Written by Mei Ling
Published 16 October 2026 | Last updated -
Who we are: Home Care Apps Team
Quick answer: To help a client claim after hospital discharge, confirm the claim route, gather the claim form, itemised bills and medical report, check the policy's deadline, submit through the insurer's official channel and track it. Never promise approval, because the insurer decides. Facts checked October 2026.
Key points
- Your role is to assist; the insurer decides every claim.
- Check the policy's claim deadline, because insurers differ.
- Collect original itemised bills, receipts and the doctor's report.
- Use the insurer's current claim form and official channel.
- If a claim is rejected, appeal to the insurer, then FMOS.
1. What is your role, and which claim route applies?
Your role is to assist, not to decide, because the insurer assesses and decides every claim. BNM's agent professionalism policy says agents help customers with "ensuring timely claims submission" and requires insurers' codes of ethics to make agents "provide assistance on claims and maintain contact with customers" (BNM, paras 1.1 and 8.2(d)). The Life Insurance Association of Malaysia (LIAM) chief executive told CodeBlue that agents have "no formal role in the claims process", although they often help customers and pass on insurer decisions (CodeBlue, 4 December 2025).
Next, ask which hospital the client used and whether a guarantee letter (GL, also called cashless admission) was issued. For MediAsas, a Preferred In-Network hospital uses the cashless GL route, and other hospitals are pay first, claim later. BNM also tells customers who need help to contact their agent, the insurer or the hospital admission counter (BNM FAQ, C11). The route decides what paperwork is left.
2. Which claim form does the client need?
Use the insurer's current official claim form for the type of claim, because forms differ by benefit. Etiqa Family Takaful's checklist separates inpatient, pre- and post-hospitalisation, emergency and outpatient claims, and Great Eastern has separate pages for inpatient and for pre- and post-hospitalisation claims. Get forms from the insurer's website, branch or servicing channel, not from old copies.
Each form has parts for different people. On AIA's form, the claimant completes Section I and the attending doctor completes Section II. Etiqa's form says every question must be fully answered, and a second signature is needed if the claimant is not the person covered. Help your client complete their own part accurately, because BNM says false or incomplete information may lead to a claim being rejected or delayed (BNM FAQ, C24). The doctor completes the medical part.
3. Which documents should you collect?
Collect the claim form, original itemised bills and receipts, the doctor's report and a copy of the client's ID, then check the insurer's list for anything extra. BNM says required documents vary by claim type but usually include completed claim forms, medical bills and supporting medical reports (BNM FAQ, C19).
| Document | Who provides it | Check |
|---|---|---|
| Claim form (claimant's statement) | The client | Answer every question |
| Medical report or attending physician's statement | The treating doctor | Some forms need it only above a bill amount |
| Original itemised bills and receipts | The hospital | Include deposit and refund receipts |
| Copy of NRIC or passport | The client | Some insurers want a certified copy |
| Lab or imaging reports, discharge summary | The hospital | Only if the insurer asks |
Great Eastern's page says a photocopy of the hospital bill and receipt is not acceptable (Great Eastern). Our guides list every document to claim and what to ask for at the discharge counter. If the client had registered nurse home visits, ask the insurer in writing what it needs, and see home nursing claims.
4. What deadlines should you check in the policy?
Check the policy and the claim form for a deadline, because insurers differ and BNM's MediAsas FAQ states none. AIA Berhad's Corporate Solutions hospital and surgical claim form (dated July 2018 on the form) says a claim "must be submitted within 90 days from the date of discharge or consultation" (AIA claim form). The Great Eastern, Allianz and Etiqa pages we read give no number of days, and Great Eastern says most policies set a claim submission window after treatment or discharge (Great Eastern guide).
Also confirm the policy was in force. For MediAsas, BNM gives a 30-day grace period for late premiums, and any outstanding premium must be paid before the claim is settled (BNM FAQ, D6). Encourage the client to submit early.
5. How do you submit, and how can the client check progress?
Submit through the insurer's official channel and keep proof of what was sent. On the same Great Eastern page, claims can be sent online, through the servicing agent, at a branch or by post, and status is shown online or by email. Allianz lists MyAllianz, the agent and a hotline for tracking. BNM says MediAsas customers can view claim status through the insurer's or takaful operator's official channels, and that processing time varies with completeness (BNM FAQ, C18 and C19).
Insurer estimates differ, and neither page is about MediAsas: Great Eastern says 10 to 14 working days after complete documents, and Allianz says 7 working days. Treat these as estimates, not promises. Keep a dated record of what you sent.
6. What if the insurer queries the claim?
Answer the query quickly, in writing, through the insurer's official channel. BNM says claims processing may be delayed until all required documents are submitted, and that the hospital or insurer will notify the customer of what is missing (BNM FAQ, C20). Insurers use their own names for this: Allianz sends a "Deferment Letter" and Great Eastern a pending requirement letter.
Ask the insurer to state what is missing in writing, supply only what is asked, and ask your client to answer health questions truthfully. If a policy exclusion or condition is cited, ask which clause applies: BNM told CodeBlue that insurers and takaful operators "cannot enforce conditions or exclusions that are not made known to the policyholder" (CodeBlue, 22 December 2025).
7. What if the claim is rejected or only partly paid?
Ask for the decision and its reasons in writing, then appeal to the insurer, and if that fails, go to FMOS or BNMLINK. BNM says a customer may appeal a claims decision by sending a request with supporting documents, which may involve FMOS or BNMLINK (BNM FAQ, C22).
FMOS, the free ombudsman for insurance disputes, says the client must first file a formal complaint with the insurer, then file "within 6 months from the date of receiving the Member's final decision". The client can also go to FMOS if the insurer does not respond within 60 days (FMOS). FMOS asks for an authorisation letter and ID from anyone representing the holder, and does not mention agents, so the client should file. BNMLINK is on 1-300-88-5465, Monday to Friday, 9am to 5pm (BNM MHIT page). See why claims are rejected in our 5 common mistakes.
8. What should you never promise?
Never say a claim will be approved, paid in full or paid by a date, because the insurer decides each claim. Etiqa's form says that "Submission of this Claim Form does not guarantee admission of liability", and BNM says GL approval is subject to assessment and policy terms (BNM FAQ, C14). Clients may still pay deductibles, co-payments or uncovered charges (C11).
For MediAsas home nursing, the FAQ gives limits (up to RM3,000 a year, maximum 90 days per lifetime) but does not say how the 90 days are counted or whether cashless applies (BNM FAQ, Appendix I item 13). Say "ask the insurer", not "covered". For the cashless step, see our guide to the guarantee letter.
What to do next
- Ask the insurer for the current claim form and the policy's claim deadline.
- Ask the client to collect original itemised bills and the doctor's report before leaving hospital.
- Keep a dated record of every document you send.
- If a claim is rejected, tell the client about the FMOS six-month limit.
- Point families planning nurse visits to the free care assessment.
FAQ
How can an insurance agent help a client claim after hospital discharge?
Help the client gather the claim form, itemised bills, receipts and medical report, check the policy deadline, and submit through the insurer's official channel. BNM expects agents to "provide assistance on claims", but LIAM says agents have no formal claims role and the insurer decides.
What documents should an agent collect?
Usually the claim form, original itemised bills and receipts, a medical report and a copy of the client's ID (BNM FAQ, C19). Check the insurer's own list, because it varies by claim type.
What should an agent not promise about a claim?
Never promise approval, full payment or a payment date. The insurer assesses every claim, and clients may still owe deductibles, co-payments or uncovered charges.
How can a client check claim status?
Through the insurer's or takaful operator's official channels once the claim is submitted (BNM FAQ, C19). Examples are Great Eastern's online portal and MyAllianz.
Is there a deadline to claim after discharge?
It depends on the policy. One AIA Berhad claim form says 90 days from discharge, while BNM's MediAsas FAQ states no deadline, so check the policy wording.
How we can help
Home Care Apps arranges registered nurse home visits across Peninsular Malaysia, subject to nurse availability in your area. Home Care Apps says it provides a detailed post-visit clinical report that can be submitted for reimbursement claims, but whether a claim is paid is the insurer's decision. Our "from" prices are on our home page, and families can try the free care assessment or send us an enquiry.
Sources
- Bank Negara Malaysia, MediAsas Frequently Asked Questions, Version 1: Pilot Programme, 29 July 2026. PDF. Items C11, C14, C18 to C20, C22, C24, D6 and Appendix I item 13.
- Bank Negara Malaysia, Policy Document on Professionalism of Insurance and Takaful Agents, issued 17 April 2023, effective 1 January 2024. BNM page.
- Bank Negara Malaysia, Medical and Health Insurance/Takaful (MHIT), BNMLINK contact details. bnm.gov.my/mhit, page read 16 October 2026.
- Financial Markets Ombudsman Service, "How to file a dispute", page last modified 14 July 2025. Link.
- CodeBlue, "Insurance Agents Play 'No Formal Role' In Medical Claims: LIAM", 4 December 2025. Link.
- CodeBlue, "BNM Tells Insurers To Settle Medical Claims Promptly, Prohibits Applying Unknown Exclusions", 22 December 2025. Link.
- AIA Berhad, "Corporate Solutions - Hospital & Surgical Claim" form, form code IP_06/2018/Ver2 (July 2018 on the form). PDF.
- Etiqa Family Takaful Berhad, "Checklist: Medical Claim Submission" and Hospitalisation Claim Form, undated, 2026 page read 16 October 2026. PDF.
- Great Eastern Life Malaysia, "Make an Inpatient/Day Surgery claim" (undated, copyright 2026, page read 16 October 2026). Link.
- Great Eastern Life Malaysia, "How to make a medical claim in Malaysia" (Greatpedia, undated, page read 16 October 2026). Link.
- Allianz Malaysia, "Individual Claims" (undated, copyright 2026, page read 16 October 2026). Link.
Note
This is general information, not medical, financial or legal advice, and Home Care Apps is a home nursing provider, not an insurer, takaful operator or insurance agent.