy terms |
Critical Illness Insurance |
Provides a lump-sum cash benefit after the diagnosis of a covered critical illness |
Funds can be used more flexibly for medical and non-medical needs |
Claims depend on illness definitions, waiting periods, exclusions, and policy requirements |
Disclaimer: This table is a general comparison to help readers understand the different functions of BPJS Kesehatan, private health insurance, and critical illness insurance. Benefits, limits, service pathways, waiting periods, exclusions, illness definitions, and claim requirements may differ depending on the applicable program or policy.
In other words, BPJS helps provide access to basic health services, private health insurance helps complement the payment of medical costs, while critical illness insurance helps provide cash funds when a serious illness begins to affect the family’s financial condition.
For some families, a combination of all three can provide more comprehensive protection than relying on only one type of protection. BPJS can serve as the foundation, private health insurance can help expand access to treatment, and critical illness insurance can help maintain family liquidity when a major risk occurs.
If BPJS, private health insurance, and critical illness insurance have different functions, then the next decision is to adjust protection to the budget. Therefore, it is important to understand the factors that affect premiums before choosing benefits and the sum insured.
Critical illness insurance premiums can differ for each person. The amount of the premium is usually influenced by the profile of the prospective insured, the selected protection value, and the terms of the insurance product used.
In general, age at enrollment is one of the main factors. The younger the prospective insured is when buying protection, the lower the risk assessed by the insurance company. Therefore, premiums for younger ages are generally more affordable than for older ages for the same protection benefits.
In addition to age, insurance companies may also consider other factors such as current health condition, medical history, lifestyle habits, occupation, amount of sum insured, protection period, and the critical illnesses covered in the policy.
Factor |
Effect on Premiums |
|---|---|
Age at Enrollment |
As age increases, premiums can generally become higher because health risks increase |
Health Condition |
A history of illness or certain health conditions can affect the risk selection process |
Sum Insured |
The greater the selected benefit value, the greater the premium that needs to be paid |
Type of Protection |
Disease coverage, protection period, and additional benefits can affect premium prices |
Policy Terms |
Waiting periods, exclusions, claim requirements, and product terms can differ between insurance companies |
Disclaimer: This information is general and does not replace the product information summary, benefit illustration, or official policy. Actual premiums may differ depending on age, risk profile, sum insured, selected benefits, underwriting results, and insurance company terms.
For Oona Critical Illness Insurance, protection is focused on three major critical illnesses, namely cancer, heart attack, and stroke. Because coverage, benefits, and policy terms may differ from other critical illness insurance products, prospective customers should check premiums based on their individual profiles and protection needs.
One important principle in planning critical illness protection is to buy while your condition is still healthy and the risk is still lower. Delaying the purchase can make premiums more expensive as age increases. In addition, if health conditions change, the process of applying for protection can become more difficult or require additional assessment from the insurance company.
Choosing critical illness insurance is not enough by looking only at the premium. You also need to understand the benefits, illness definitions, waiting periods, claim payment methods, and policy terms thoroughly.
Calculate the estimated cost of critical illness treatment at the health facility you want. Also add the family’s living expenses and income replacement needs during recovery, for example for 12 to 24 months. From this calculation, you can estimate the minimum sum insured that suits your family’s financial needs.
Do not only look at the names of illnesses listed in the brochure. The definitions of cancer, heart attack, or stroke can differ between insurance products. For example, a policy may require a stage, severity level, medical examination results, or certain conditions before a claim can be approved.
Most critical illness insurance policies have a waiting period, which is the period after the policy becomes active when claims cannot yet be submitted for certain conditions. Waiting periods can differ between products, so it is important to understand when protection truly begins to apply.
Check whether benefits are paid as a lump sum after the diagnosis of a covered critical illness, or follow a certain payment structure based on the condition and policy terms. For family financial protection, lump-sum cash benefit payments can help provide liquidity when treatment costs and daily needs begin to increase.
Lower premiums do not necessarily mean more suitable protection. Compare benefits, covered illnesses, claim definitions, waiting periods, exclusions, sum insured, and ease of the claim process before choosing a product.
Choose an insurance company that is licensed and supervised by the Financial Services Authority (OJK). This is important so that you buy a product from a provider that has legality and follows insurance industry regulations in Indonesia.
Ultimately, critical illness protection is not only about premium costs, but about a family’s readiness to face financial risks that can arise after a diagnosis of cancer, heart attack, or stroke. By understanding the benefits, coverage, waiting periods, and policy terms, you can choose protection that better suits your family’s needs.
Delaying critical illness protection is one of the common mistakes in family financial planning. While still healthy and actively working, insurance applications are usually easier to process, while premiums can be more affordable than when age has increased or health conditions have begun to change.
If someone already has a history of illness or has been diagnosed with a certain health condition, applying for insurance can become more difficult. Insurance companies may request additional examinations, provide special terms, exclude certain conditions, or reject the application according to underwriting results and policy terms.
A healthy lifestyle remains the main step to reduce the risk of cancer, heart attack, and stroke. Before determining the sum insured, also understand the importance of critical illness protection in family financial planning, especially if you have dependents, installments, or regular needs that continue when you are sick. To evaluate protection options, you can learn about the benefits and check prices for free through the Oona Critical Illness Insurance page.
