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All Journal International Journal of Health and Pharmaceutical (IJHP)
Yulita, Hanna
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Nursing Public Health

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Healthcare Insurance Agreement Regarding Financing of Health Services by Insurance Companies Novia Laras, Dewi; Yulita, Hanna; Ikhsan, Muhamad; Puspitaloka Mahadewi, Erlina
International Journal of Health and Pharmaceutical (IJHP) Vol. 5 No. 3 (2025): August 2025 (Indonesia - Malaysia)
Publisher : CV. Inara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51601/ijhp.v5i3.424

Abstract

This study analyzes health insurance as a form of financial protection designed to reduce the burden of medical costs when a participant experiences a health problem. In practice, the relationship between the participant and the insurance provider is based on a legal agreement called an insurance contract. This contract is legally binding on both parties: the insurer (insurance company) and the insured (insurance participant), and includes rights and obligations that must be fulfilled during the coverage period. In Indonesia, public understanding of health insurance contracts remains relatively low. Many participants do not fully understand the content and implications of the agreement they sign, including the terms and conditions, guaranteed benefits, coverage limits, and claims procedures. This approach was chosen to gain a comprehensive understanding of the patterns, causal factors, and impacts of agreement health insurance reported in various cross-country studies and insurance schemes, both public, private, and community-based health insurance contracts, whether administered by social institutions like BPJS Kesehatan (Social Security Agency for Health), or by commercial insurance companies, have different structures and provisions. Problems gap arise when participants lack detailed knowledge of the scope and limitations of their insurance contracts, resulting in underutilization of available benefits. Furthermore, from the service provider's perspective, contract implementation often faces administrative and communication challenges, which can impact participant satisfaction and perceptions of service quality. The result of study is important to examine more deeply the content and implementation of health insurance contracts, as well as the extent to which participants understand their rights and obligations. A better understanding of insurance contracts will improve the effectiveness of health protection and strengthen public trust in the Indonesian health insurance system.
Management Analysis of The Implementation of The Utmost Good Faith Principle In Insurance Agreements Yulita, Hanna; Puspitaloka Mahadewi, Erlina
International Journal of Health and Pharmaceutical (IJHP) Vol. 5 No. 3 (2025): August 2025 (Indonesia - Malaysia)
Publisher : CV. Inara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51601/ijhp.v5i3.425

Abstract

This study analyzes insurance with an agreement between two parties, namely an insurance company called the insurer and a policyholder called the customer, where the insurance company promises to provide financial protection against risks such as accidents, illness, death and others while the customer makes premium payments periodically or all at once. One of the important principles in making an insurance agreement is Utmost Good Faith (Good Faith). In Indonesia, there are several examples of cases of violations of the principle of utmost good faith such as not disclosing previous illnesses, misuse of Health Insurance benefits, not providing clear information regarding the risks and benefits of insurance such as unit links. Therefore, insurance companies are challenged to be able to obtain honest information from customers and must convince customers, to provide information and claim reimbursement in accordance with the agreement made in the policy, both methodically and materially. This study uses a qualitative method. The source used is Google Scholar using search keywords are the principle of utmost good faith and insurance agreement. Research results: this study wants to know the implementation of the principle of utmost good faith in Insurance, problems, how to overcome and solutions in the future to benefit the Insurance business in Indonesia.
Co-Authors Muhamad Ikhsan Novia Laras, Dewi Puspitaloka Mahadewi, Erlina