Hospital & Surgery Guard

TM Hospital and Surgery Guard is a cashless hospital-and-surgery rider (produk asuransi tambahan / rider) that bolts onto a TM Link unit-linked basic policy. It is not a standalone plan — it cannot exist without a live basic policy underneath it. What it does is upgrade the basic policy’s hospital cover into a full as-charged inpatient, surgery, and selected-outpatient benefit, plan-tiered, in Rupiah.

Two structural ideas carry the pitch:

1. Regional architecture you choose. The plan ladder runs from Indonesia and Malaysia (Platinum IDMY / IDMY Plus), through Asia excluding Singapore, Japan and Hong Kong (Platinum Asia / Asia Plus), to Worldwide (Platinum Worldwide / Worldwide Plus), with a separate high-limit Plan Exclusive for HNW cases. The customer matches the region to their real life, not to a one-size product.

2. As-charged within an annual ceiling. Benefits pay on a Reasonable and Customary basis (Biaya Wajar dan Lazim), capped by an overall annual limit (Limit Tahunan Keseluruhan) — Rp 100M to Rp 3B on the standard plans, far higher on Exclusive. A 10% no-claim discount (No Claim Discount) on the next anniversary rewards a claim-free year.

In one line: Add this rider to your TM Link policy and your hospital cover stops being basic — it follows you across the regions you actually travel, pays your real bills up to an annual ceiling you choose, and costs 10% less next year if you do not claim.

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The RIPLAY does carry an official sample illustration (Simulasi). It uses Gilang, 30-year-old male, TM Link Wealth Accumulation basic policy, with an HS Guard Platinum IDMY Plan 1.500 rider (configuration HS15A4: Indonesia and Malaysia region, Non Pro-rata, Deductible Rp 0). Decoded:

Critical insight for the agent narrative: the rider’s strength is regional architecture and renewability to 99, not headline cheapness. The single Rp 4.739M data point is real but is one age/plan/region combination — do not present it as “the price.” The special-disease staging (Rp 5M cap in Year 1, 50% in Year 2) is a genuine claim-timing risk for early diabetes or hypertension claims. Frame the first 24 months as a qualification window: chronic conditions become fully claimable from Year 3.

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Sweet Spot — Lead with HS Guard

• Age 28–50, married, 1–2+ dependents.
• Household income Rp 20M+/month (affluent and above; Plan 500 is the entry rung).
• Already owns, or is buying, a TM Link unit-linked basic policy — this rider stacks on that host.
• Real regional exposure: recurring travel to Singapore, KL, Bangkok, or children studying overseas.
• Treats hospital cover as non-negotiable and values certainty on room rates and specialist fees across borders.
• Healthy enough at entry to clear the 24-month pre-existing window without it being the deciding issue.

Borderline Fit — Discuss but qualify carefully

• Age 51–60 — entry is still allowed (max entry age 60) but rider cost escalates meaningfully and pre-existing friction rises; usually Plan 500 only. Probe medical history first.
• Early-career, Rp 10–15M/month — can afford the rider Cost of Insurance but the TM Link host cost may strain the budget; educate on total host-plus-rider economics before pitching a tier.
• Customers on a competitor health rider — if they chase features, the three-region ladder is differentiated; if they chase price alone, they will churn again.
• Domestic-only families considering a Plus or Worldwide tier — the regional spend is wasted; right-size them down to a domestic plan or a simpler product.

Do Not Pitch

• Customers with no TM Link basic policy and no willingness to buy one — the rider cannot be sold standalone. The host is non-negotiable.
• Mass-middle budgets under ~Rp 3M/year for health — the rider Cost of Insurance alone is Rp 4.7M+ at age 30 and rises annually.
• Customers expecting cash value or surrender value from the rider — it is pure expense; only the host carries any cash value.
• Late-life prospects (65+ already insured, or over the age-60 entry cap) — entry is closed past 60; for existing older insureds the cost is rarely justifiable outside HNW.
• Anyone who needs maternity, congenital, mental-health, or routine dental cover as the priority — these are excluded; this is the wrong product for them.

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Rule of thumb: if the customer’s first sentence is about travel, regional hospitals (Bangkok, KL, Singapore), a large catastrophic ceiling, or already owning a TM Link policy, HS Guard is in the conversation. If their first sentence is “cheapest possible,” “Indonesia only,” or “I don’t want a unit-linked policy,” it usually is not.

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This section is QUALITATIVE, not quantitative. Health-category PDF coverage in the Indonesia Life Insurance Market Intelligence set remains below the 60% threshold required for population statistics, so the comparison below is a descriptive read against peer cashless H&S riders and products, not a benchmarked distribution. Treat every “category typical” line as analyst judgment from category knowledge, to be firmed up once coverage clears 60%.

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Opening — establish the right frame

“When you travel for work or family — Singapore, Bangkok, KL — you assume your health cover travels with you. Usually it doesn’t. Most domestic hospital plans stop at the border. I want to talk about what happens the day you need a hospital and you’re not in Indonesia.”

“Pas Bapak/Ibu jalan untuk kerja atau keluarga — Singapura, Bangkok, KL — biasanya kita anggap asuransi kesehatan ikut jalan juga. Kenyataannya sering enggak. Kebanyakan plan rumah sakit dalam negeri berhenti di perbatasan. Saya mau bahas apa yang terjadi kalau pas butuh rumah sakit, Bapak/Ibu lagi enggak di Indonesia.”

Frame the rider correctly (it boosts your basic policy)

“This isn’t a separate policy you manage on its own. It’s a rider — it sits on top of your TM Link basic policy and upgrades the hospital cover that’s already there. Your basic policy stays the foundation; this just turns the hospital protection from basic into real, as-charged cover.”

“Ini bukan polis terpisah yang Bapak/Ibu urus sendiri. Ini rider — nempel di atas polis dasar TM Link Bapak/Ibu, dan dia naikin perlindungan rumah sakit yang sudah ada. Polis dasar tetap jadi fondasi; rider ini cuma ngubah proteksi rumah sakitnya dari standar jadi beneran nutup biaya rumah sakit sesuai tagihan.”

The regional value prop (the three-tier story)

“You get three regional choices, not one. Indonesia and Malaysia. Or Asia without Singapore and Japan — because you actually go to Bangkok and KL, and those hospitals cost less, so you shouldn’t overpay for cover you won’t use. Or Worldwide — your child gets sick studying abroad and you’re covered the same way. You pick the region that matches your real life.”

“Ada tiga pilihan wilayah, bukan satu. Indonesia dan Malaysia. Atau Asia tanpa Singapura dan Jepang — karena Bapak/Ibu seringnya ke Bangkok sama KL, dan rumah sakit di sana lebih murah, jadi enggak perlu bayar lebih buat cover yang enggak kepakai. Atau Seluruh Dunia — anak sakit pas kuliah di luar negeri, tetap ketutup. Bapak/Ibu pilih wilayah yang sesuai kehidupan nyata.”

The no-claim discount narrative (long-term value)

“If you go a full year without a claim, next year’s cost drops 10%. It rewards staying healthy and softens the natural cost increase that comes with age. Small on its own — but over many claim-free years it genuinely adds up.”

“Kalau setahun penuh enggak ada klaim, biaya tahun depan turun 10%. Ini ngehargain Bapak/Ibu yang jaga kesehatan, sekaligus ngeredam kenaikan biaya yang wajar seiring umur. Kelihatannya kecil — tapi kalau bertahun-tahun enggak klaim, diskon 10% tiap tahun itu lumayan banget.”

The waiting-period honesty close (manage expectations)

“Let me be straight about one thing. If you already have high blood pressure or diabetes, those won’t be covered for the first 24 months — you pay, but those specific conditions are excluded until month 25. That’s normal in this market, but I tell every client upfront so there’s no surprise at the hospital.”

“Saya mau jujur soal satu hal. Kalau Bapak/Ibu sudah ada darah tinggi atau diabetes, kondisi itu belum ketutup 24 bulan pertama — tetap bayar, tapi kondisi spesifik itu dikecualikan sampai bulan ke-25. Ini hal yang umum di pasar, tapi saya kasih tahu di awal ke semua nasabah biar enggak kaget pas di rumah sakit.”

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1. “BPJS already covers me — why pay for this?”

Customer “Saya sudah ada BPJS, ngapain bayar lagi?”

Don't say “BPJS is bad.” — it sounds dismissive and most clients rely on it.

Don't say “BPJS itu jelek.”

Do say “BPJS is a solid foundation and you should keep it. The gap is choice and speed — referral queues, the hospitals and class of room you can access, and treatment abroad, which BPJS does not cover. This rider sits on top: you choose the private hospital, including in Malaysia or wider Asia, and it pays your real bill up to your annual limit. It doesn’t replace BPJS — it covers what BPJS can’t.”

Do say “BPJS itu fondasi yang bagus, tetap dipakai. Bedanya di pilihan dan kecepatan — antrean rujukan, rumah sakit dan kelas kamar yang bisa diakses, dan perawatan di luar negeri yang BPJS enggak nutup. Rider ini nempel di atasnya: Bapak/Ibu pilih rumah sakit swasta, termasuk di Malaysia atau Asia, dan dibayar sesuai tagihan sampai batas tahunan. Bukan ganti BPJS — tapi nutup yang BPJS enggak bisa.”

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2. “The cost goes up as I get older — won’t it become unaffordable?”

Customer “Biayanya naik terus pas tua — nanti enggak kebayar dong?”

Don't say “It won’t go up much.” — the RIPLAY says it rises with age; don’t promise otherwise.

Don't say “Naiknya enggak seberapa kok.”

Do say “You’re right that the cost rises with age — that’s true of every as-charged hospital plan, because medical inflation is real. Two things help here: first, the 10% no-claim discount each year you don’t claim, which offsets part of the increase. Second, starting now, while you’re younger and healthier, locks in the lowest entry point and clears the waiting periods early, so the cover is fully working by the time you’re more likely to need it.”

Do say “Betul, biayanya naik seiring umur — itu berlaku di semua plan rumah sakit yang bayar sesuai tagihan, karena inflasi medis itu nyata. Dua hal yang bantu: pertama, diskon no-claim 10% tiap tahun enggak klaim, yang ngurangin sebagian kenaikan. Kedua, mulai sekarang pas masih muda dan sehat, ngunci biaya masuk paling rendah dan ngelewatin masa tunggu lebih awal, jadi pas mulai sering butuh, cover-nya sudah jalan penuh.”

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3. “I already have a basic policy — why add a rider on top?”

Customer “Saya kan sudah punya polis dasar — kenapa harus nambah rider?”

Don't say “Your basic policy isn’t enough.” — it sounds like you’re criticizing their earlier decision.

Don't say “Polis dasar Bapak/Ibu enggak cukup.”

Do say “Your basic policy is doing its job — that’s the life and investment layer. What it doesn’t do is pay your hospital bills as-charged across regions. This rider plugs into that same policy and adds exactly that: real hospital and surgery cover up to an annual limit you choose, without you starting a new policy from scratch. It builds on what you already own.”

Do say “Polis dasar Bapak/Ibu sudah jalan sesuai fungsinya — itu lapisan jiwa dan investasi. Yang dia enggak lakuin adalah bayar tagihan rumah sakit sesuai biaya nyata lintas wilayah. Rider ini nyambung ke polis yang sama dan nambahin persis itu: cover rumah sakit dan operasi beneran sampai batas tahunan yang Bapak/Ibu pilih, tanpa bikin polis baru dari nol. Dia nambah di atas yang sudah dimiliki.”

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4. “Up to Rp 300 million sounds big — but is one annual limit enough?”

Customer “Sampai Rp 300 juta kedengarannya besar — tapi cukup enggak satu limit setahun?”

Don't say “You’ll never hit the limit.” — you can’t promise that.

Don't say “Enggak bakal kepakai habis kok.”

Do say “Good question, because the annual overall limit is the real ceiling — every benefit draws from it. For most domestic and regional hospital events, Rp 300 million in a year is ample. If your concern is a large, catastrophic event — major surgery, a long ICU stay abroad — that’s exactly what the Plus tiers (up to Rp 3 billion) and Plan Exclusive (much higher) are designed for. We size the limit to your real exposure, not a guess.”

Do say “Pertanyaan bagus, karena batas tahunan keseluruhan itu plafon yang sebenarnya — semua manfaat narik dari situ. Untuk kebanyakan kejadian rumah sakit dalam dan luar negeri, Rp 300 juta setahun itu lega. Kalau yang Bapak/Ibu khawatirkan kejadian besar — operasi mayor, ICU lama di luar negeri — justru itu gunanya tier Plus (sampai Rp 3 miliar) dan Plan Exclusive (jauh lebih tinggi). Kita ukur batasnya sesuai risiko nyata, bukan kira-kira.”

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5. “I have diabetes — and I heard chronic illness is limited at first.”

Customer “Saya ada diabetes — katanya penyakit kronis dibatasi di awal ya?”

Don't say “It’s only 24 months, that’s standard.” — it minimizes a real gap.

Don't say “Cuma 24 bulan, itu standar.”

Do say “I won’t minimize it. Two things apply. Pre-existing diabetes is excluded for 24 months from the start date. And listed special diseases — diabetes is one — are capped at Rp 5 million in year one and 50% in year two, full from year three. So if your diabetes is stable on medication, starting now means full cover for complications by year three. If it’s newly diagnosed or unstable, we may wait a few months until your control is documented, so you enter on a cleaner footing. I’d rather you hold cover you can actually use.”

Do say “Saya enggak akan ngecilin ini. Ada dua hal. Diabetes yang sudah ada dikecualikan 24 bulan dari tanggal mulai. Dan penyakit khusus yang terdaftar — diabetes salah satunya — dibatasi Rp 5 juta di tahun pertama, 50% di tahun kedua, penuh dari tahun ketiga. Jadi kalau diabetes Bapak/Ibu stabil dengan obat, mulai sekarang berarti tahun ketiga sudah cover penuh untuk komplikasi. Kalau baru ketahuan atau belum stabil, mungkin kita tunggu beberapa bulan sampai kontrolnya tercatat, biar masuknya lebih bersih. Saya lebih milih Bapak/Ibu pegang cover yang beneran kepakai.”

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These are the issues most likely to trigger an OJK complaint or a churn-back under 2026 conduct rules. Build agent training around avoiding all seven.

1. POJK 36/2025 co-payment regime (effective Jan 2026). A new co-payment requirement applies to all health insurance products from January 2026. The 2026-06-04 RIPLAY (internal edition 11/2024) does not yet reflect a POJK 36/2025 co-pay clause in its benefit tables. Do not tell a customer “no co-payment” on the strength of this RIPLAY. Confirm the live co-pay treatment from TMLI’s current product circular before quoting any out-of-pocket figure, and disclose that a regulatory co-payment now applies to health products generally.

2. Rider-requires-basic-policy dependency. HS Guard cannot stand alone. If the TM Link basic policy lapses, surrenders, or its investment value is exhausted, the rider dies with it — including the “renewable to age 99” promise. Never sell “cover to 99” without disclosing that it is conditional on keeping the basic policy in force. Document the dependency.

3. Annual Overall Limit (Limit Tahunan Keseluruhan) exhaustion. Every benefit — room, surgery, outpatient, special disease — draws from one shared annual ceiling. A customer who reads each benefit line as a separate pot will feel mis-sold when the ceiling is hit. State explicitly that the annual overall limit is the true cap and all benefits share it.

4. Reasonable and Customary basis (Biaya Wajar dan Lazim). Benefits pay on a Reasonable and Customary basis, not “100% of whatever the hospital charges.” If a provider bills above the customary table, the excess is the customer’s. Never imply unconditional full reimbursement; explain that charges above the R&C table are not covered.

5. Special-disease staged benefit (Year 1 capped, Year 2 50%). For the 17 listed special diseases (diabetes, hypertension, asthma, hernia, kidney disease, tumours, and others), year-one benefit is capped at Rp 5 million and year two at 50% of approved claims, with full benefit only from year three. A customer who believes they have the full annual limit for a chronic condition from day one will complain at first claim. This staging must be put in writing on the SPAJ and read back by the customer.

6. Publishing_gap B — brochure unavailable. Only the RIPLAY is published; the customer-facing brochure is not publicly available (TMLI internal portal). The customer cannot self-serve full collateral. Agents must source authoritative terms from TMLI directly and avoid filling gaps with assumptions. Treat any benefit detail not in the RIPLAY as unconfirmed until checked against the policy or an official TMLI document.

7. Pre-existing and waiting-period disclosure. Pre-existing conditions are excluded for 24 months from the start (or from an endorsement/reinstatement date, whichever is latest); the 24-month clock resets on a mid-policy endorsement. Gastroenteritis, typhus, headache (cephalgia), and vertigo are limited to a maximum 2 calendar days per disability and 2 disabilities per policy year during the first 24 months. Re-qualify the customer’s health at every endorsement and disclose these limits before writing the case.

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1. Obtain the unpublished brochure and confirm the POJK 36/2025 co-pay treatment. Request the current HS Guard brochure and product circular from TMLI’s internal portal, and specifically confirm how the January-2026 co-payment regime applies to this rider. This is the single biggest data gap (publishing_gap B) and the top compliance exposure. Refresh trigger: the moment the brochure or an updated RIPLAY edition becomes available, re-run this brief and diff it line-by-line against the 2026-06-04 version.

2. Build a bilingual “24-Month Waiting and Special-Disease Matrix” one-pager (EN + ID). Map the common chronic conditions (diabetes, hypertension, asthma, hernia, kidney disease) to a visual timeline — Year 1 Rp 5M cap, Year 2 50%, Year 3+ full, and the 24-month pre-existing line. Have the customer sign it at SPAJ stage. This one artifact prevents the majority of waiting-period complaints.

3. Build a “Regional Tier Chooser” questionnaire. A short flow that sorts customers into Domestic, Asia-Focus, Worldwide, or HNW-Exclusive based on real travel and exposure, so agents recommend the right tier instead of overselling Worldwide or Plus to a domestic-only customer. Cuts churn and mis-selling risk.

4. Produce a “rider boosts your basic policy” explainer for warm TM Link holders. Since HS Guard adds to an existing TM Link policy with light underwriting, an existing-policyholder upsell is the lowest-friction sale. A one-page EN+ID explainer that frames the rider as a hospital-cover upgrade (not a new policy) captures this segment fast.

5. Write a co-payment and annual-limit disclosure script for the field. A short, mandatory talk-track covering (a) the annual overall limit is shared across all benefits, (b) Reasonable and Customary basis means charges above the customary table are not covered, and © the POJK co-payment now applies to health products. Agents read it back and the customer confirms understanding before the SPAJ is signed.

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