6 March 2021
Home | About Us | Product List | General Information | Provider List | Client Area | Contact Us
Application Procedure

Claims Procedure

Payment Method

Privacy policy

Application Procedure

For new application please submit following document :
  1. Copy of Valid ID (KTP/SIM/Passport /Kitas)
  2. Birth certificate (for Insurer below 17 year)
  3. Fully filled and Signed Application and Medical Questions
  4. Medical Questioner for related illness (if any )
Claim Related Download Center For Individual

For USD Plan
»
 Claim Procedure for Health Insurance
»
 Claim Procedure for Travel Insurance
»
 Claims Submission Slip - USD
»
 Individu Outpatient/Inpatient Claim Form
»
 Dental Claim Form
»
 Oral Examination Report
»
 Claim Form for Travel Insurance
»
 Referral for Follow Up Care
»
 Treatment Plan for Chemotherapy Radiotherapy
»
 Treatment Plan for Physiotherapy Chiropractic Acupuncture

For IDR Plan
»
 Individu Outpatient/Inpatient Claim Form

Claim Related Download Center For Group

»
 Claims Procedure For Healthy Group
»
 Pengecualian Polis
»
 Persyaratan Santunan Kematian
»
 Dental Claim Form
»
 Group Outpatient & Inpatient Claim Form
»
 Maternity Claim Form
»
 Surat Kematian
Home |  About Us |  Product List |  General Information |  Provider List |  Client Area |  Contact Us
Copyright © 2019 PT. International Services Pacific Cross. All rights reserved.