Claims Procedures

How do I make a reimbursement claim?

1. Policy Holder / Beneficiary applies for  the Reimbursement claim by completing Claim Form and enclosing the supporting documents according to the type of claim. The TMLI Claim Form and supporting documents for each type of claim can be found in the Claim Form menu.
2. The claims can be submitted to TMLI Head Office or Sales Office nearby.
3. The claim can be processed if the claim form and all supporting documents completely received by TMLI.
4. TMLI will process the claim within a maximum of 14 (fourteen) working days from the date of the document submission and required information is completely received by TMLI.

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How do I make a guarantee claim?

Procedure of Cashless Inpatient at Overseas Provider (AAI Indonesia)

1. The Insured or Insured’s family or Policyholder contacts AAI Indonesia to inform his/her plan to do inpatient at Overseas Provider Hospital.
2. AAI Indonesia verifies the data, maximum 3 (three) working days, and then AAI Indonesia sends Hospital Admission Form (“HAF”) to be filled by the physician who examines the Insured in Indonesia. If any, please attach the last medical record.
3. The Policyholder or Insured sends the filled HAF via email or fax minimum 3 (three) working days before departure date.
4. AAI Indonesia sends the copy of Initial Guaranteed Letter.
5. The Insured visits the Provider Hospital for admission.
6. The Insured gives the copy of Initial Guaranteed Letter and Insurance Card during admission.The Insured undergoes hospitalization at the Provider Hospital.
7. When the Insured is discharged from the hospital, the Provider Hospital sends the notification and supporting document to AAI Indonesia Regional.
8. The Provider Hospital informs the Insured to process the inpatient discharge administration. The Insured processes the discharge administration at the Provider Hospital including paying the excess claim (if any). Some Provider Hospitals require the Insured to open their credit card since the admission. If there is excess claim, the excess claim will be paid by the opened credit card.
9. Once done, the Insured may go home.

 

Procedure of Cashless Inpatient at Overseas Provider (Imcare177)

1. The Insured or Insured’s family or Policyholder contacts I’m Care or TMLI’s Hotline to inform his/her plan to do inpatient at Overseas Provider Hospital minimum 5 (five) working days before departure date.
2. I’m Care verifies the data. If required, please attach the last medical record.
3. I’m Care sends the Covering Letter to TMLI or Insured email (if any).
4. The Insured visits the Provider Hospital for admission. The Insured gives the Covering Letter and Insurance Card during admission.
5. The Insured undergoes hospitalization at the Provider Hospital.
6. When the Insured is discharged from the hospital, the Provider Hospital sends the notification and supporting document to I’m Care.
7. The Provider Hospital informs the Insured to process the inpatient discharge administration. The Insured processes the discharge administration at the Provider Hospital including paying the excess claim and admin fee (if any). Some Provider Hospitals require the Insured to pay the deposit and/or open their credit card since the admission. If there is excess claim, the excess claim will be paid by the deposit or opened credit card.
8. Once done, the Insured may go home.

 

Procedure of Cashless Inpatient at Domestic Provider

1. The Insured visits the Domestic Provider Hospital for admission
2. Provider Hospital confirms and verifies the data to Third Party Administration (AAI Indonesia / I'm Care 177) including Insured Data, Policy Number, Plan and Policy Benefit
3. TPA will check the participation and send the form and Statement Letter to be filled in by the physician and patient
4. Provider Hospital sends the filled form to TPA
5. TPA will issue the Guaranteed Letter
6. The Insured undergoes hospitalization at the Provider Hospital and TPA will do monitoring
7. When the Insured is discharged from the hospital, the Provider Hospital sends the notification and supporting document to TPA
8. The Provider Hospital informs the Insured to process the inpatient discharge administration. The Insured processes the discharge administration at the Provider Hospital including paying the excess claim (if any)
9. Once done, the Insured may go home