FAQ 3: What Are the Requirements for Cashless and Reimbursement Claims?

Cashless Claim Requirements

The claim process for participants is divided into two options, depending on the system the participant wishes to use. Here are the terms and conditions for claims using the Cashless system:

• Participants must receive treatment or care at a hospital or clinic that is registered or partnered with the insurance provider.
• Participants must bring and use their insurance membership card, which will serve as a substitute for the payment method.
• Participants must bring their ID card (KTP or Passport).
• Participants should ensure that the type of treatment or care is covered by the insurance they are enrolled in.
• Participants must check that their benefit limit is sufficient.
• If the benefit limit is insufficient or there is an overpayment, the excess amount will be charged to the participant at the location.
• For inpatient care, all necessary documents must be provided to be sent to the relevant party.

Reimbursement Claim Requirements

Here are the terms and conditions for claims using the Reimbursement system:

• Participants go to a hospital or clinic that is not partnered with the insurance provider.
• Participants go to a partnered hospital or clinic but fail to bring their insurance membership card.
• Participants should ensure that the type of treatment or care is covered by the insurance they are enrolled in.
• Participants must check that their benefit limit is sufficient.
• If the benefit limit is insufficient or there is an overpayment, the excess amount will be charged to the participant.
• Participants must process the reimbursement claim through the AMAN app.