Claims
You can download the claim form from here. You must complete the form, including the part on bank information. This section is important as we will pay the approved claim directly to your bank account via e-payment. Once completed, you may submit the claim form, together with the necessary documents, to your Life Planner or at any of our AIA Customer Centres for processing.
You can check your claim status by registering as a user of our AIA+ App. Please click on this link to register. You can also speak to your Life Planner, visit any of our Customer Centres or contact our Care Lines - 1300 88 1899 (for policies with AIA Bhd.) or 1300 88 8922 (for certificates with AIA PUBLIC).
Yes. Just submit your claim documents including the approval letter, settlement details, copy of bills and official receipts certified by the other paying party to us.
No, you must submit your original bill or receipt from the hospital for medical reimbursement. If you are claiming for the balance which has not been paid by another insurer, please submit your claim to us once these documents have been returned to you.
Present your original documents to our AIA agency leader or authorised AIA staff at any of our Customer Centres together with letter from lawyer request original for court purpose. They will help to verify your duplicate copies against the original documents. Once the verification is done, you can submit the certified true copy documents together with the claim form and the said letter by lawyer.
Please submit the following supporting documents together with your claim form:
- Breakdown of charges by item and description
- Name of medication prescribed
- Duration of medication supply
- We may request for additional documents/ information when necessary
The following items are typically not covered:
- Telephone charges
- Newspaper
- Miscellaneous Charges
- Medical Report Fees
- Glasses, hearing aids or fitting
Co-insurance basically means that you agree to share the cost of healthcare services with your insurer. You will have to pay for a set percentage of the medical expense before your medical insurance begins to pay.
For overseas medical expenses, please submit your claim together with the required documents. Please refer to the checklist in the claim form for the documents we require to process your claim.
We will need a letter from the National Registration Department of Malaysia confirming the death. We will also need the certified copy of the death certificate issued by the country where the Insured Person had passed away.
Please call our AIA Care Line at 1300 88 1899 or the AIA PUBLIC Care Line at 1300 88 8922 (for Takaful plans).
Hospitalisation / Day Care Procedure
A Planned Admission is when a hospital admission is recommended by your attending specialist to treat your medical condition. Here is how a Planned Admission is done when you have medical insurance / takaful with AIA:
- You can request for the Guarantee Letter (GL) facility to finance the medical expenses for your hospitalisation in an AIA panel hospital instead of having to settle the expenses yourself first.
- Thereafter, you must sign a Pre-Authorisation Form (PAF) to provide your consent. The Admission Section will need to be completed by the attending specialist.
- This form is submitted by the panel hospital through a designated AIA portal to request for GL approval.
- You will be informed by the hospital once the GL is issued, after which the hospital admission will be hassle-free.
An Emergency Admission or Unplanned Admission is when an immediate or same-day hospital admission is necessary after consultation with the specialist. Here is how an Emergency Admission is done:
- The Guarantee Letter (GL) facility request process is similar to that of a Planned Admission, except that the approval process will be prioritised.
- AIA will provide a response within a stipulated timeframe, depending on when the hospital submits the GL request.
- Issuance of the GL will be subject to your policy / certificate coverage as well as its terms and conditions.
- In the event that a GL is not issued, you will have to pay for hospital expenses incurred.
The pre-authorisation process is done prior to hospital admission to determine whether your insurance policy / takaful certificate benefits can cover the estimated expenses to be incurred for the hospitalisation.
- The Pre Authorisation Form (PAF) Admission Section will be completed by the attending specialist.
- In the PAF, the information required includes your medical condition and the reason for hospitalisation.
- You will need to provide your consent and sign the PAF. Once completed, it will be submitted by the hospital through a designated AIA portal.
- If the admission meets the terms and conditions of your policy / certificate coverage, AIA will pre-authorise the claim and provide the hospital with an initial Guarantee Letter.
A Guarantee Letter (GL) is a credit facility agreement between AIA and its panel hospitals for direct settlement of your hospitalisation claim. Hospital expenses that are covered by the policy / certificate benefits are paid directly by AIA to the hospital instead of you having to pay first; thus providing you with peace of mind when it comes to your healthcare needs.
Here are some details to keep in mind:
- The GL facility is offered as a value-added service for you at selected private hospitals (AIA panel hospitals).
- AIA reserves the right not to offer the GL facility if the hospitalisation or medical claim is non-payable, or not covered under the terms and conditions of your medical policy / certificate.
- For most Individual Medical Policies / Certificates, the GL facility is only available for hospitalisation claims (you are admitted) and not for outpatient procedures.
| Outpatient Procedure | Day Care Procedure |
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The Guarantee Letter (GL) facility is available to you when you undergo day care procedures in AIA panel hospitals. As day care procedures do not require overnight admission, you need not worry about being able to obtain GL if you are not admitted.
If you require hospitalisation in an AIA panel hospital, all the necessary arrangements for a Guarantee Letter (GL) will be made by the hospital admission staff directly with AIA. If you choose to seek healthcare in non-panel hospitals, you will be required to pay the full hospitalisation expenses and submit a claim for reimbursement thereafter.
Note: Assistance from a Life Planner will not be necessary as AIA will handle the entire process. Life Planners will be notified about their customers’ GL status.
Factors that are considered for Guarantee Letter (GL) processing include (but are not limited to):
- Policy / certificate terms, conditions and benefits
- Medical history
- Age
- Gender
- Diagnosis
- Type of treatment
When an Initial GL is given, this means AIA has pre-authorised the claim based on information provided prior to your hospital admission and it will be subject to the actual treatment that is required during hospitalisation. A Final GL means the hospitalisation claim has been approved and actual incurred expenses that are covered will be payable to the hospital. You will have to pay any expenses that are non-coverable to the hospital before leaving the hospital.
AIA reserves the right to review the approval under circumstances where the actual treatment differs from what is stated in the pre-authorised Initial GL.
A denial of Guarantee Letter (GL) can be due to any one of the following reasons and scenario:
Scenario 1: The hospitalisation claim will not be approved if:
- The claimant or patient is not covered under the policy / certificate
- Policy / certificate is not in-force
- Policy / certificate exclusion
- Insured / Covered Person exclusion
- 30-days waiting period
- 120-days waiting period
- Congenital conditions
- Maternity related conditions
- Psychiatric conditions
- Cosmetic treatment
- Dental-related condition
- Treatment is investigative and/or experimental
- Treatment can be done as an outpatient and does not require hospital admission
Scenario 2: AIA could not pre-authorise the claim and you are required to pay the hospitalisation expenses in full as well as submit a claim for processing and reimbursement upon approval.
- There is a need to investigate if you have a pre-existing condition that was not declared during the policy / certificate application.
- The cashless facility benefit may not be available for certain policies.
All private hospitals in Malaysia require their patients to pay a deposit prior to hospital admission. Here is what you need to know about Hospital Deposit:
- The deposit amount varies between the different hospitals and this admission deposit is even higher for hospital admissions without a Guarantee Letter (GL).
- Before being discharged, the hospital will obtain the final GL which will indicate how much you have to pay out of pocket, if any.
- The hospital can use the deposit to offset expenses that are non-coverable under your policy / certificate.
- If you are admitted to any AIA Platinum hospitals, a deposit during admission will not be necessary if the initial GL has already been obtained.
- For additional expenses incurred during admission or prior to discharge, the hospital may request you to arrange some form of deposit to ensure that you have the financial resources to pay for non-covered expenses, if any.
| Coverable Expenses | Non-Coverable Expenses |
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Refer to the Exclusion list in your policy / certificate contract |
If your policy / certificate comes with the co-insurance / co-takaful or the deductible feature, it means you would need to share the cost of your medical expenses with AIA.
- Co-insurance / co-takaful is a percentage of the medical expenses that you have to pay, while the rest of the cost is covered by your medical policy / certificate.
- Deductible is an agreed sum of upfront payment that you have to make for your medical expenses before your medical insurance / takaful kicks in.
When you have recovered and are fit for discharge from the hospital, a waiting time should be expected. To understand why, here is the discharge process:
- Firstly, the doctor has to complete the Discharge Section of the original Pre Authorisation Form (PAF) (Information needed includes discharge diagnosis, what treatment was provided, and what procedures were performed).
- The hospital billing staff will finalise all expenses to generate the Final Bill (hospital invoice).
- The hospital billing staff will compile all documents (completed PAF, Final Bill with detailed itemisation, copies of imaging and laboratory reports) and prepare them in a compatible digital format before submitting to AIA via a designated portal.
- When AIA receives the full documentation, our claims assessor will conduct the claims assessment and adjudicate coverable expenses subject to your policy / certificate benefits, terms and conditions. Besides that, we also review the hospital charges to ensure that they are reasonable and customary.
- If there is a need for clarification or enquiries about the treatment or charges, AIA will refer back to the hospital and await their reply.
- If there are no other issues, the claims are considered processed and AIA will issue a Final GL to the hospital, notifying them of the coverable expenses and what is not covered (if any).
- The hospital will then conduct their discharge process upon receiving the GL confirmation.
You are recommended to do the following:
- Request for a copy of the hospital invoice together with the itemised breakdown of the bill.
- Seek to verify any charges that you see in the itemised bill that are not in accordance to what you have used in the ward.
- Verify that the doctor’s ward visit charges are in accordance to the number of consultations you had with the doctor.
- Seek clarification from the hospital staff at the discharge counter if there is any doubt.
- Request immediately for amendment should there be any abnormalities in the bill.
AIA works alongside a large network of private hospitals nationwide to give our customers peace of mind in seeking healthcare services wherever they are.
The AIA Platinum Hospital Network comprises of selected hospitals from the AIA panel. These hospitals are recommended by AIA to our customers because they meet our selected criteria such as quality, affordability, and customer experience. Customers will also get to enjoy additional benefits such as:
- Waiver of administrative fees
- During admission, the hospital will not request for deposit from patients who have already obtained an approved GL
- Shorter waiting time because of priority GL processing
- Exclusive rates such as discounts on health screening packages and other value-added services
To find an AIA Panel Hospital, you can:
- Visit the AIA website here
- Use the Panel Locator in the AIA+ mobile app
- Call our Care Line at 1300 88 1899
Post Hospitalisation
Individual Policy
This is a new Guarantee Letter service for Individual Medical policy/certificate holders which will enable them to opt for a cashless visit in their post hospitalisation care.
Customers can easily request for the GL via the AIA+ App:
- Click on the “Guarantee Letter Request” tab, select the visit date and fill in the information required
- If there is a valid discharge Guarantee Letter for past hospitalisations that is eligible for Follow-up GL issuance, the “Post Hospitalisation” option in the dropdown will be displayed.
- Select “Post hospitalisation” from the option
- Select the correct hospitalisation guarantee number below for your upcoming post hospitalisation visit (Note: If there are more than one hospitalisation that is eligible for the GL request, there will be multiple records displayed for selection)
- Upload the image of the follow-up appointment card / letter and submit the request.
Please click here for the journey.
If this happens, the admitting panel hospital can submit the Post-Hospitalisation GL request to AIA on behalf of customer.
No, the Post Hospitalisation GL only covers the treating doctor(s) as stated in the post hospitalisation GL.
Click on the Bell Icon on the top right of your app dashboard. You will be brought to your inbox. The GL notifications are under ‘Statements & Letters”.
The Post Hospitalisation GL is only valid for a follow up after a hospitalisation has taken place. Therefore, you will only see the display if:
- You had an admission with a final GL issued for your discharge from 23 June onwards and,
- Your appointment date is within the validity of the follow up days as stated in the policy contract.
Corporate Policy
AIA will be introducing a new feature called “One GL per Post-Hospitalisation Visit”. With this, members will need to request a new GL for each post-hospitalisation follow-up visit with the treating doctor(s). This process is to ensure that the member benefit utilisation is kept current therefore providing a faster and more seamless experience during their subsequent visits. It applies for those hospitalisation / out-patient visit effective from 23 Jun 2022 onwards.
Customers can easily request for their GL via the AIA+ App.
- Click on the “Guarantee Letter Request” tab, select the visit date and fill in the information required
- If there is a valid discharge Guarantee Letter for past Hospitalisation that is eligible for Follow-up GL issuance, the “Post Hospitalisation” option in the dropdown will be displayed.
- Select “Post hospitalisation” from the option
- Select the correct hospitalisation guarantee number below for your upcoming post hospitalisation visit (Note: If there are more than one hospitalisation that is eligible for the GL request, there will be multiple records displayed for selection)
- Upload the image of the follow-up appointment card / letter and submit the request.
Please click here for the journey.
If this happens, the admitting panel hospital can submit the Outpatient specialist or Post-Hospitalisation GL request to AIA on behalf of the member.
For any Final Guarantee Letter (hospitalisation GL) issued prior to 23 June 2022, whereby the GL includes follow-up visits, it will be valid as per the stated duration. Hence, they do not need to request for a new GL.
Click on the Bell Icon on the top right of your app dashboard. You will be brought to your inbox. The GL notifications are under ‘Statements & Letters”.
Post Hospitalisation GL is only valid for a follow up after a hospitalisation. Therefore, you will only see the display if:
- You had an admission with a final GL issued for your discharge from 23 June onwards and,
- Your appointment date is within the validity of the follow up days.
These GL selections are only valid for follow up visits and if there is a valid initial GL issued. The app is configured to only show the display of you have a valid initial GL for a subsequent collection of medication. Likewise, if you have a valid GL issued for Physiotherapy / Dialysis eligible for follow up, only then you can see it in the dropdown selection.
