HEALTH CLAIM SUBMISSION REQUIREMENT & PROCEDURE
As one form of our efforts to provide optimum services, we provide call center services which can be access by the participants. Call Center Services can be accessed through:
An institution which is a legal entity and registered as a Hospital in the country where the hospital is based to provide care and treatment for sickness and injury, and the Hospital:
A section of the hospital that is permanently set as the Intensive Care Unit of the Hospital, which is open 24 hours solely to provide emergency care / critical that require audio and visual observation continuously, and are equipped to provide care and specialized medical services that are not available elsewhere in that hospital.
A doctor who qualified and has diploma in western medical science and has a valid license to practice as a general practitioner that issued by the competent authority of the country in which he practices, and providing care and medical services within the scope of license and expertise.
A doctor who has special expertise in western medical science and recognized by the competent authority in the country in which they practices.
Health conditions that require immediate healing treatments, in order to avoid death or serious deterioration in the outlook for health, either during the event or for the long term.
Unexpected events, unplanned, sudden, unforeseen, comes from outside and caused by violence causes bodily injury by accident that regardless of any other cause. Inhalation of gases and vapors and omissions inadvertently consume toxic materials or chemicals are also considered as an accident, with the proviso that only accidental bodily injury that occurs within 30 days from breathed or consumption, it will be considered as the cause of the accident. Drowning is also considered as an accident.
The physical condition of the deviation from normal and healthy condition.
Costs/Expenses that have been known since the beginning as the obligation of participants, this cost/expenses must be paid by the participant directly to the Hospital / Clinic, such as non- medical expenses (soap, tissue, laundry, sanitary napkins, Pampers and the like).
Medical expenses which are not covered under the insurance policy and become liability of the participant. The excess is known after Chubb received a bill from the hospital / clinic and after going through the process of analyzing the claim is known that medical expenses not covered by Chubb.
Network Hospitals / Clinics as a partner of Chubb, to provide medical services to the Participant of Chubb’s Health Insurance.
Third Party Administration, which is a company that has been appointed by Chubb to do management of the claim including guarantee of treatment and customer service.
It is a method of service on a "cashless" basis where by carrying Chubb Health Insurance card, participants can seek treatment to network clinic / hospital provider (partner) who has worked with Chubb health insurance without have to make a payment in cash (except for any costs which are not covered by Health Insurance Policy).
All medical bills will be charged by the clinic / hospital provider to Chubb for further analysis. In case the costs are not covered by the policy, it will be charged as an excess claims to policyholders and to be paid within 14 days to Chubb.
Reimbursement SystemIt is a method of service where participants pay in advance the cost of treatment at the hospital of participant choice, then submit all original invoice including complete claim documents to PT. Chubb through Company HR. All documents will be analyzed according to benefits/ coverage contained in the Health Insurance Policy. Claims payment for the approved claim will be made through the company’s bank accounts (or according to the initial agreement between Chubb with the company).
Special note coverage Glasses:
Note : This special note applied only if the participant have glasses benefit as stated in the Policy.
To obtain settlement of claim reimbursement, participants must submit a claim to Chubb through his company HR, to include all of the requirements necessary claim documents.
All claim documents will be analyzed according to benefits / coverages contained in the Health Insurance Policy. Chubb will settle the claim within 10 working days after the complete claim documents received by the Chubb Insurance
Expired date of claim submission:
OUTPATIENT AND DENTAL TREATMENT
Note: *) If the Claim Form of Dental Care/ Outpatient treatment not be carried away by the participants at the time of treatment, on the original receipt must be included medical diagnosis given by a physician who treats with signature and seal of the treating doctor.
SPECIAL NOTE CARD PARTICIPANTS
Do not carry a Participant’s card
For the case of hospitalization, participants forget or do not carry Chubb health insurance cards, please contact Customer Service Chubb Health Insurance to request initial guarantee letter. Initial guarantee valid for 2 x 24 hours. Participants are expected to be able to show the card Participant after the deadline. If the card is not available, there should be an explanation of the HR company in writing that describe the status of the Card Member.
For outpatient cases, when participants forget or do not carry Chubb health insurance cards, the participant is considered as a public patient. Participants must pay in advance the cost of treatment and subsequently filed a reimbursement claim to Chubb through HR company.
Membership card lost or damage
Warranty provisions for Inpatient
Inpatient Guarantee applies if the Participant admitted to the hospitalization within at least eight (8) hours for necessary health care due to illness or accident referred doctor. Especially for surgery, this provision does not apply.
If participants choose to hospitalization abroad, the system applies reimbursment. Participants must pay the cost of treatment in advance then submit it to PT. Chubb, as reimbursment claims procedure (on page 9).
Entitled Room & Board are not available due to full book
Room rate as per Participant entitlement is not available at the Hospital
Conditions APS (On Demand Self)
That is a condition where since the beginning the room occupied by participant is higher than his entitled room on his own request or Participants treated abroad. In this case, the participant must pay in advance the cost of treatment is going on and then propose reimbursement to Chubb Insurance, as per reimbursement claims procedure (on page 9). The maximum reimbursement is as per conditions listed in the policy.
SPECIAL NOTE FOR OUTPATIENT BENEFITS
Participants were asked to pay in cash for the purchase of vitamins / multivitamins
When in network hospital / clinic provider, Participants were asked to pay in cash the cost of purchasing vitamins / multivitamins, participants can still make a claim purchase vitamins / multivitamins on reimbursement basis according to the conditions of the policy.
Terms repetition purchase prescription drugs (iter)
Purchasing prescription drugs repetition (iter) a maximum of two (2) times were made within 14 (fourteen) days from the first recipe submitted. Except already get written approval of the medical team Chubb
Excess costs are those costs which from the beginning has been known to be a participant liability, costs shall be paid by the participant directly to the Hospitals / Clinics.
Completion Excess Cost
If there is excess cost, the Participant is required to pay the entire cost of the excess before leaving the hospital.
Examples of services that result in excess Cost:
Excess claims are costs that are not covered and being obligation of the Participant. The excess is known after Chubb receive bill from the hospital / clinic and after going through the process of analyzing the claim is known that there are costs that are not covered by Chubb.
Completion Claims Settlement
Examples of Excess Claim:
Settlement of Bill
By bank account transfer, addressed to the following bank account
By a cash deposit, the Parties shall mencantumkam news on deposit payment sheet, which contains:
In this case, participants are required to pay the administrative costs imposed the sender Bank.
By the transfer via ATM, the ATM machine that has the facility to include the sender's message (Non-Cash ATM), the Participant is required to include the sender's message, which contains:
In this case, participants are required to pay the administrative costs imposed the sender Bank.
If participants make payments through one of the above media without sending news, then after making the payment, participants MUST notify Chubb, via email: Health.ID@chubb.com by stating:
Payment of the excess claims in the absence of news or clear information, can not be recorded as a settlement
Competing for the first time, Customer Service team of Chubb in Indonesia won two medals in The Best Contact Center Indonesia 2017 competition, held by the Indonesia Contact Center Association (ICCA).
Branch Admin Servicing Support of Chubb in Indonesia, Fitrya Robbyani won a Gold Medal for the Individual, Back Office – Small category, while Customer Service Assistant Manager of Chubb in Indonesia, Neni Agustuti won a Silver Medal for the Individual, Supervisor – Small category. Aside from that Customer Service, Travel Back Office Agent of Chubb in Indonesia, Karina Sahara and Customer Service Inbound Agent of Chubb in Indonesia, Mariati Lausefa achieved Top 20 positions for the Individual, Back Office – Small category and the Individual, Agent Regular – Small category.
As many as 49 call centers and over 500 individuals competed in four categories – Corporate Program, Teamwork, Talent and Individual. The competing professionals were judged in two stages of competition, and winners were then announced on 11 August 2017 in Jakarta.
Chubb’s participation in The Best Contact Center Indonesia 2017 competition is certainly in line with the company’s commitment to provide consistent superior experience for our customers. This event is seen as one of the efforts to improve service capabilities and to measure service quality delivered to customers.