Underwriting Medical Requirement PT Sun Life Financial Indonesia (for PD Retail Relations - Bancassurance)

V.14052019
Age & Medical Type for Insured
Sum Assured in IDR Rupiah
0-17 18-35 36-40 41-45 46-50 51-55 56-60 61-70
up to IDR500,000,000 Non Medical Non Medical Non Medical Non Medical Non Medical Non Medical Non Medical Non Medical
IDR500,000,001 - IDR600,000,000 Non Medical Non Medical Non Medical Non Medical Non Medical Non Medical Non Medical C+
IDR600,000,001 - IDR750,000,000 Non Medical Non Medical Non Medical Non Medical Non Medical Non Medical C C+
IDR750,000,001 - IDR1,000,000,000 Non Medical Non Medical Non Medical Non Medical Non Medical Non Medical C E+
IDR1,000,000,001 - IDR1,500,000,000 Non Medical Non Medical Non Medical Non Medical Non Medical E E H
IDR1,500,000,001 - IDR2,000,000,000 Non Medical Non Medical Non Medical Non Medical E E E H
IDR2,000,000,001 - IDR2,250,000,000 Non Medical Non Medical Non Medical Non Medical E E E H
IDR2,250,000,001 - IDR2,500,000,000 Non Medical Non Medical Non Medical Non Medical E E E H
IDR2,500,000,001 - IDR3,000,000,000 A+ D+ Non Medical E+ F F F H
IDR3,000,000,001 - IDR4,000,000,000 A+ D+ E+ E+ F F F H
IDR4,000,000,001 - IDR5,000,000,000 A+ E+ E+ E+ F F F H
IDR5,000,000,001 - IDR10,000,000,000 A+ E+ F F G G G H
IDR10,000,000,001 and above A+ G G G G G G H

Financial Requirements
Sum Assured Risk REQUIRED FINANCIAL DOCUMENTS FOR INSURED

IDR2,500,000,000 - IDR5,000,000,000 - - - -

FINANCIAL
IDR5,000,000,001 - IDR10,000,000,000 - - -
QUESTIONNAIRE

FINANCIAL LAST YEAR TAX REPORT OR 4 YEAR-AUDITED FINANCIAL REPORTS

IDR10,000,000,001 and above RAD/RAM REPORT
QUESTIONNAIRE 3 MONTH-BANK STATEMENTS (For Business Owner/Company)

MCU Type Requirement Details Notes:

A Physical Examination - - - - - - - 1. Medical Requirements applied for 1 (one) year accumulated Sum Assured Risk in Sun Life
A+ Physical Examination APS - - - - - - Financial Indonesia
C Physical Examination - CMU ECG - - - - 2. Financial Requirements applied for total all Sum Assured Risk in Sun Life Financial Indonesia
C+ Physical Examination APS CMU ECG - - - -
D Physical Examination - CMU - BDTS-1 - - -
D+ Physical Examination APS CMU - BDTS-1 - - -
E Physical Examination - CMU ECG BDTS-1 - - -
E+ Physical Examination APS CMU ECG BDTS-1 - - -
F Physical Examination APS CMU - BDTS-1 Treadmill - -
G Physical Examination APS CMU - BDTS-1 Treadmill CXR -
H Physical Examination APS CMU - BDTS-1 Treadmill CXR Male : BDTS-2 / Female : BDTS-3

Remarks
APS Attending Physician Statement, includes : Copy result of medical examinations, Doctor, Hospital / Laboratorium address, copy of medical card
If prospective customer does not have a personal physician and aged over than 45 yo : - For MALE, please do : BDTS-2
- For FEMALE, please do : BDTS-3
CMU Chemical Microscopical Urinalysis
ECG Resting 12 - Lead Electrocardiogram
Treadmill Treadmill/Exercise Electrocardiography
CXR Chest X-Ray, posterior - anterior view, large view
BDTS-1 Fasting Blood Sugar, HbA1c, Cholesterol Total, HDL, LDL, Trygliceride, Cholesterol ratio, Ureum, Creatinine, ALT, AST, GGT, Alkaline Phospatase, Direct Bilirubin, Albumin, Globulin, HBsAg, Anti HCV, HIV Test
BDTS-2 For Male : PSA Test, Complete Blood Count
BDTS-3 For Female : Complete Blood Count
Complete Blood Count (CBC) : Erythrocytes, Leucocytes, Platelets, Hemoglobin, Hematocrit, Monocytes, Basophils, Eosinophils, Neutrophils, Lymphocytes, Erythrocyte Sedimentation Rate (ESR/LED)
ACR Agent's Confidential Report
ACL Agent's Covering Letter
RAD/RAM Report Regional Agency Director/Regional Agency Manager Report