Have the documents below ready:

Hospitalization:

1. Medical resume from the hospital/clinic and filled out by the attending physician
2. Original receipt from hospital/clinic 
3. Details of costs and names of drugs during hospitalization
4. If the purchase of drugs is separate, then attach:
   a. Original receipt from the pharmacy, equipped with a copy of the drug prescription, drug number and name of the prescribing doctorb
   b. Stamped
5. If there is a separate diagnostic test examination, then attach:|
   a. Original receipt from laboratory/RS
   b. Cover letter for diagnostic examination from a doctor
   c. Details of the name of the diagnostic examination
   d. Stamped
6. Copy of diagnostic examination results
7. Referral letter for hospitalization (if obtained from a doctor outside the hospital)
8. Cover letter from the doctor if further examination needs to be done
9. Reimbursement claim form
10. Certificate or receipt of claim payment from other insurance, if the claim is paid in whole or in part by other insurance
11. Reimbursement claim documents submitted in Indonesian and/or English language

Outpatient:

1. Original receipt from doctor/RS/clinic/optics
2. Details of costs and names of drugs given
3. If the purchase of medicine is separate, then attach:
   a. Original receipt from the pharmacy, accompanied by a copy of the drug prescription, drug number and name of the prescribing doctor
   b. Stamped
4. If there is a separate diagnostic test examination, then attach:
   a. Original receipt from laboratory/RS
   b. Cover letter for diagnostic examination from a doctor
   c. Details of the name of the diagnostic examination
   d. Stamped
5. Referral letter from a general practitioner (for specialist doctors, a referral letter is required)
6. Reimbursement claim form
7. Reimbursement claim documents submitted in Indonesian and/or English language

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Fill out the form properly and correctly, make sure the information matches the documents

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