Pertanyaan yang Sering Diajukan Mengenai Klaim Asuransi

Death Claim

Inpatient Claim (Great Eastern)

Inpatient Claim (Bancassurance)

Frequently Asked Questions Regarding Claims

What are the requirements for filing a death claim?
Requirements for filing a death claim for a life insurance policy :
1. Native police
2. Death claim application form
3. Doctor's Certificate (SKD) form for death claims
4. Death Certificate from the local government/civil servants
5. Certificate of proof of burial/cremation
6. Death certificate from the police if death was due to an accident
7. Death certificate from the embassy if died abroad
8. Proof of identity (KTP)
9. Family card (KK)
10. Other documents deemed necessary
When is the right time to file a death claim?
Death claims can be filed immediately after the policyholder's death and up to 90 days (3 months) from the date of death. If a death claim is filed after this 90-day waiting period has passed, the heirs will need to provide a chronological letter explaining the reasons for the delay in filing the claim.
What benefits will the heirs receive if the insured dies? The
insurance benefit that heirs can receive is the sum insured plus the existing investment value after deducting outstanding fees.
I don't know where the insured keeps the original policy book. Can a death claim still be filed if the original policy book cannot be attached or accompanied?
A death claim can still be filed by attaching a police report explaining the reason for the loss of the policy book, along with other death claim requirements.
What is an early claim?
An early claim is a situation where a death claim is filed when the policy is less than two (2) years old. In exceptional cases like this, Great Eastern reserves the right to conduct a medical investigation to obtain additional information regarding the cause of death of the insured.
If the insured dies at home without a medical examination, can a claim be filed without a medical certificate (SKD)?
A claim can be filed by attaching a chronological letter or a story from the heirs detailing the cause of the insured's death, from when they were healthy, then sick, until their final death.
If the heir is still a minor, can they receive the benefits?
The heir's parents can act as guardians to receive the benefits. If the heir's parents are also absent, then an adult sibling can receive the death benefit on their behalf.
If the insured dies due to HIV/AIDS infection, will the death benefit still be paid? If the cause is HIV infection or a condition directly caused by AIDS, the death benefit will not be paid.
How long does it take to pay death benefits?
It takes 14 days from the date the complete documents are received. If further investigation is required, it may take longer.
If the insured dies and is buried not in a public cemetery, but rather in a dedicated family cemetery or in a dedicated family yard, is a burial certificate from the government or civil service still required?
In such cases, only a certificate from the local neighborhood association (RT) head is required.

If you have any questions that are not answered on this page, you can send an email to wecare-id@greateasternlife.com so that our Customer Service Officer can provide a more complete answer to your question.

Or you can get a guide to filing an insurance claim here .

Manfaat apa yang didapat jika mengambil produk kesehatan Great ProInsure Hospital untuk klaim perawatan rumah sakit?
Produk Great ProInsure Hospital memberikan Manfaat Santunan Rawat Inap harian apabila nasabah dirawat di Rumah Sakit yang diakibatkan oleh Penyakit atau Cedera dengan maksimal 365 hari per kejadian.
Apakah Great Eastern Life Indonesia akan menanggung biaya jika nasabah dirawat inap di rumah sakit luar negeri?
Great Eastern Life Indonesia menanggung biaya perawatan di luar negeri sesuai dengan ketentuan Polis. Setelah pengobatan selesai, biaya perawatan tersebut dapat diajukan ke Great Eastern Life Indonesia untuk reimbursement.
Jika nasabah mempunyai polis serupa di perusahaan asuransi lain dan perawatan rumah sakit telah dijaminkan oleh asuransi tersebut, apakah klaim masih dapat diajukan di asuransi Great Eastern Life Indonesia juga?
Dalam hal ini nasabah dapat mengajukan klaim di asuransi Great Eastern Life Indonesia untuk manfaat santunan sesuai yang dipertanggungkan dalam polis.
Apakah kuitansi dan perincian rawat inap yang dilampirkan ketika mengajukan klaim harus asli?
Kuitansi yang dilampirkan asli atau terlegalisir yang dikeluarkan oleh Rumah Sakit beserta perincian biayanya.
Kapan saat yang tepat untuk mengajukan klaim rawat inap?
Semua dokumen pengajuan klaim rawat inap perlu diterima oleh bagian pengurusan klaim Great Eastern Life Indonesia selambat-lambatnya 30 (tiga puluh) hari sejak tanggal nasabah keluar dari Rumah Sakit .
Adakah penyakit yang dikecualikan jika nasabah mengambil produk kesehatan untuk perawatan tersebut?
Beberapa penyakit dikecualikan selama masa asuransi, yang berarti nasabah tidak dapat mengajukan klaim untuk penyakit tersebut. Informasi selengkapnya ada di dalam ketentuan polis.
Apakah biaya tindakan operasi tanpa rawat inap dapat diganti?
Sesuai ketentuan polis, manfaat pembedahan satu hari akan dibayarkan.
Apa yang dimaksud dalam kondisi yang telah ada sebelumnya (pre-existing condition)?
Pre-existing condition adalah segala jenis kondisi, penyakit, cedera atau ketidakmampuan Pemegang Polis dan/atau Peserta baik telah ataupun belum mendapatkan diagnosis, konsultasi, saran dan/atau perawatan dari Dokter, yang terjadi sebelum tanggal mulai asuransi dan baik yang diketahui atau tidak diketahui Penanggung.
Apakah pengobatan dan perawatan yang berhubungan dengan kehamilan dapat diganti?
Tindakan medis yang langsung atau tidak langsung berhubungan dengan kehamilan, melahirkan, pengguguran kandungan, sterilisasi atau usaha untuk meningkatkan kesuburan tidak dapat ditanggung.
Apakah biaya perawatan gigi dapat diganti?
Produk asuransi kami tidak menanggung biaya perawatan gigi apapun.
Berapa lama waktu yang diperlukan untuk pembayaran manfaat klaim perawatan tersebut?
Waktu yang diperlukan adalah 14 hari terhitung dari tanggal berkas diterima dengan lengkap. Jika proses investigasi lebih lanjut diperlukan, akan dibutuhkan waktu lebih panjang.

Jika ada pertanyaan Anda yang belum terjawab di laman ini, Anda bisa mengirim e-mail ke wecare-id@greateasternlife.com agar Customer Service Officer kami dapat memberikan jawaban yang lebih lengkap atas pertanyaan Anda.

What are the benefits of the Great Health Cover Additional Insurance (Rider) product for hospital care?
The Great Health Cover Additional Insurance (Rider) bancassurance product provides insurance benefits in the form of reimbursement for inpatient care, outpatient care, surgical procedures, and medical expenses. Medical service reimbursement is not only valid in Indonesia; it is also valid in Singapore and Malaysia.
If a customer receives treatment or care at a hospital abroad, will the costs be covered?
Yes, claims can be submitted and covered according to the policy's terms and conditions.
If a customer has a policy with another insurance company and their hospital care is covered by that insurance, can a claim still be filed with Great Eastern Life Indonesia as well?
Claims can be filed with Great Eastern Life Indonesia, and we will pay reimbursement. The Replacement Compensation Benefit will reduce the maximum Room Cost Reimbursement limit per policy year according to the Great Health Cover Additional Insurance Benefit Table.
Do the receipts and details of hospitalization submitted during hospitalization have to be original?
For the Great Health Cover rider, the receipts and details of expenses submitted must be original.
When is the right time to submit a claim for insurance benefits from the Great Health Cover Additional Insurance (Rider) product?
All inpatient claim submission documents must be received by the Great Eastern Life Indonesia claims management department no later than 30 (thirty) calendar days after the occurrence of the risk covered by the Great Health Cover Additional Insurance (Rider) product.
Are there any diseases excluded if the customer takes out a health product for treatment?
There are several diseases excluded in the first 12 months, meaning the customer cannot file a claim for them during the first year of the policy. Some diseases are also excluded during the coverage period, as detailed information can be found in the policy terms.
If a client is hospitalized and requires surgery, are the costs reimbursed?
Surgical benefits are payable if the client undergoes surgery, whether requiring hospitalization or not. Further information is provided in the policy terms.
Are inpatient surgery costs reimbursable? One-day surgery is reimbursable; more information is provided in the policy terms.
What is meant by a pre-existing condition?
Pre-existing condition is any type of illness or injury, whether the signs or symptoms are known to the customer or not, whether or not they have received treatment, medication, advice, consultation from a doctor, whether or not they have been diagnosed, regardless of whether or not the actual treatment has been carried out, which occurs before the Great Health Cover Rider Start Date or the Great Health Cover Rider reinstatement date, whichever occurs last.
Are pregnancy-related treatments and care reimbursable?
Medical procedures directly or indirectly related to pregnancy, childbirth, abortion, sterilization, or fertility enhancement efforts are not covered.
Can a client seek treatment at a clinic if they live in a remote area far from a hospital?
Yes, but we will only cover the costs if the clinic meets the various requirements outlined in the policy.
If a customer is unable to complete the required claim documents, for example, if the receipt is lost, can the claim be paid?
Without a receipt, the claim cannot be paid.
Are dental costs reimbursable?
Dental costs are only covered if the result of an accident.
How long does it take for payment/benefits for a medical claim to be processed?
It takes 14 days from the date the complete documents are received. If further investigation is required, it may take longer.
What are the claim requirements for hospitalization under the Great Health Cover Additional Insurance (Rider) product?
- Completed hospital care claim form.
- Doctor's Certificate for hospital care claims completed by the treating doctor.
- Original receipts and expense details. These documents will not be returned, except in connection with benefits coordination, in which case, if the Company is able to pay the claim, the Company will provide a note on the receipt stating the amount of the claim payment that the Company made;
- Details of medications and photocopies of all diagnostic test results including laboratory, radiology, ultrasound, CT scan, MRI, and other tests performed during hospitalization.
- Details of reimbursement of Accommodation costs which are part of the Hospital bill.
- Police Accident Certificate (if hospital treatment is due to an accident);
- Power of Attorney for Provision of Medical Record Information.
- Specifically for Replacement Compensation, a copy of the original receipt and cost details along with treatment documents legalized by the Hospital.
- Other documents deemed necessary by the Company