PT. ASURANSI ALLIANZ UTAMA INDONESIA
Claim Division

Jakarta
Allianz Tower
Jl. HR. Rasuna Said
Kawasan Kuningan Persada Super Blok 2
Jakarta 12980
Indonesia
Tel: +6221-2926 8888
Fax: +6221-2926 9090
Email : Feedback@allianz.co.id

Bandung
Lippo Centre Bandung, 3rd floor
Jl. Jend. Gatot Subroto No. 2,
Bandung 40262
Phone : 022-308612, 308613
Fax     : 022-308616

Surabaya
Bumi Bapindo Building, 5th floor/508
Jl. Basuki Rachmat 129 - 137,
Surabaya 60271
Phone : 031-5320695, 5319132, 5319133
Fax     : 031-5320948
         
Medan
Jl. Mayjend. S. Parman No. 316 – 60
(Simpang Jl. Sudirman),
Medan 20152
Phone : 061-510062
Fax     : 061 510063

Health Claim Procedure
Procedure in Submitting Claim by Reimbursement:

1. Member and/or policy holder must submit :

• Allianz claim form (page 1) should be completed with the member’s data and signed by the member,
• Allianz claim form (page 2) on Medical Resume should be clearly filled in and has to state the signature, name, and license number of the doctor giving the treatment (usually by stamping the form),
• If member forget to bring along Allianz medical resume form, especially for outpatient treatments, member could ask the doctor to state the medical resume, treatment, and therapy on the receipt and/ or prescription,
• Original receipt (with details of payments) with legal stamp based on government regulation (not in the form of note, invoice, etc.) unless there is a formal written notification from the related health institution, then that document could be treated as a receipt. For claim billings from countries outside Indonesia, should be in the form of “Tax Invoince/ Official Receipt”,
• Copy of prescription,
• Copy of the request to undergo other supporting diagnostic tests (laboratory/ x-ray/ anatomy pathology, etc.) and copy of the result,
• Report on any operation including detail of the operation expenses.

2. All claim documents that have been completed should be sent to Allianz within 
   30 days after going through a medical treatment.

3. If the policyholder and/ or member submitted an incomplete claim form, as
   mentioned in point 1, Allianz will treat is as a claim that has not been
   submitted.

4. Allianz has the right to receive all information/ medical records from the
   hospital and/ or other parties related with the diagnose and/ or medical
   treatment given to the member.

5. If the claim is approved by Allianz, then we will settle a payment upon the
   insurance benefit according to Allianz agreement, the latest 14 (fourteen) days
   since the complete document has been received by Allianz.

6. If the policyholder and/ or member or doctor giving the treatment, provided a
   report on the diagnose and/ or other information that is not according to the
   real condition/ illness and changed it after a claim has been rejected, then
   Allianz has the right to reject the claim.

If a member is insured by another insurer, then the member should submit a written notification from the other insurer upon the payment that has been settled enclosed with the copy of complete documents that has been legalized.