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Panduan Klaim Asuransi Kesehatan di Singapura

Dalam beberapa tahun terakhir, kesadaran akan perlunya asuransi kesehatan telah meningkat, hal ini tidak disebabkan oleh meningkatnya inflasi medis di tingkat lokal. Namun, sebagai penasihat finansial, kami sering menerima pertanyaan dari klien yang tidak yakin tentang proses klaim atas rencana tersebut. Oleh karena itu, kami hendak memberikan petunjuk dan menjelaskan proses yang terkadang membingungkan ini.

Warga Singapura dan Permanent Residences ditawarkan asuransi kesehatan dasar wajib dalam bentuk Medishield Life (MSL) oleh pemerintah Singapura. Banyak yang telah meningkatkan MSL mereka dengan Integrated Shield Plans (ISP) dan Rider terkait untuk mengurangi biaya yang harus dikeluarkan ketika keadaan darurat muncul. Pada saat yang sama, mereka yang memiliki pekerjaan tetap yang biasanya juga dilindungi oleh tunjangan asuransi karyawan mereka.

Namun, banyak orang asing yang hanya mengandalkan tunjangan karyawan jika mereka dirawat di rumah sakit. Kami sering menyarankan penambahan paket kesehatan pribadi di atas tunjangan karyawan untuk perlindungan tambahan, jika terjadi perubahan pekerjaan.

Jika pengobatan dilakukan di Singapura, kami berharap daftar FAQ berikut dapat membantu Anda menavigasi proses klaim dengan lancar.

1. Bagaimana cara mengajukan klaim saya?

Untuk Warga Negara Singapura & Permanent Residence, Anda disarankan melakukannya melalui pengarsipan elektronik yang biasa disebut E-File. Anda dapat meminta kantor penerimaan rumah sakit tempat Anda dirawat untuk melakukan pengarsipan elektronik. Proses ini hanya memfasilitasi penagihan langsung ke perusahaan asuransi Anda. Hal ini tidak boleh disalahartikan sebagai persetujuan atas klaim penerimaan.

Untuk Orang Asing, kecuali perusahaan asuransi kesehatan Anda menyediakan fasilitas penagihan langsung, Anda diharuskan membayar sendiri tagihannya dan selanjutnya mengajukan klaim penggantian.

2. Bagaimana saya dapat meminta Surat Jaminan jika rumah sakit memerlukannya?

Kebanyakan Penanggung memberikan Surat Jaminan elektronik, silakan berbicara dengan petugas penerimaan rumah sakit dan mereka akan memeriksa dan memberi tahu Anda mengenai hal ini. Kebanyakan perusahaan asuransi bekerja langsung dengan rumah sakit untuk penerbitan eLOG. Perlu diketahui bahwa LOG sama sekali bukan pengajuan atau persetujuan klaim. Ini hanyalah sebuah surat untuk mengurangi setoran tunai di muka oleh pasien sebelum masuk dan/atau operasi.

3. Kepada siapa saya harus mengajukan klaim terlebih dahulu?

Meskipun tunjangan karyawan memegang status pembayar pertama sebelum asuransi kesehatan pribadi Anda (ISP atau jenis asuransi kesehatan lainnya), berdasarkan pengalaman kami, kami menyarankan Anda untuk mengajukan klaim ke asuransi kesehatan pribadi Anda sebelum mengejar tunjangan karyawan Anda. Hal ini akan memberi Anda keuntungan berupa waktu pemrosesan & penggantian biaya yang lebih cepat, plafon klaim yang lebih tinggi, dan manfaat masa rawat inap yang lebih lama sebelum dan sesudah rawat inap.

4. Kapan saya harus mengajukan klaim?

Setelah keluar dari rumah sakit/operasi, namun sebaiknya tidak lebih dari 3 bulan setelah prosedur.

5. Kemana saya harus mengajukan klaim?

Untuk Warga Negara Singapura/Tempat Tinggal Permanen, Anda hanya dapat mengajukan klaim asuransi Integrated Shield Plan melalui pengajuan elektronik oleh rumah sakit/klinik.

Untuk Orang Asing dengan Integrated Shield Plan dan jenis asuransi kesehatan lainnya, Anda dapat mengajukan langsung ke portal asuransi Anda secara online. Hubungi penasihat finansial Anda untuk mendapatkan tautan yang relevan.

Untuk semua pekerja dewasa yang ditanggung oleh perusahaan mereka, Anda dapat mengajukan klaim melalui portal tunjangan karyawan (portal broker/perusahaan asuransi).

6. Dokumen apa saja yang harus saya serahkan?

Minimal, Anda harus menyerahkan dokumen-dokumen berikut:

  • Surat Ringkasan Pemulangan
  • Formulir Klaim yang telah ditandatangani
  • Formulir Laporan Dokter yang telah ditandatangani
  • Faktur Rumah Sakit/Klinik

Terakhir, jika Anda memiliki beberapa polis asuransi kesehatan, perhatikan bahwa:

  • Anda dapat mengajukan klaim dari beberapa polis, satu demi satu, selama jumlah total penggantian biaya di seluruh perusahaan asuransi tidak melebihi total tagihan yang dibayarkan.
  • Setiap Penanggung akan meninjau klaim secara keseluruhan terhadap hak Anda dan/atau melakukan sublimit secara terpisah dari penyelesaian penanggung lainnya.
  • Apabila terjadi tumpang tindih penggantian klaim antar penanggung, maka penanggung dengan status pembayar pertama akan mengganti penanggung dengan status pembayar terakhir.
  • Medishield Life dan Integrated Shield Plan memiliki status pembayar terakhir, sedangkan asuransi kesehatan perusahaan berdasarkan tunjangan karyawan Anda memiliki status pembayar pertama.

Jika Anda tidak yakin dengan hak/manfaat asuransi Anda, hubungi saya untuk meminta peninjauan!

Important: The information and opinions in this article are for general information purposes only. They should not be relied on as professional financial advice. Readers should seek independent financial advice that is customised to their specific financial objectives, situations & needs. This advertisement or publication has not been reviewed by the Monetary Authority of Singapore.

Published By:

Fendy Susanto

Fendy hails from a family who value entrepreneurship, where he understands that ones’ finance is ones’ responsibility. He follow suit after leaving his decade-long career in construction industry, becoming a Financial Advisor, an Entrepreneur and a Content Creator.

Prior to joining this career, Fendy had lost his Mom and Dad to Cancer and Heart Attack, respectively. Having a first hand experience on how devastating that was financially and emotionally, his main goal is to “Leave no Life Unprotected”

With his creative traits and his warm personality, rest assured that your needs always comes first at the best possible way. No doubts on the level of advices and services delivered as testified by his clienteles.

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根据《个人数据保护法》，鑫盟理财私人有限公司征求您的同意向您收集并使用您的个人信息。鑫盟理财将根据公司的个人数据保护政策所阐述的用途使用您的个人资料（例如姓名，证件号码，联系电话，邮寄地址，电邮地址和照片）。 该政策可在本公司网站上查寻，网址为 https://fa.com.sg/data-protection-policy/.

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  • Financial Alliance Pte Ltd ( “FAPL”) is licensed by the Monetary Authority of Singapore (“MAS”) and allowed to conduct financial advisory activities in accordance with the Financial Advisers Act (Cap. 110) (“FAA”) and the Securities & Futures Act (Cap. 289) (“SFA”) within the jurisdiction of the Republic of Singapore and in accordance with the licenses granted by MAS
  • 鑫盟理财私人有限公司( “鑫盟理财”)持有由新加坡金融管理局(“MAS”)所颁发的牌照，并许可在新加坡共和国境内依据财务顾问法（第110章）和证券与期货交易法（第289章）进行财务咨询等相关业务
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  • Such documents and information are provided by Financial Alliance Pte Ltd (“FAPL”) is for general information only and is not intended for anyone other than the recipient.
  • 此类由鑫盟理财所提供的文件和信息仅供收件人做一般信息参考。
  • It does not take into account the specific investment objectives, financial situation or particular needs of any particular person.
  • 此类文件和信息不会把-个人投资目标，财务状况或其特定需求等考虑在内。
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  • These documents may not be published, circulated, reproduced or distributed in whole or in part to any other person without FAPL’s prior written consent.
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  • This document is not intended for distribution to, publication or use by any person in any jurisdiction, where such distribution, publication or use would be contrary to applicable law or would subject FAPL and its related corporations, connected persons, associated persons and/or affiliates to any registration, licensing or other requirements within such jurisdiction.
  • 鑫盟理财无意在分发，出版或使用此类文件可能违反当地法律，或本公司及关联公司或关联人士需要注册，获得许可或符合规定的司法权区向当地人士分发、出版此类文件或供其使用。
  • You shall ensure that you have and will continue to be fully compliant with all applicable laws in your home country when entering into discussion or contracts with FAPL.
  • 在与鑫盟理财进行讨论或签订合约时，您应确保您已完全遵守并将继续遵守您所在原居住国的所有适用法律及条规。

In compliance with the Personal Data Protection Act, Financial Alliance Pte Ltd (“FAPL”) seek your consent to collect and use your personal data (e.g. name, NRIC, contact numbers, mailing addresses, email addresses and photograph) for the purposes of and in accordance with FAPL’s Data Protection Policy, which can be found on FAPL’s website at https://fa.com.sg/data-protection-policy/.

根据《个人数据保护法》，鑫盟理财私人有限公司征求您的同意向您收集并使用您的个人信息。鑫盟理财将根据公司的个人数据保护政策所阐述的用途使用您的个人资料（例如姓名，证件号码，联系电话，邮寄地址，电邮地址和照片）。 该政策可在本公司网站上查寻，网址为 https://fa.com.sg/data-protection-policy/.

By submitting this form, you are deemed to have read and understood FAPL’s Personal Data Policy.

提交此表格，即表示您已阅读并理解鑫盟理财私人有限公司的个人数据政策