Outpatient or dental claim

How to file an outpatient or dental claim

We understand this may be a difficult time so first, let’s tell you the important stuff that will be helpful for you to know:

1. If you (the insured) receive medical treatment from a hospital or clinic that is not in our network, you’ll need to submit a claim. Please do this within 60 days after you are discharged following treatment. Please ensure you give us all the information we need.

2. Should your claim paperwork be incomplete, we’ll give you another 30 days in which to send us any outstanding documents or resubmit any incomplete parts of your claim.

If you need any help at all, please don’t hesitate to contact us on 1500525.


-    Receipts with all treatment cost details


-    All medical prescriptions and details of costs

-    Letter from attending doctor with a copy of any lab results

-    To claim for glasses / spectacles, attach refractive eye examination report from an ophthalmologist

-    For dental claims, attach teeth number/teeth formation on the claim form

-    For physiotherapy claims, attach the original physiotherapy receipt and a doctor’s referral letter 

-    For repeat prescriptions, we need a copy of the first prescription 

Note: Please use a Rp6,000 duty stamp for receipts above Rp1,000,000

Please submit your claim by post to the following address:  


How we deal with Employee Benefits claims


When should I submit my claim?


How will you pay me?


When will you pay me?


What if I have a question or a complaint?

Frequently asked questions


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