reimbursement claim
Also called: reimburse, penggantian biaya
A claim method by paying medical costs first and then requesting reimbursement.
What it means
A reimbursement claim is a way to file a health insurance claim where the participant pays the medical costs first, then submits a reimbursement request to the insurance company with receipts and medical documents. This method can be used at any hospital, not limited to partners. However, reimbursement follows benefit limits and policy terms, and funds are only returned after the claim is approved.
Why it matters for families
Reimbursement gives flexibility in choosing healthcare facilities but requires readiness of emergency funds. Families must have reserve money to pay upfront, because reimbursement is not always instant. If documents are incomplete, the process can be delayed or the claim denied.
Example
For example, a father is treated at a non-partner hospital with a cost of Rp20 million and pays himself. He collects receipts, medical summaries, and lab results, then submits a reimbursement claim. After the claim is approved, the company reimburses according to the policy benefit limit, for example Rp15 million, so the remainder is his own responsibility.
Common misunderstanding
Some people think reimbursement is as fast as cashless. The correction is that reimbursement requires verification time and upfront funds from the participant.