Jakarta, March 19th 2019

No. : QUO/03-148/ITM/2019/FF

To : INDO TAMBANGRAYA MEGAH, PT

WISMA PONDOK INDAH 3
JALAN SULTAN ISKANDAR MUDA, PONDOK INDAH
JAKARTA SELATAN

Att. : PUJI RAHADIAN/ FIRMAN MESIAS

Subject : OCCUPATIONAL HEALTHCARE SERVICES - 2019

Dear Pak Puji/ Pak Firman,

Refer to your email previously, Date: 15th March 2019 – Subject: (Invitation Open Tender) Health Provider
for Indo Tambangraya Megah, Tbk, that you need information about occupational healthcare services, it is
pleasure being able presenting this OCCUPATIONAL HEALTHCARE SERVICES PROPOSAL, for your
perusal and consideration.

Detailed information and investment of the proposed services can be found in the enclosed below.

Thank you for your RFQ to Global Assistance & Healthcare (GAH) and please do not hesitate to contact the
undersigned at your convenience if you require further assistance.

Best Regards,

Fery Ferdiansyah
Business Development Manager
Mobile : +62811189101/ +628111332838
 OCCUPATIONAL HEALTH SERVICES - 2019

SERVICE RATE
NO ITEM QTY UoM
(IDR)
1 Visiting Company Doctor - SpOH 1 per Visit Rp 1,300,000
(5 visit per week @8 hours per visit)

2 Visiting OH Nurse / Paramedic & Claim Adjuster 1 per Visit Rp 750,000

(5 visit per week @8 hours per visit)

3 Business Trip Company Medical Doctor to Mine Site per Day Rp 1,500,000
o Transportation and accomodation covered by
PT. Indo Tambangraya Megah Tbk
o Travell allowance and transportation during in
Jakarta covered by GAH

4 Helpline Access Membership per Member Rp 30,000

o Acces to arrangement of hospital referral;
o Medical Evacuation;
o Case Monitoring;
o Escort
fee for service basis

5 Equipment & Disposables 1,500,000

o Blanket 1
o Alcohol Swab BD Box/ 100 1
o Gloves Non Sterile L Sensi Box/ 100 1
o Nasal Oxygen Canula Adult 1820 1
o Medical Waste Bin 1
o Refill Oxygen 1
o Diagnostoc Test - Riester 1
o Thermometer Digital 1
o Weight Height Scale Scale 1
o Instrument Trolley 1
o Nebulizer 1
o X-Ray Viewer Single 1
o Statetoscope 1

6 Health Promotion Talk - 2 (two) times 2 per year Free of Charge

7 Handling Fee
o </= Rp. 100.000.000,- 7%
o > Rp. 100.000.000,- 5%

8 AED 1 per Months Rp 1,500,000

 ADDITIONAL FEE FOR ADDITIONAL SERVICES

NO SERVICE UoM PRICE

1 Hospital Visit (Max 4 Hours/ Visit)
a. GP per Visit Rp 500,000
b. Specialist per Visit Rp 650,000

2 Non - Hospital Visit (Max 4 Hours/ Visit)

a. GP per Visit Rp 500,000
b. Specialist per Visit Rp 650,000

3 Medical Escort - commercial flight

(to Singapore/ Bangkok)
a. GP per case USD 5,500
b. Specialist per case USD 7,500

4 Medical Evaciation - ambulans charter/ per case at cost

flight charter (ke Singapore/ Bangkok)

5 Medical Repatriation per case at cost

CONSUMABLE NESCO MULTICHECK

UNIT COST
NO ITEM DESCRIPTION
(IDR)
1 Nesco Cholesterol Test Strip Box/ 10 250,000
2 Nesco Glucose Test Strip Box/ 25 270,000
3 Nesco Uric Acid Test Strip Box/ 25 250,000
4 Nesco Lancet Box/ 200 50,000

ANAPHYLACTIC KIT

UNIT COST
NO ITEM DESCRIPTION
(IDR)
1 Epineprin Injeksi Amp Box/ 30 10,000
2 Sidiadryl Inj Vial Box/ 10 15,000
3 Syringe 3 ml Box/ 100 Terumo 6,000
4 Alcohol Swab BD Box/ 100 600
5 Hansaplast Strip 2637 Box/ 100 500
6 HardCase 200,000
THE VISITING COMPANY DOCTOR

Basic qualification is:

• Graduate of accredited recognized and accredited Faculty of Medicine;
• Possess STR (Registered Doctor);
• Having 3 years experience minimum as Leader/Coordinator of Company Doctors and implementing
Occupational Health and Industrial Hygiene Programs preferably in mining company (could be blend
with other industrial type);
• Certified ACLS and/or or ATLS and certified SpOH;
• Certified Hiperkes;
• Understand and abide by the government and company regulations particularly in Occupational Health
and Safety;
• Have sound knowledge and experience in managing medical claims;
• Computer literate (MS Word, Excel, Internet);
• Intermediate professional English (Fluent in medical professional English);

Scope of Service:
▪ Performing daily activities relate with occupational medicine aspect and refer to Concept of
Occupational Health management System;
▪ Obligating to work for 8 hours per day, 5 (five) times in a week at Jakarta Office;
▪ Responsible for all activities that relate to medical aspect.

NURSE/ PARAMEDIC

Basic qualification is:

• Graduate of accredited recognized Nursing College (minimum D3 Akademi Keperawatan);
• Possess SIPP (Surat Izin Profesi Perawat);
• Min. 2 years as Field Nurse/Claim Adjuster;
• Certified with BTCLS (Basic Trauma & Cardiac Life Support);
• Have sound knowledge and experience in managing medical claims;
• Computer literate (MS Word, Excel, Internet);
• Intermediate professional English (Fluent in medical professional English)

Scope of Service:
▪ Support Company Doctor in performing daily activities relate with occupational medicine aspect and
refer to Concept of Occupational Health management System;
▪ Obligating to work for 8 hours per day, 5 (five) times in a week at ITM Jakarta Office
 ESTIMATED TOTAL CONTRACT VALUE CALCULATION

Unit Unit Price Total Price Estimated TOTAL PRICE

NO DESCRIPTION Qty
IDR Monthly Contract (Month) IDR
1 Visiting Company Doctor - SpOH 22 Days Rp 1,300,000 Rp 28,600,000 9 Rp 257,400,000
2 Visiting OH Nurse / Paramedic & Claim Adjuster 22 Days Rp 750,000 Rp 16,500,000 9 Rp 148,500,000
3 Helpline Access Membership 1000 Member Rp 30,000 Rp 30,000,000 9 Rp 270,000,000
4 Equipment & Disposables 1 Pack Rp 1,500,000 9 Rp 13,500,000
5 AED - Rental 1 Unit Rp 1,500,000 9 Rp 13,500,000
ESTIMATED TOTAL COST Rp 78,100,000 Rp 702,900,000

Notes:
1. Value added taxes (10% VAT or PPn) would be charged in addition to the scheduled fees if applicable;
2. Global Assistance & Healthcare would ensure pool of doctors and/or nurses/claim adjusters to support
the service on best effort basis. However from time to time, Global Assistance & Healthcare staff may
be removed from the roster for training and annual leave. In their place will be assigned a staff with
similar qualifications and experience.
3. Helpline Access membership fee is not including service delivered. The service charge will be based
on case basis (fee for service) at cost plus handling fee.
4. Helpline Access membership fee is including medical consultation by phone through Global
Assistance & Healthcare 24 Hours Helpline Center or by e-mail.
5. Equipment Rental rate is including delivery to JKT Office, maintenance, and calibration.

TIMING
FHI is able to mobilize the medical staff with minimum of 14 (fourteen) working days prior notice.

Global Assistance & Healthcare is responsible for:

▪ Ensuring that suitably qualified staff is present at the work location as per schedule;
▪ Payment of salaries and benefits of the staff;
▪ Provision of personal and medical insurances;
▪ Continuity of doctor, nurse/claim adjuster, OH Specialist pool based on best effort basis;
▪ Ensure 24 hours manned Helpline Center (if Helpline Access membership subscribed);
▪ Provide ambulance service on best effort basis (if Helpline Access membership subscribed).

ITM is responsible for:

▪ Payment of scheduled fees within 14 - 30 days of receipt of invoice;
▪ Provide appropriate working room and office equipments for the Medical Doctor;
▪ Provide list of employee covered by the Medical Access and list of contact persons