21
Our Provider Network Listing Welcome to our Provider Network! Note that we have many Networks to suit different Clients so make certain you are using the right List. Check with your Insurance Company, HRD or with our Customer Service staff if you are not sure. This is our Network List for Indonesia Only, All Services, All Classes. If you are not certain what services you are entitled to use on a cashless basis, please check your insurance policy or talk to your Human Resources Department (HRD). If you would like details of our other network providers, an "All Providers" list is available from our website at www.Global-Assistance.net . The cashless medical services available from each of the Facilities listed are indicated with a P mark (see below). Note also that the cashless services available to you personally will depend on your insurance policy or company entitlements. If you have any questions regarding this list, or if you experience any problems of any kind in accessing services from these Providers, please call the customer service number on the back of your Membership Card or call us on (021) 782 8022. We continue to build and expand our Network of Providers to suit our clients - so please check for updates to this list at our website www.Global-Assistance.net . Abbreviations used below are as follows... IP = Inpatient services MA = Maternity Services OP = Outpatient services DB = Basic Dental services DC = Complex Dental services Opt = Optical services MC = Medical Checkup services PT. Global Asistensi Manajemen Indonesia (GAMI) INDONESIA State/Province: Bali Denpasar Facility Name Type Telephone IP Address Opt O DB DC M M Jimbaran Clinic P JL. By Pass Ngurah Rai No. 95 XX, Kedonganan - Tuban Clinic - 24 Hours (0361) 701467 Kimia Farma Clinic P Jl.Diponegoro No.125, Denpasar Clinic - 24 Hours (0361) 255 914 Klinik Penta Medica P Jl. Teuku Umar Barat, Marlboro No. 88 Clinic - 24 Hours (0361) 7446144 Kuta Clinic P Jl. Raya Kuta 100X, Kuta Clinic - 24 Hours (0361) 758 495 Merdeka Medical Centre (MMC) P P P Jl. Merdeka VIII / 2 Tanjung Bungkak, Denpasar Clinic - 24 Hours (0361) 233 790 Nusa Dua Clinic P P Jl.Pratama No.81A-81B, Nusa Dua Clinic - 24 Hours (0361) 778 098 Poliklinik&Apotek Metta Beliton P Jl. Beliton No. 1 Clinic - Not 24 Hours (0361) 227334 RB Kasih Ibu Dalung Permai P P Kompleks Perumahan Bumi Dalung Permai Blok C1 - C4 Hospital & Clinic (0361) 3093939 P Remedium Care Clinic P P Jl. By Pass Ngurah Rai No. 243, Sanur Clinic - 24 Hours (0361) 7430729 RS BaliMed P P P P Jl. Mahendratta No. 57, Denpasar Hospital & Clinic (0361) 8450773 P RS Kasih Ibu Bali P P P P Jl. Teuku Umar 120, Denpasar Hospital & Clinic (0361) 223 036 P RS Prima Medika P P Jl. P. Serangan No.9 X Hospital & Clinic (0361) 236 225 P RSB Aricanti P P Jl. Raya Mas, Ubud Maternity Only Hospital (0361) 974 573 P RSIA Puri Bunda Denpasar P P Jl. Gatot Subroto VI/19, Denpasar Hospital & Clinic (0361) 437 999 P RSU Kasih Ibu Kedongan P P P P Jl. Uluwatu No. 69 A, Kedongan - Kuta Hospital & Clinic (0361) 703270 P RSU Sari Dharma P P P P Jl. Pulau Seram 8, Denpasar Hospital & Clinic (0361) 226 866 P Released: 12 May 2010, 1:53:55PM Page 1 of 21 Network Listing - Indonesia Only All Services Maximizing Service, Minimizing Risk Health Benefits Administration & Risk Management PT Global Asistensi Manajemen Indonesia (GAMI) Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

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Page 1: List Provider, 12 May 2010

Our Provider Network ListingWelcome to our Provider Network! Note that we have many Networks to suit different Clients so make certain you are using the right List.

Check with your Insurance Company, HRD or with our Customer Service staff if you are not sure.

This is our Network List for Indonesia Only, All Services, All Classes.

If you are not certain what services you are entitled to use on a cashless basis, please check your insurance policy or talk to your Human

Resources Department (HRD). If you would like details of our other network providers, an "All Providers" list is available from our website at

www.Global-Assistance.net.

The cashless medical services available from each of the Facilities listed are indicated with a P mark (see below). Note also that the

cashless services available to you personally will depend on your insurance policy or company entitlements.

If you have any questions regarding this list, or if you experience any problems of any kind in accessing services from these Providers, please

call the customer service number on the back of your Membership Card or call us on (021) 782 8022.

We continue to build and expand our Network of Providers to suit our clients - so please check for updates to this list at our website

www.Global-Assistance.net.

Abbreviations used below are as follows...

IP = Inpatient services MA = Maternity Services OP = Outpatient services DB = Basic Dental services

DC = Complex Dental services Opt = Optical services MC = Medical Checkup services

PT. Global Asistensi Manajemen Indonesia (GAMI)

INDONESIA

State/Province: Bali

Denpasar

Facility Name Type Telephone IPAddress OptO DB DCM M

Jimbaran Clinic PJL. By Pass Ngurah Rai No. 95 XX,

Kedonganan - Tuban

Clinic - 24 Hours (0361) 701467

Kimia Farma Clinic PJl.Diponegoro No.125, DenpasarClinic - 24 Hours (0361) 255 914

Klinik Penta Medica PJl. Teuku Umar Barat, Marlboro No. 88Clinic - 24 Hours (0361) 7446144

Kuta Clinic PJl. Raya Kuta 100X, KutaClinic - 24 Hours (0361) 758 495

Merdeka Medical Centre (MMC) P P PJl. Merdeka VIII / 2 Tanjung Bungkak,

Denpasar

Clinic - 24 Hours (0361) 233 790

Nusa Dua Clinic P PJl.Pratama No.81A-81B, Nusa DuaClinic - 24 Hours (0361) 778 098

Poliklinik&Apotek Metta Beliton PJl. Beliton No. 1Clinic - Not 24 Hours (0361) 227334

RB Kasih Ibu Dalung Permai P PKompleks Perumahan Bumi Dalung

Permai Blok C1 - C4

Hospital & Clinic (0361) 3093939 P

Remedium Care Clinic P PJl. By Pass Ngurah Rai No. 243, SanurClinic - 24 Hours (0361) 7430729

RS BaliMed P P P PJl. Mahendratta No. 57, DenpasarHospital & Clinic (0361) 8450773 PRS Kasih Ibu Bali P P P PJl. Teuku Umar 120, DenpasarHospital & Clinic (0361) 223 036 PRS Prima Medika P PJl. P. Serangan No.9 XHospital & Clinic (0361) 236 225 PRSB Aricanti P PJl. Raya Mas, UbudMaternity Only Hospital (0361) 974 573 PRSIA Puri Bunda Denpasar P PJl. Gatot Subroto VI/19, DenpasarHospital & Clinic (0361) 437 999 PRSU Kasih Ibu Kedongan P P P PJl. Uluwatu No. 69 A, Kedongan - KutaHospital & Clinic (0361) 703270 PRSU Sari Dharma P P P PJl. Pulau Seram 8, DenpasarHospital & Clinic (0361) 226 866 P

Released: 12 May 2010, 1:53:55PM Page 1 of 21

Network Listing - Indonesia Only All Services

Maximizing Service, Minimizing Risk

Health Benefits Administration & Risk Management

PT Global Asistensi Manajemen Indonesia (GAMI)

Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 2: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Bali

SingarajaRSU Grehosadha Parama Sidhi P P P PJl. Ahmad Yani No. 117 A,

Baktiseraga - Singaraja

Hospital & Clinic (0362) 32701 P

State/Province: Banten

CilegonKlinik Al Falah P PRuko Sukmajaya Blok B No. 20Hospital & Clinic (0254) 7035602

Klinik Amalia Cilegon P PJl. SA. Tirtayasa No. 7Clinic - 24 Hours (0254) 391307

Klinik Bona Medika P PFestival Ruko Blok B. 10-11,

Bonakarta

Clinic - 24 Hours (0254) 387684

Klinik Prima Husada Cilegon P PJl. Raya Merak No. 36Clinic - 24 Hours (0254) 391688

Klinik Pusat Kesehatan Ananda P PJl. R. Suprapto KM 8Clinic - 24 Hours (0254) 310609

Klinik Serang Medika P PJl. Raya Serang Cilegon Ruko Legok

Sukma Jaya

Clinic - Not 24 Hours (0254) 223992

Klinik Utama Medical Service II P PJl. Letjend Suprapto No. 9 RawanujuClinic - Not 24 Hours (0254) 220422

Klinik&Apotik Waringin P PJl. Raya Waringin Kurung SerdangClinic - Not 24 Hours (0254) 310609

Klinik-Apotik Prima Sehat PJl. SA. Tirtayasa No. 96Clinic - Not 24 Hours (0254) 391688

RS Krakatau Medika P P P PJl. Semang Raya, CilegonHospital & Clinic (0254) 396 333

RSIA Kurnia Cilegon P P P PJl. Jombang Mesjid No. 4Hospital & Clinic (0254) 391161 PRSIA Mutiara Bunda Cilegon PJl. SA Tirtayasa No. 86Hospital & Clinic (0254) 376888 P

PangdeglangKlinik Difa 24 Jam P PJl. Raya Labuan KM.12, MenesClinic - 24 Hours (0253) 502160

Rangkas BitungRS Misi Lebak P P P PJl. Multatuli No. 41 RangkasbitungHospital & Clinic (0252) 201014 P

SerangKlinik & Apotik Ratu Farma PJl. Maulana Yusuf No. 17Clinic - Not 24 Hours (0254) 200465

Klinik Cijawa Medika P PJl. KH. A. Fatah Hasan No. 8Clinic - Not 24 Hours (0254) 204735

Klinik Ikhlas Medika I P PKompleks Bumi Agung PermaiClinic - 24 Hours (0254) 207918

Klinik Ikhlas Medika II P PJalan Raya Serang Jakarta-

Pakupatan

Clinic - 24 Hours (0254) 207918

Klinik Modern Medika Cikande PJl. Raya Serang KM. 68, Ruko Modern

Medika, Cikande

Clinic - Not 24 Hours (0254) 400554

Klinik Modern Medika Kragilan PJl. Raya Serang KM. 15 Ruko D-9,

Kragilan - Serang

Clinic - 24 Hours (0254) 281720

Klinik Utama Medical Service I P PJl. Kol. H. Tb. Suwandi Ruko Puri Tiara

No. 17

Clinic - Not 24 Hours (0254) 220422

Klinik Wahana Sehat P PJl. Juhdi No. 31Clinic - Not 24 Hours (0254) 207374

Klinik Wisata Medika P PJl. Raya Anyer No. 09Clinic - Not 24 Hours (0254) 605141

RS Kencana Serang P P P PJl. A. Yani No. 21Hospital & Clinic (0254) 211554 PRSIA Budi Asih Serang P P PJl. K.H Sokhari No. 39Hospital & Clinic (0254) 212484 P

Released: 12 May 2010, 1:53:56PM Page 2 of 21

Network Listing - Indonesia Only All Services

Maximizing Service, Minimizing Risk

Health Benefits Administration & Risk Management

PT Global Asistensi Manajemen Indonesia (GAMI)

Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 3: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Banten

TangerangApotek Century Plaza Bintaro Plaza Bintaro Jaya LT. 1 Blok D3, Jl.

Bintaro Utama IIIA Pondok Aren

Pharmacy (021) 7353485

Clinic Pamulang Medical Centre P PJl.Pamulang Raya, Blok DII/2 -

Pamulang

Clinic - 24 Hours (021) 740 5317

Klinik & RB Pinang Sari I P PJl. KH. Hasyim Ashari no.9, CipondohClinic - 24 Hours (021) 731 2915 PKlinik Anakku BSD P P PRuko Golden Madrid 2 Blok I - 8, Jl.

Letjen Sutopo BSD City

Clinic - Not 24 Hours (021) 7091 3227

Klinik Banjar Medika P PJL. KH. Hasyim Ashari 001/004 NO.28,

Cipondoh

Clinic - 24 Hours (021) 5541401

Klinik Bunda Medika P PJl. Aria Putra No. 114, Kedaung

Pamulang

Clinic - 24 Hours (021) 740 2465

Klinik dan Apotik Mulya PJl. KH. Hasyim Ashari No. 10 Sudimara

Pinang, Pinang

Clinic - 24 Hours (021) 730 7888

Klinik Dr. Nenie Herawati PVilla Melati Mas, Jl. Melati Raya C

II/No. 3

Clinic - Not 24 Hours (021) 7023 0383

Klinik Karuna Medika P PJl. Imam Bonjol Kav. 19-20, Kavling

Pemda Karawaci

Clinic - 24 Hours (021) 5588776

Klinik Medifarma Pondok Cabe P PRuko Pondok Cabe Mutiara Blok C II -

12A, Jl Pondok Cabe Raya, Pamulang

Clinic - Not 24 Hours (021) 742 7803

Klinik Pinang Sari II PJl. KH. Mas Mansyur no.90, CipondohClinic - 24 Hours (021)7344 0767

Klinik Provita P PJl. Ir. H. Juanda No. 125, CiputatClinic - 24 Hours (021) 7492619

Klinik Sapta Mitra Tangerang P PJl. Pandaan Raya No. 21 Perumnas I,

Cibodasari - cibodas

Clinic - 24 Hours 021-55799768

Klinik Selaras PJl. Raya Serpong RE No. 43 - 45 BSD

Sektor IV

Clinic - 24 Hours (021) 537 0310

Klinik Siliwangi Medika P PJl. Siliwangi D2/ 11, CiputatClinic - 24 Hours (021) 740 5330

Klinik Sumber Sehat Medika P PJl. Raya Pasar Baru No. 5Clinic - Not 24 Hours (021) 552 0731

Mayapada Hospital P P P PJl.Honoris Raya Kav 6, Kota ModernHospital & Clinic (021) 552 9035 P POmni Internasional Hospital P P P PJl. Alam Sutera Boulevard Kav. 25,

Serpong

Hospital & Clinic (021) 53125555 P P

RS Aminah P P P PJl. HOS Cokroaminoto (Ciledug Raya)

No. 4A, Kreo Selatan - Larangan

Hospital & Clinic (021) 737 1919 P

RS An-Nisa Tangerang P P P PJl. Gatot Subroto No. 96 KM. 3,

Cibodas

Hospital & Clinic (021) 5525564 P

RS Ariya Medika P P P PJl. Industri Raya I Blok A No. 1 - 10,

Jatake

Hospital & Clinic 021-5902229 P

RS Asshobirin P P P PJl. Raya Serpong KM. 11, Pondok

Jagung

Hospital & Clinic (021) 5374293 P

RS Global Medika P P P PJl. MH Thamrin No. 3 CikokolHospital & Clinic (021) 55780888 P PRS Ichsan Medical Centre (IMC)

BintaroP P P PJl. Raya Jombang No. 56, Bintaro

Sektor IX

Hospital & Clinic (021) 7456379 P

RS Internasional Bintaro P P P PJl. MH Thamrin Blok B3 No.1, Sektor 7,

Bintaro Jaya

Hospital & Clinic (021) 745 5500 P P

RS Melati P PJl. Merdeka No. 92Hospital & Clinic (021) 552 3945 PRS Paramita P P P PKawasan Industri CCM Kav. FL -8, Jl.

Raya Serang KM. 28.5, Balaraja

Hospital & Clinic (021) 5954858 P

RS QADR P P PKomp. Islamic Village, Desa Kelapa

Dua PO Box 492

Hospital & Clinic (021) 546 4466

RS Sari Asih Karawaci P P P PJl. Imam Bonjol no 38, KarawaciHospital & Clinic (021) 552 2794 PRS Syarif Hidayatullah P P P PJl.Ir.H Juanda No.95, CiputatHospital & Clinic (021) 740 2718 PRS Usada Insani P P PJl. KH. Hasyim Ashari 24, TangerangHospital & Clinic (021) 5575 2575 PRS. Sari Asih Ciledug P P P PJl. HOS. cokroaminoto No. 38, CiledugHospital & Clinic (021) 7333430 PRSB Permata Sarana Husada P PPamulang Permai Blok D3 No. 2,

Pamulang - Tangerang

Maternity Only Hospital (021) 7407422 P

RSIA Bunda Sejati P P P PJl. Prabu Siliwangi No. 11 JatiuwungMaternity & Children (021) 5900136 PRSIA Cinta Kasih P P P PJl. Ciputat Baru Raya No. 10, CiputatHospital & Clinic (021) 7424639 PRSIA Lestari Cirendeu Tanggerang P P P PJl. Cirendeu Indah III No. 37, CiputatHospital & Clinic (021) 740 9969 PRSIA Putra Dalima P PJl.Rawabuntu Utara Sektor 1-2 Blk

UA26-27, BSD - Tangerang

Hospital & Clinic (021) 537 6002 P

RSIA Sari Asih Sangiang P PJl. Moh. Toha (Jl. Raya Mauk) KM. 3.5Hospital & Clinic (021) 5582732 PRSIA Selaras P PJl. Raya Serang Km.18,5 Desa Bojong

Cikupa

Maternity & Children (021) 596 9145 P

RSU Bhakti Asih P PJl. Rd. Saleh No. 10, Karang Tengah

Raya

Hospital & Clinic (021) 730 5663 P

RSU Mulya P P P PJl. KH. Hasyim Ashari No. 18,

Sudimara, Pinang

Hospital & Clinic (021) 732 2443 P

Siloam Hospitals Lippo Village P P P PJl. Siloam No.6, Lippo Karawaci 1600Hospital & Clinic (021) 546 0055 P P

Released: 12 May 2010, 1:53:56PM Page 3 of 21

Network Listing - Indonesia Only All Services

Maximizing Service, Minimizing Risk

Health Benefits Administration & Risk Management

PT Global Asistensi Manajemen Indonesia (GAMI)

Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 4: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Bengkulu

RS Rafflesia Bengkulu P P P P Jl. Mahoni No. 10Hospital & Clinic (0736) 21710 P

State/Province: Jakarta

Jakarta BaratApotek Century Carrefour Daan

Mogot

Carrefour Daan Mogot KM. 21, Lt.

Ground Blok C No. 1

Pharmacy (021) 5532226

Apotek Century Mall Ciputra Mall Ciputra LT Upper Ground No. 95

A, Grogol

Pharmacy (021) 5663612

Apotek Century Mall Daan Mogot Daan Mogot Mall Lt. Dasar No. 2&3Pharmacy (021) 5456134

Apotek Century Puri Farma Pasar Puri Indah, Jl. Puri Indah Raya 1

No. 7 Kembangan Selatan

Pharmacy (021) 5824860

Jakarta Eye Center Kebon Jeruk P PGedung Graha Multi, Jl. Panjang No.

55 Kebon Jeruk

Hospital & Clinic (021) 5306 754

Klinik Anggrek - Tenis Raya P PJl.Tenis Raya No. 8 CClinic - Not 24 Hours (021) 99711627

Klinik Kusuma P PJl. Peta Selatan No. 50Clinic - Not 24 Hours (021) 5419747

Klinik Yadika Tegal Alur P PJl. Kamal Raya A7 No. 7-11, Tegal AlurClinic - 24 Hours (021) 70605247

RS Hermina Daan Mogot P P P PJl. Kintamani Raya No.2 Kawasan

Daan Mogot

Hospital & Clinic (021) 540 8989 P

RS Jantung Harapan Kita P PJL. Letjen. S Parman Kav. 87 SlipiHospital & Clinic (021) 5681111

RS Kanker Dharmais P PJl. S. Parman Kav 84-86, SlipiHospital & Clinic (021) 568 1570

RS Medika Permata Hijau P P P PJl.Raya Kebayoran Lama, No. 64Hospital & Clinic (021) 534 7411 PRS MH. Thamrin Cengkareng P P P PJl. Daan Mogot Km. 17, CengkarengHospital & Clinic (021) 619 4581

RS Pelni Petamburan P P P PJL AIP II KS Tubun 92-94Hospital & Clinic (021) 548 0608 PRS Puri Indah P P P PJl. Puri Indah Raya Blok S-2,

Kembangan Selatan

Hospital & Clinic (021) 2569 5322

RS Royal Taruma P P P PJl. Daan Mogot No. 34, GrogolHospital & Clinic (021) 56967788 P PRSAB Harapan Kita P PJl. Letjen S Parman Kav.87, SlipiMaternity & Children (021) 566 8284 PRSUD Cengkareng P P P PJl. Kamal Raya, Bumi Cengkareng

Indah, Cengkareng Timur

Hospital & Clinic (021) 5437 2874 P

Siloam Hospitals Kebon Jeruk P P P PJl Raya Pejuangan, Kebon JerukHospital & Clinic (021) 530 0888 P P

Released: 12 May 2010, 1:53:56PM Page 4 of 21

Network Listing - Indonesia Only All Services

Maximizing Service, Minimizing Risk

Health Benefits Administration & Risk Management

PT Global Asistensi Manajemen Indonesia (GAMI)

Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 5: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Jakarta

Jakarta PusatJakarta Eye Centre - Menteng P PJl. Cik Ditiro NO. 46, MentengHospital & Clinic (021) 3107 434

Klinik Al - Afiat PJl. K. H. Mas Mansyur No. 74 C, Tanah

- Abang

Clinic - 24 Hours (021) 392 5206

Klinik Baruna P PJl. Cikini Raya No.60Clinic - 24 Hours (021) 314 1040

Klinik Citra Petamburan PJl. AIP II KS Tubun No. 39Clinic - 24 Hours (021) 568 8846

Klinik Drg. Efindy PJl. Kebon Kacang I No. 98Clinic - Not 24 Hours (021) 30040151

Klinik Medisari PJl. Rawasari Barat No. E281, RawasariClinic - 24 Hours (021) 422 4383

Klinik Rawasari PJl. Percetakan Negara no. D - 764Clinic - 24 Hours (021) 421 2528

Klinik Sarana Medika PJl. Taman Kimia No.1Clinic - Not 24 Hours (021) 31922 357

Raden Saleh Medical Centre P P PJl. Raden Saleh Raya No. 4, Gedung

Dinar Lt. 1

Clinic - 24 Hours (021) 31923508

RS (YPR) Yayasan Panti Raharja

"SAWO"P P P PJl. Sawo No. 58 - 60Hospital & Clinic (021) 3192 2553 P

RS Abdi Waluyo P P P PJL. HOS. Cokrominoto 33, MentengHospital & Clinic (021) 314 4989 PRS Bersalin YPK P PJl. Gereja Theresia 22Hospital & Clinic (021) 3909725 PRS Bunda Jakarta P P PJl. Teuku Cik Ditiro No.28, MentengHospital & Clinic (021) 3192 2005 PRS Husada P P PJl. Mangga Besar, No.137-139Hospital & Clinic (021) 649 0090

RS Islam Jakarta Cempaka Putih P P P PJl Cempaka Putih, Tengah I/1Hospital & Clinic (021) 425 0451 PRS Khusus THT Bedah

"Proklamasi"P PJl. Proklamasi 43Hospital & Clinic (021) 390 0002

RS Kramat 128 P P PJl. Kramat Raya No.128Hospital & Clinic (021) 390 9514

RS Menteng Mitra Afia P P PJl. Kali Pasir No.9, CikiniHospital & Clinic (021) 315 4050

RS MH. Thamrin Internasional

SalembaP P P PJl.Salemba Tengah 26-28Hospital & Clinic (021) 390 4422 P P

RS Pertamina Jaya P P P PJl. Jend. A.Yani No.2, By PassHospital & Clinic (021) 421 1911

RS PGI Cikini P P P PJl. Raden Saleh No. 40Hospital & Clinic (021) 38997777 PRS St. Carolus P P P PJl Salemba Raya 41Hospital & Clinic (021) 390 4441 P PRSIA Evasari P P P PJl. Rawamangun No.45-47Maternity & Children (021) 420 2851 PRSIA Tambak P PJl. Tambak No. 18, ManggaraiMaternity & Children (021) 2303444 PRSPAD Gatot Soebroto "Pav.

Dharmawan"P P P PJl. Dr. Abd. Rachman Saleh No.24Hospital & Clinic (021) 350 0004 P

RSPAD Gatot Soebroto "Pav.

Kartika"P P P PJl. Dr. Abd. Rachman Saleh No.24Hospital & Clinic (021) 384 0484 P

RSPAD Gatot Soebroto (Pav Ika) P P P PJl. Dr. Abdul Rahman Saleh No. 24Hospital & Clinic (021) 3441008

RSPAD Gatot Soebroto Pav Dr

Imam SudjudiP P P PJl. Dr. Abd. Rachman Saleh No.24Hospital & Clinic 021-3504941-2 P

Sahid Sahirman Medical Centre PGround Fl. Istana Sahid Apartment,

Jl.Jend.Sudirman 86

Clinic - Not 24 Hours (021) 572 7208

SBU Garuda Sentra Medika P PJl. Kebon Sirih No. 44Clinic - 24 Hours (021) 424 1000

Sentra Medika Internasional (SMI) PJl. HOS Cokroaminoto No. 16Clinic - 24 Hours (021) 3144989

Wellness Clinic PJl. Pegangsaan Timur No. 21, Megaria

Complex

Clinic - 24 Hours (021) 390 9672

Released: 12 May 2010, 1:53:56PM Page 5 of 21

Network Listing - Indonesia Only All Services

Maximizing Service, Minimizing Risk

Health Benefits Administration & Risk Management

PT Global Asistensi Manajemen Indonesia (GAMI)

Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 6: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Jakarta

Jakarta SelatanApotek Century Duta Indah Ruko Plaza Pondok Indah I Blok UA

No. 34

Pharmacy (021) 7692006

Clinic Aditya Medical Center PJl. Adityawarman I/14, Kebayoran BaruClinic - 24 Hours (021) 720 3180

Clinic ESTI P PJl. Bangka Raya No.28-30Clinic - 24 Hours (021) 719 4434

deBlitz'R Dental Care P PBellezza Shopping Arcade Unit

230-231, Jln. Letjend Supeno No. 34

Dental Clinic (021) 5366 4742

Fira Aruan Medical Care P PGedung BEJ - Tower 1 LL Floor, Jl.

Sudirman Kav. 52-53

Clinic - Not 24 Hours (021) 70556161

Hendra Hidayat Implant Center PSahid Sudirman Residence FI, 1 Unit

1, Jl. Jend.Sudirman 86

Clinic - Not 24 Hours (021) 5250180

Jakarta Medical Center Clinic P P Jl. Buncit Raya No. 15Clinic - 24 Hours (021) 794 0836

Klinik & Apotik Namira P PJl. Jatipadang Raya No. 62, Pasar

Minggu

Clinic - Not 24 Hours (021) 7820645

Klinik All Care Dental Clinic P PPlaza 5 Blok B/15 Jl. Margaguna Raya,

Pondok Indah

Dental Clinic (021) 7278 8688

Klinik Citra Kebayoran PJl. Raya Kebayoran Lama No. 33Clinic - 24 Hours (021) 536 73906

Klinik Dharma Bhakti PJl. Cilandak KKO Raya No. 45Clinic - Not 24 Hours (021) 781 9848

Klinik Medika I P PJl. Radio Dalam Raya No. 8Clinic - 24 Hours (021) 725 0849

Klinik Medika II PJl. Buncit Raya No. 38Clinic - 24 Hours (021) 798 5178

Klinik Medika Pura P PJl. Tebet Raya No. 31Clinic - Not 24 Hours (021) 83792701

Klinik Medira Jakarta PJl. Taman Margasatwa No. 24Clinic - 24 Hours (021) 780 1830

Klinik Medusa Sentra Medika P PWisma Mulia Lt. 23, Jl.Jend Gatot

Subroto Kav. 42

Clinic - Not 24 Hours (021) 52906465

Klinik Petukangan Medical Centre P PJl. Ciledug Raya No. 8A, PetukanganClinic - Not 24 Hours (021) 7340906

Klinik Tiara PJl. Senopati No.84Clinic - 24 Hours (021) 7210 980

Klinik Yadika Petukangan P PJl. Damai Raya No.1 Petukangan

Selatan

Clinic - 24 Hours (021) 737 0881

Medicare Clinic P P PMenara Kadin Ind.27th Fl. Jl.HR

Rasuna Said X/5, Kav.2-3

Clinic - Not 24 Hours (021) 527 4556 P

Medikaloka Health Care Center P PGraha Irama 2nd floor, HR Rasuna

said blok x-1

Clinic - Not 24 Hours (021) 5261118

Nusantara Medical Center P P PGd. Granadi 3rd Fl. J. Rasuna said,

Kav. 8-9 Kuningan

Clinic - Not 24 Hours (021) 527 4567 P

RS Agung Manggarai P P P PJl. Sultan Agung No.67, ManggaraiHospital & Clinic (021) 829 4955

RS Asri Duren Tiga P P P PJl. Duren Tiga Raya No. 20Hospital & Clinic (021) 7992211 PRS Dr. Suyoto P P P PJl. RC. Veteran No.178 BintaroHospital & Clinic (021) 734 2012 PRS Gandaria P P PJl. Gandaria Tengah II/6, Kebayoran

Baru

Hospital & Clinic (021) 725 0718

RS Jakarta P P P PJl. Jend Sudirman Kav.49Hospital & Clinic (021) 573 2241 P PRS Jakarta Medical Center P P P Jl. Buncit Raya No. 15Hospital & Clinic (021) 798 0888 PRS Khusus THT & Bedah Ciranjang P PJl. Ciranjang No.20&22, Kebayoran

Baru

Hospital & Clinic (021) 7243 366

RS Medistra P P P PJl. Gatot Subroto Kav. 59Hospital & Clinic (021) 521 0200 P PRS Pondok Indah P P P PJl. Metro Duta Kav.UE, Pondok IndahHospital & Clinic (021) 765 7525 P PRS Prikasih P P PJl. RS Fatmawati No. 74, Pondok LabuHospital & Clinic (021) 750 4669 PRS Pusat Pertamina P P P PJl. Kyai Maja No.43, Kebayoran BaruHospital & Clinic (021) 7219400 P PRS Setia Mitra P P P PJl. RS Fatmawati, No.80-82Hospital & Clinic (021) 765 6000 PRS Siaga Raya P P PJl. Siaga Raya Kav. 4-8, Pejaten Barat

Ps. Minggu

Hospital & Clinic (021) 797 2750 P

RS Tebet P P P PJl. Letjen MT. Haryono No. 8Hospital & Clinic (021) 830 7540 PRS Tria Dipa P P P PJl Raya Pasar Minggu No.3A,

Pancoran

Hospital & Clinic (021) 797 4071 P

RS Zahirah P P P PJl. Sirsak No. 21, JagakarsaHospital & Clinic (021) 78888723 PRSB Duren Tiga PJl. Duren Tiga Raya N0. 5, PancoranHospital & Clinic (021) 7976605 PRSB Panti Nugraha P PJl. Senayan No.26, Kebayoran BaruMaternity Only Hospital (021) 722 3939 PRSIA Aulia P P P PJl. Jeruk Raya No.15, JagakarsaMaternity Only Hospital (021) 727 0208 PRSIA Budhi Jaya P P P PJl. DR Saharjo No 120Maternity Only Hospital (021) 8311722 PRSIA Kemang Medical Care P P P PJl. Ampera Raya No.34, RagunanMaternity & Children (021) 27545454 PRSIA Muhammadiyah Taman

PuringP P P PJl. Gandaria I/20, Kebayoran Baru -

Jaksel

Hospital & Clinic (021) 7208358 P

RSIA Yadika Kebayoran Lama P P P PJl. Ciputat Raya No.5 Kebayoran LamaMaternity & Children (021) 729 1074 PSahid Sahirman Memorial Hospital P P P PJl. Jend. Sudirman No. 86Hospital & Clinic (021) 57853911 PSuryatenggara Dental Clinic PJln. Karet Pedurenan 240, RT 005/06

Kec. Setiabudi

Clinic - Not 24 Hours (021) 5225595

Brawijaya Women&Children

HospitalP P P PJl. Taman Brawijaya No. 1, Cipete

Utara

Hospital & Clinic (021) 7211337 P

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Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 7: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Jakarta

Jakarta TimurKlinik Batu Ampar PJl. Batu Ampar III No. 5, Kramat JatiClinic - Not 24 Hours (021) 8088 6446

Klinik Bina Husada Bhakti P PJl. Penggilingan Raya No. 1 RT.01/07Clinic - 24 Hours (021) 46829425

Klinik Devita P P PJl.Jatinegara Timur No. 5, JatinegaraClinic - Not 24 Hours (021) 8191312

Klinik Drg. Hari Sumitro P PJl. Raya Jatinegara 57 A, (Klinik

Devita)

Dental Clinic (021) 851 6274

Klinik Era Medika P PJl. Dewi Sartika No. 292c, CawangClinic - Not 24 Hours (021) 808 70172

Klinik Medika Group P PJl. Batu Ampar III No. 5, Kramat JatiClinic - 24 Hours (021) 808 86446

Klinik Medista Jakarta PJl. Otista Raya No. 82Clinic - 24 Hours (021) 819 8693

Klinik Mitra Cakung PJl. Balai Rakyat No.17, Cakung TimurClinic - 24 Hours (021) 921 3801

Klinik Mitra Kramat Jati PJl. Masyid Al - Amin No.10Clinic - 24 Hours (021) 922 8909

Klinik Sapta Mitra Duren Sawit P PJl. Pondok Kelapa Raya Ruko Blok C4

No. 2E, Duren Sawit

Clinic - 24 Hours (021) 8651331

Klinik Sartika PJl. Dewi Sartika No. 22Clinic - Not 24 Hours (021) 910 0682

Klinik Suci Husada P PJl. Suci No. 21 Susukan, CiracasClinic - Not 24 Hours (021) 87798796

Klinik Tjakra Cijantung P P PJl. Raya Bogor KM. 24 No. 12 A,

Cijantung

Clinic - Not 24 Hours (021) 8401677

Klinik Waras Medika PJl. H. Ten No.41Clinic - Not 24 Hours (021) 489 1244

RS Dharma Nugraha P P P PJl. Balai Pustaka Baru, No. 19,

Rawamangun

Hospital & Clinic (021) 470 7433 P

RS Fakultas Kedokteran UKI P P PJl. Sutoyo - CawangHospital & Clinic (021) 809 2317

RS Haji Jakarta P P P PJl.Raya Pondok GedeHospital & Clinic (021) 800 0693 PRS Harapan Bunda Jakarta P P P PJl. Raya Bogor Km. 22Hospital & Clinic (021) 840 0257 PRS Harum P P P PJl.Tarum Barat, Kali MalangHospital & Clinic (021) 861 7212 PRS Islam Jakarta Timur P P P PJL. Raya Pondok KopiHospital & Clinic (021) 863 0654 PRS Khusus Jantung Binawaluya P PJl. TB. Simatupang No. 71Hospital & Clinic (021) 8778 1605

RS Mediros P P PJl. Perintis Kemerdekaan, Kav. 149Hospital & Clinic (021) 472 1336

RS MH. Thamrin Pondok Gede P PJl. Raya Pondok Gede, No. 23-25Hospital & Clinic (021) 809 3602

RS Mitra Internasional P P P PJl. Raya Jatinegara Timur, No.85-87Hospital & Clinic (021) 280 0888 PRS Omni Medical Center P P P PJl. Pulomas Barat VI.Hospital & Clinic (021) 472 3332 P PRS Rawamangun P P P PJl. Balai Pustaka Raya No.29-31,

Rawamangun

Hospital & Clinic (021) 4893531 P

RS Yadika Pondok Bambu P P P PJl. Pahlawan Revolusi No.47, Pondok

Bambu

Hospital & Clinic (021) 861 5754 P

RS. Kepolisian Pusat Raden Said

SukantoP P P PJl. Raya Bogor, Kramat JatiHospital & Clinic (021) 8093288 P

RSIA Bunda Aliyah P P PJl. Pahlawan Revolusi No. 100,

Pondok Bambu

Maternity & Children (021) 8660 2525 P

RSIA Hermina Jatinegara P P P PJl. Raya Jatinegara Barat, No. 126Maternity & Children (021) 8191 223 PRSIA Resti Mulya P P P PJl. Komarudin Raya No. 5,

Penggilingan

Hospital & Clinic (021) 4802192 P

Jakarta UtaraOilia Medical Centre P PJl. Swasembada Barat 12/2EClinic - Not 24 Hours (021) 43901357

RS Atmajaya P PJl. Pluit Raya No. 2Hospital & Clinic (021) 660 6127

RS Islam Jakarta Utara P P P PJl.Tipar, Cakung No. 5, SukapuraHospital & Clinic (021) 440 0778 PRS Mitra Keluarga Kelapa Gading P P P PJl. Bukit Gading Raya, Kav. 2 Kelapa

Gading

Hospital & Clinic (021)4585 2700 P P

RS Mitra Kemayoran P P P PJl. Landasan Pacu Timur, KemayoranHospital & Clinic (021) 654 5555 P PRS Port Medical Center P P P PJl. Enggano No. 10, Tanjung PriokHospital & Clinic 021-43902350 PRS Puri Medika Jakarta P P P PJl. Sungai Bambu Raya 5, Tanjung

Priok

Hospital & Clinic (021) 4390 3355 P

RS Satya Negara P P PJl. Agung Utara Raya, Blok A No.1Hospital & Clinic (021) 6471 5200

RSIA Hermina Podomoro P P P PJl. Danau Agung II, Blok E3 No. 28-30Maternity & Children (021) 640 4910 PRSUD Koja P P P PJl. Deli No. 4 Tanjung PriokHospital IPD Only (021) 4393 8478 PRS Royal Progress PJl. Danau Sunter Utara Paradise IHospital & Clinic (021) 6400261

State/Province: Jambi

RS Asia Medika Jambi P P P PJl. Soekarno Hatta Pal MerahHospital & Clinic (0741) 573333 P PRS St. Theresia P P PJl. Dr. Sutomo No.19Hospital & Clinic (0741) 23119

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Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 8: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Jawa Barat

BandungDr. Soeseno Hadi, M. Kes PJl. Merdeka No 44Practitioner (022) 4202386

Klinik An-Nur Bandung P PJl. Setiabudi No. 63Clinic - Not 24 Hours (022) 203 1922

Melinda Hospital Bandung P P P PJl. Pajajaran 46 BandungMaternity & Children (022) 4222788 P PRS Advent Bandung P P P PJl. Cihampelas No.161Hospital & Clinic (022) 203 4386 P PRS Al Islam Bandung P P PJl. Sukarno Hatta No.644Hospital & Clinic (022) 756 3231

RS Immanuel Bandung P P P PJl. Kopo No 161Hospital & Clinic (022) 520 1656 PRS Kebon Jati, Bandung P PJln. Kebonjati No. 152Hospital & Clinic (022) 603 1969

RS Muhammadiyah Bandung P PJl. KH. Ahmad Dahlan No.53Hospital & Clinic (022) 730 1062

RSB Limijati P P PJl. LL. RE Martadinata No.33 - 39Maternity Only Hospital (022) 42077 70 PRSIA Hermina Pasteur-Bandung P P P PJl. dr. Djundjunan No. 107Maternity & Children (022) 6072 525 PRSU Bungsu P P P PJL. Veteran No. 6Hospital & Clinic (022) 431 550 PRSU Pindad Bandung P PJl.Jend. Gatot Subroto, No. 517Hospital & Clinic (022) 732 1964

Santosa Bandung Internasional

HospitalP P P PJl. Kebonjati No. 38Hospital & Clinic (022) 4248333 P P

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Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 9: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Jawa Barat

BekasiBio Medi Centre PJl. MH Thamrin Blok D15, Ruko

Union-Lippo Cikarang

Clinic - 24 Hours (021) 8990 3220

Clinic & RB Hosana Medika 5 P PJl.Cikarang Baru Raya,Ruko Elite Blok

3B No.74-77, Cikarang Baru

Clinic - 24 Hours (021)8911 1431 P

Clinic Renicha Putra Cikarang PJl.Raya Cikarang Cibarusah, Lippo

Cikarang

Clinic - 24 Hours (021) 897 1852

Clinic Yayasan Mulya Medika P PJl. Raya Jati Mulya, Bekasi TimurClinic - 24 Hours (021) 820 3272

Global Awal Bros Hospital P P P PJl. KH. Noer Ali Kav. 17-18, KalimalangHospital & Clinic (021) 8885 5333 PKlinik & RB Graha Bina Husada P PJl. Industri Selatan No. 1A Blok NN 3A,

Kawasan Industri Jababeka II

Clinic - 24 Hours (021) 8983 6243

Klinik Annisa II P PJl. Raya Cibarusah No. 31 R, Komp.

Ruko Point, Sukaresmi, Cikarang

Clinic - 24 Hours (021) 897 6189

Klinik Annisa III P PJl.Raya Cibarusah Blok A-5, Ruko

Sentra Cikarang

Clinic - 24 Hours (021) 899 09010

Klinik Asyifa Husada P PPerumahan Villa Mutiara Jaya, Blok N

78 No.12 Cibitung

Clinic - Not 24 Hours (021) 7021 7179

Klinik Citra Medika I Pekayon P PJl. Pekayon Raya No. 6Clinic - 24 Hours (021) 8240 6922

Klinik Citra Medika II Tm. Narogong P PJl. Taman Narogong Raya No. 7Clinic - 24 Hours (021) 8216390

Klinik Citra Sehat Tambun PPerumahan Citra Villa Blok A-1/26,

Tambun

Clinic - 24 Hours (021) 88370203

Klinik Fajar Medika PRuko MM2100, Depan Makro, CibitungClinic - Not 24 Hours (021) 898 1162

Klinik Fikri Husada P PJl. Gardena Raya B6-32, Perum

Harapan Baru, Regency

Clinic - Not 24 Hours (021) 480 1285

Klinik Harapan Sehat I P PJl. Teuku Umar No. 33, CibitungClinic - 24 Hours (021) 88336674

Klinik Harapan Sehat II P PRuko Perum Telaga Harapan Blok F

No. 16, Cikarang Barat

Clinic - 24 Hours (021) 88336674

Klinik Harapan Sehat III P PPerum Villa Mutiara Jaya Blok MB 16

No. 07, Cibitung

Clinic - 24 Hours (021) 88336674

Klinik Hosana Medica Cibitung P PTeuku Umar No.19, CibitungClinic - 24 Hours (021) 883 38414

Klinik Hosana Medica Mangun Jaya P PJl. Mangun Jaya I Blok A No. 6,

Tambun

Clinic - 24 Hours (021) 88363507

Klinik Hosana Medika Jababeka P PKws Industri Jababeka B8, CikarangClinic - 24 Hours (021) 893 7941

Klinik Indo Farma PJl. Indo Farma I, Cikarang BaratClinic - 24 Hours (021) 88323971

Klinik Industri Medika (INTRIMED) P PRuko Mega Mall Blok C2, Kawasan

Industri MM-2100 Cibitung

Clinic - Not 24 Hours (021) 8980734

Klinik Jaya Medika P PPerum Permata Harapan Baru Ruko

Blok H-46, Medan Satria

Clinic - Not 24 Hours (021) 88988163

Klinik Legenda Sehat PJln. Zamrut Utara Blok U16 No.100,

Kota Legenda

Clinic - Not 24 Hours (021) 8260 0148

Klinik Meditama PRuko Plaza Roxy B-11, Jl. Kasuari

Raya, Cikarang Baru

Clinic - 24 Hours (021) 89835757

Klinik Melviana PJl. Saparua Raya No.239, Perumnas III

Bekasi

Hospital & Clinic (021) 880 7610

Klinik Mulya Medika II P PPerum Gramapuri Blok D1 No. 5,

Cibitung

Clinic - 24 Hours (021) 88362481

Klinik Niza Asyifa' Bersama 1 PPerumahan Telaga Harapan Blok E1/1,

Cibitung

Clinic - 24 Hours (021)891 09638

Klinik Niza Asyifa' Bersama 2 PPerumahan Villa Mutiara Jaya Blok

M-85/9, Cibitung

Clinic - 24 Hours (021) 68700672

Klinik Nugraha 1 PPerumahan Telaga Murni Blok C9/19,

Cibitung

Clinic - 24 Hours (021) 89106448

Klinik Nugraha 2 PJl. Raya Taman Aster, CibitungClinic - 24 Hours (021) 88339192

Klinik Pondok Gede Agung P P PJl. Raya Hankam No. 58 C-D, Pondok

Gede

Clinic - 24 Hours (021) 846 4030

Klinik Prima Husada Tambun P PJl. Sultan Hasanudin No. 175, TambunClinic - Not 24 Hours (021) 880 3966

Klinik Sapta Mitra Bekasi Utara P PJl. KH.M.Tabrani Blok IA-IB,

Margamulya

Clinic - 24 Hours (021) 70266932

Klinik Sapta Mitra Cikarang P PJl. Raya Cikarang-Cibarusah, Ruko

No. 39A Sukaresmi, Cikarang Selatan

Clinic - Not 24 Hours (021) 8975369

Klinik Sehat Sejahtera PJl. Raya Nusantara No. 2, Perumnas IIIClinic - 24 Hours (021) 883 49427

Klinik Trisa PJl. Setiadarma II No.8, Tambun

Selatan, Tambun Selatan

Clinic - Not 24 Hours (021)8836 8863

Klinik Vita Insani P PJl. Nangka Raya B II No.24, Bekasi

Barat

Clinic - 24 Hours (021) 885 9988

Klinik Wijaya Kesuma PPerumahan Taman Narogong Indah,

Jl. Narogong Saksi Raya A Blok A-20

No. 1

Clinic - 24 Hours (021) 8210779

Klinik Yayasan Bina Medika PKp. Kongsi Rt. 02/II, CikarangClinic - 24 Hours (021) 890 0050

Klinik Yayasan Karya Medika I PJl. Ir. H. Juanda No.38CClinic - Not 24 Hours (021) 880 1293

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Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 10: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Jawa Barat

Klinik Yayasan Karya Medika III PJl. Perjuangan No.30, Teluk BuyungClinic - Not 24 Hours (021) 885 1152

Klinik Yayasan Karya Medika IV PJl. Narogong Km 11, Bantar GebangClinic - Not 24 Hours (021) 825 4629

Klinik Yayasan Karya Medika V PRuko Harko Jababeka, CikarangClinic - Not 24 Hours (021) 8983 2569

Klinik&Apotek Guci Medika P PJl. Pramuka No. 79, Rawa LumbuClinic - 24 Hours (021) 82433158

Klinik&Apotik Sapta Mitra Bekasi

TimurP PJl. Raya Pondok Timur Ruko gading

Mas 8F-G, Pengasinan - Rawa Lumbu

Clinic - 24 Hours (021) 82602180

Klinik&RB Hosana Medika Serang

BaruP PJl. Raya Serang Cibarusah Kp. Bumi

Sari RT. 07/04, Desa Sukaragam, Kec

Serang Baru

Clinic - Not 24 Hours (021) 89952613

PBDS & RSB Juwita P PJl. M. Hasibuan No. 78Maternity Only Hospital (021) 8829590 PRB & Klinik Annisa IV P PJln. Raya Cibarusah Raya No. 63, Kp.

Pasir Randu RT. 011/006, Desa

Sukasari, Sergangbaru

Clinic - 24 Hours (021) 8995 4434

RB&Klinik Indosehat 2003 P PJl. Beruang Raya HI/185-187, CikarangMaternity Only Hospital (021) 89834420 PRB&Klinik Ratna PJl. Ratna No. 75 RT. 005/09 Jati

Kramat

Clinic - 24 Hours (021) 84998134

RB&Klinik Ridhoka Salma P PJl. Imam Bonjol No. 7, Kp. Gardu

Sawah, Cikarang Barat

Hospital & Clinic (021) 89116527

RB&Klinik Yayasan Angelika

MedikaP PJl. Bossih Raya Blok E5 No. 12-13,

Pondok Tanah Mas - Cibitung

Clinic - 24 Hours (021) 88330750

RB&Praktek Bersama Kartika

HusadaP PPasar Sentral Lippo Cikarang, Blok

ESA 2.3.5 Jalan Utama B II Cibarusah

Cikarang

Clinic - 24 Hours (021) 98172736

RS Amanda Serang P P P PJl. Serang No. 83, Cikarang SelatanHospital & Clinic (021) 8971643 PRS Ananda Bekasi P P P PJl. Sultan Agung No.173Hospital & Clinic (021) 885 4338 PRS Annisa Bekasi P P P PJl. Cikarang Baru No.31, Lemah AbangHospital & Clinic (021) 890 4165 PRS Bhakti Husada Cikarang P P PJl. RE. Martadinata, CikarangHospital & Clinic (021) 890 0530

RS Bhakti Kartini Bekasi P P P PJl. Kartini No.11Hospital & Clinic (021) 880 1954 PRS Budi Lestari P P PJl. KH Noer Ali No.2, Depan Perumnas

II

Hospital & Clinic (021) 8893486

RS Citra Harapan P P P PJl. Raya Harapan Indah Kaw. Sentra

Niaga No. 3-5, Harapan Indah, Medan

Satria

Hospital & Clinic (021) 88870606 P

RS Graha Juanda P P PJl. Ir. H. Juanda No. 326Hospital & Clinic (021) 881 1832

RS Hosana Medika Bekasi P P P PJl. Pramuka No. 12 RT 004/002, Kel

Sepanjang Jaya, Kec Rawa Lumbu

Hospital & Clinic (021) 8221570 P

RS Hosana Medika Lippo Cikarang P P P PRuko Thamrin Blok C No.3, Lippo

Cikarang

Hospital & Clinic (021) 897 2472 P

RS Karya Medika P P P PJl.Raya Imam Bonjol No. 9B, Cikarang

Barat

Hospital & Clinic (021) 890 3003 P

RS Medika Cikarang P P PJl. Ry Ind Pasirgombong,

Jababeka-Cikarang

Hospital & Clinic (021) 890 4160

RS Medirossa P P P PJl. Industri Tegal Gede, Cikarang

Selatan

Hospital & Clinic (021) 89833216 P

RS Mekar Sari P P P Jl. Mekar Sari No.1Hospital & Clinic (021) 880 1891

RS Miracle Medica Cikarang P P P PJl. KH. Dewantara No. 33 Pilar,

Cikarang Utara

Hospital & Clinic (021) 89116177 P

RS Mitra Keluarga Bekasi Barat P P P PJl. Jend Ahmad YaniHospital & Clinic (021) 885 3333 P PRS Mitra Keluarga Bekasi Timur P P P PJl. Pengasinan MargahayuHospital & Clinic (021) 881 7777 P PRS Permata Bekasi P P P PJl. Legenda Raya No. 9 Mustika JayaHospital & Clinic (021) 8254748 PRS Permata Bunda Cibitung P P PJ. Gramapuri I Blok CI No. 8-10,

Perumahan Gramapuri, Taman sari,

Wanasari Cibitung

Hospital & Clinic (021) 88328001 P

RS Ratna Husada P P PJl. Pramuka no.12 NarogongHospital & Clinic (021) 822 1571

RS Rawa Lumbu P P P PJl. Dasa Darma No. 20-23, Rawa

lumbu

Hospital & Clinic (021) 82422512 P

RS Sentosa P PJl. Pahlawan No. 60, Duren JayaHospital & Clinic (021) 880 6140 PRS. Harapan Keluarga P P P PJl. Kasuari Raya Kav. 1A&B, Kota

Jababeka, Cikarang Baru

Hospital & Clinic (021) 8983 5838 P

RS. St. Elisabeth Bekasi P P P PJl. Raya Narogong No. 202, Kemang

Pratama, Bojong Rawalumbu

Hospital & Clinic (021) 82430101 P

RSB Ibu Soedibyo P PJl. KH Agus Salim No.100 BMaternity Only Hospital (021) 880 2435 PRSB Setia P Pjl. Raya Serang Cibarusah No.41Maternity Only Hospital (021) 897 1240 PRSB Taman Harapan Baru P PJl. Taman Harapan Baru Raya R-1

No.20, Kel. Pejuang, Kec. Medan

Satria

Maternity Only Hospital (021) 8887 1202 P

RSIA Amanda Cikarang P P P PJl. Raya Industri No. 36, Cikarang

Utara

Hospital & Clinic (021) 89110011 P

RSIA Anna P P P PJl. Pekayon Raya No. 36Hospital & Clinic (021) 8243 2211 P

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Page 11: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Jawa Barat

RSIA Bella P PJl. Ir H Juanda No 141Maternity & Children (021) 880 1775 PRSIA Dokter Adam Talib P P P PJl Raya Teuku Umar No. 25, Cikarang

Barat

Hospital & Clinic (021) 88332304/6 P

RSIA Hermina Bekasi P P P PJl. Kemakmuran No 39, MargajayaMaternity & Children (021) 884 2121 PRSIA Jati Sampurna P P P PJl. Studio ANTV, Jati sampurnaHospital & Clinic (021) 8541457 PRSIA Jatimulya Medical Centre P PJl. Jatimulya Raya No.14Maternity & Children (021) 8203 785 PRSIA Sri Tina P P P PJl. Imam Bonjol No. 80, Cikarang BaratMaternity & Children (021) 8900579 PRSIA Yayasan Karya Medika II P P P PJl. Hasanuddin No.63, TambunMaternity & Children (021) 8832 4366 PRSU Kartika Husada P P PJl. Raya Mangun jaya, Kp. Rukem

Tambun

Hospital & Clinic (021) 88327281 P

Siloam Hospitals Cikarang P P P PJl. MH. Thamrin Kav. 105, Lippo

Cikarang

Hospital & Clinic (021) 897 2187 P P

BogorKlinik Amanah P Jl. Raya Cibanteng Babengket,

Ciampea

Clinic - 24 Hours (0251) 620 880

Klinik Amanda Medika PJl.M. Nasir No.21,Bojong Kolor,G. PutriClinic - 24 Hours (021) 8240 3372

Klinik Dr. Sutadi PJl. Veteran No. 48C, BogorClinic - 24 Hours (0251) 324 460

Klinik Dr. Sutadi II PJl. Raya Pancasan Tonggoh No. 40,

Bogor

Clinic - 24 Hours (0251) 330702

Klinik Insani Bogor P PJl. Pahlawan 73 B CiteureupClinic - 24 Hours (021) 87942723

Klinik Lido & Apotik PRuko Villa Mutiara Lido No. 10,

Cigombong

Clinic - 24 Hours (0251) 222 666

Klinik Medika I - MKGR PJl. Raya Wangun No. 363, CiawiClinic - 24 Hours (0251) 240 379

Klinik Medika III PJl. Raya Leuwiliang No. 79, BogorClinic - 24 Hours (0251) 8641 056

Klinik Medissa P Jl. MayJend. HE Sukma no. 12,

Bantarjati

Clinic - 24 Hours (0251) 245 536

Klinik Medista Bogor PRuko Warung Jambu Blok A - 2,

Bantarjati

Clinic - 24 Hours (0251) 385 976

Klinik Nurdin Medika Jl.H. Ashari No.22 CibinongClinic - Not 24 Hours (021) 8240 3372

Klinik Prima PJl. Pahlawan No. 81, BondonganClinic - 24 Hours (0251) 374860

Klinik Siba PJl. Sindang Barang No. 159 AClinic - 24 Hours (0251) 373 323

Klinik Sudirman PJl. Raya Jend.Sudirman No.38 D,

Bogor

Clinic - 24 Hours (0251) 314 940

RS Azra Bogor P P P PJl. Raya Pajajaran 219Hospital & Clinic (0251) 8318 456 P PRS Bina Husada, Cibinong P P P PJl. May.Oking Jajaatmaja, CibinongHospital & Clinic (021) 875 3422 PRS Bogor Medical Center P P P PJl. Pajajaran Indah V No. 97Hospital & Clinic (0251) 8390 435 P PRS Islam Bogor P P P PJl. Perdana Raya No. 22Hospital & Clinic (0251) 8316 822

RS Karya Bhakti P P P PJl. Dr. Sumeru No. 120Hospital & Clinic (0251) 8312 292 PRS MH Thamrin Cileungsi P PJl. Raya Narogong KM.16 Limus

Nunggal, Cileungsi

Hospital & Clinic (021) 823 5052 P

RS PMI Bogor P P P PJl. Raya Pajajaran, PO. Box 59Hospital & Clinic (0251) 8324 080

RSIA Citra Insani P P P PJl. Raya Parung No.242 Lebakwangi,

Pemagarsari

Maternity & Children (0251) 8611507 P

RSIA Hermina Bogor P P P PJl. Ring Road - I Kav. 23,25,27, Perum.

Taman Yasmin Bogor

Maternity & Children (0251) 8328 222 P

RSIA Mary Cileungsi Hijau P P P PJl. Ry Narogong Km. 21, CileungsiHospital & Clinic (021) 8249 2222 P

CianjurRSUD Cianjur P PJl. Rumah Sakit No. 1Hospital & Clinic (0263) 261 026

CibinongRSIA Trimitra P P P PJl. Raya Jakarta-Bogor KM. 43Maternity & Children (021) 8763055 P

CibuburHolistic Care Dental Clinic PLittle China Blok JB 06, Legenda

Wisata Cibubur

Clinic - Not 24 Hours (021) 8230991

Klinik Artha Sari Medika PJl. Alternatif No. 41 CibuburClinic - 24 Hours (021) 8459 1048

Klinik Yadika Cibubur P PJl. Lapangan No.9 Pekayon, CibuburClinic - 24 Hours (021) 871 1515

RS MEILIA CIBUBUR P P P PJl. Alternatif Cibubur, Cileungsi Km. 1Hospital & Clinic 021- 8444 444 P PRSIA & Klinik Spesialis Permata

CibuburP P P PJl. Alternatif Cibubur-Cileungsi No.6AHospital & Clinic (021) 845 8806 P

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Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 12: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Jawa Barat

CikampekKlinik AQMA Cikampek P PJl. Stasiun no. 93 CikampekClinic - 24 Hours (0264) 319 307

Klinik Keluarga Graha Medis P PJl. A. Yani No. 51, CikampekClinic - 24 Hours (0264) 310 101

Klinik Putra Medika Cikampek PJl. Ir. H. Juanda No. 19, SukasariClinic - 24 Hours (0264) 301 652

RS Karya Husada P P PJl. Jend. A. Yani No. 98, CikampekHospital & Clinic (0264) 316 188

CimahiRS Mitra Kasih P P P PJl. Raya Cibabat No. 341Hospital & Clinic (022) 665 4852 P

CirebonRS Mitra Plumbon P P P PJl. Raya Plumbon KM. 11Hospital & Clinic (0231) 323100 PRS Pelabuhan Cirebon P PJl. Sisingamangaraja No. 45Hospital & Clinic (0231) 205 657 PRS Pertamina Cirebon P PJl. Patra Raya KlayanHospital & Clinic (0231) 224646

RS Putera Bahagia CIREBON P P P PJl. Ciremei Raya No. 114, PerumnasHospital & Clinic (0231) 207351 PRSIA Sumber Kasih Cirebon P P P PJl. Siliwangi 135Maternity & Children (0231) 203 815 P

DepokHospital Cinere P P PJl. Maribaya Blok F2,

Cinere-Sawangan

Hospital & Clinic (021) 754 5488 P

Klinik Medisina PJl. Muhtar No. 32 - 34, SawanganClinic - 24 Hours (0251) 611 054

Klinik Naura Medica PJln. Kemakmuran Raya No. 37, Depok

II Tengah

Clinic - 24 Hours (021) 7782 4756

RS Harapan Depok P PJl. Pemuda No.10Hospital & Clinic (021) 777 3817

RS Mitra Keluarga Depok P P P PJl. Margonda Raya, PancoranmasHospital & Clinic (021) 7721 0700 P PRS Sentra Medika Cisalak P P P PJl. Raya Bogor Km. 33, CisalakHospital & Clinic (021) 874 3790

RS Tugu Ibu Cimanggis P P P PJl. Raya Bogor Km 29, CimanggisHospital & Clinic (021) 8710870 PRSIA Graha Permata Ibu P PJl. KHM. Usman No. 168, KukusanHospital & Clinic (021) 7778899 PRSIA Hasanah Graha Afiah P P P PJl. Raden Saleh No. 42Hospital & Clinic (021) 77826267 PRSIA Simpangan Depok P PJl. Raya Bogor KM. 36 Sukamaju,

Sukmajaya

Hospital & Clinic (021) 8747620 P

RSIA Tumbuh Kembang P PJl Raya Bogor Km. 31 No.23, Pal

Sigunung - Cimanggis

Maternity & Children (021) 871 2300 P

RSU Bhakti Yudha Depok P P P PJl. Raya Sawangan DepokHospital & Clinic (021) 752 0082 PRSU Bunda Margonda P P P PJl. Margonda Raya No. 28, Pondok

Cina

Hospital & Clinic (021) 78890551 P

RSU Hermina Depok P P P PJl. Raya Siliwangi No. 50, Pancoran

Mas

Maternity & Children (021) 772 02525 P

KarawangKlinik & RB Wadas Medika P P PJl. Raya Buahaseum No. 63,

Lemahabang-Wadas

Clinic - 24 Hours (0267) 510999 P

Klinik Ananda Karawang P PRuko Resinda F3/10Clinic - Not 24 Hours (0267) 4651056

Klinik AQMA Karawang PJl. Surotokunto No.17, Johar -

Karawang

Clinic - 24 Hours (0267) 401 624

Klinik CITO Karawang P PJl. Kertabumi No.29Clinic - Not 24 Hours (0267) 410 173

Klinik Mitra Sehat Karawang P PJl. Raya Kosambi Curug, No. 31, KlariClinic - Not 24 Hours (0267) 432 526

Klinik Purwa Medika Karawang P PJl. Raya Tamelang No. 53, MekarjayaClinic - 24 Hours (0267) 433 653

Klinik&RB Fikri Medika P P PJl. Raya Kosambi, Telaga Sari, Ds.

Blendung

Hospital & Clinic (0267) 433636 P

RS Bayukarta Karawang PJl. Kertabumi No 44Hospital & Clinic (0267) 401 818

RS Citra Sari Husada P P P PJl. Raya Kosambi, Telaga Sari KM. 3,

Klari

Hospital & Clinic (0267) 437507 P

RS Dewi Sri Karawang P P P PJl. Arief Rahman Hakim, No. 1AHospital & Clinic (0267) 402 855

RS Islam Karawang P P P PJl. Pangkal Perjuangan KM. 2

(By-Pass)

Hospital & Clinic (0267) 414520-5 P

RSU AQMA P PJln. Raya Ciselang, Cikampek UtaraHospital & Clinic (0264) 8386 830

RSU Fikri Medika P P P PJl. Raya Kosambi, Telagasari KM. 3,

Klari

Hospital & Clinic (0267) 861 5555 P

RSU Proklamasi Rengasdengklok P PJl. Raya Rengasdengklok, Km.2Hospital & Clinic (0267) 482 192

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Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 13: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Jawa Barat

PurwakartaKlinik AQMA Plered PJl. Anjun No. 96, PleredClinic - 24 Hours (0264) 270 830

Klinik AQMA Purwakarta PJl. Ibrahim Singadilaga No. 14,

Purwakarta

Clinic - 24 Hours (0264) 200 377

Klinik&Apotik KOPINDOSAT P PJl. RE. Martadinata No. 39Clinic - Not 24 Hours 0264-202382

RS Efarina Etaham P P P PJl. Bungur Sari No. 1Hospital & Clinic (0264) 219168 P

SubangKlinik AQMA Subang PJl. Compreng No. 25, Pusaka JayaClinic - 24 Hours (0260) 552 195

RS II PTPN VIII Subang P PJl. Otto Iskandardinata No. 1Hospital & Clinic (0260 ) 411 632 P

SukabumiKlinik Al - Ikhlas PJl. Raya Siliwangi No. 407, CicurugClinic - 24 Hours (0266) 733 033

Klinik Citra II P Jl. Surya Kencana Pamuyuran no. 12,

Cibadak

Clinic - 24 Hours (0266) 532 593

RS Bhakti Medicare P P P PJl. Raya Siliwangi No. 186B, CicurugHospital & Clinic (0266) 731555 PRS Hermina Sukabumi P P P PJl. Raya SukarajaHospital & Clinic (0266) 9100989 PRS Islam Assyifa Sukabumi P PJl. Jend. Sudirman No. 3Hospital & Clinic (0266) 222 663 PRS Kartika Medical Center P P P PJl. Jendral ahmad Yani No. 18 AHospital & Clinic (0266) 6250902 PRS. Betha Medika P P P PJl. Raya Cisaat No. 595Hospital & Clinic (0266) 224128 P

SumedangRS Pakuwon Sumedang P P P PJln. Raden Dewi Sartika No. 17Hospital & Clinic (0261) 2108 34 PRSUD Sumedang P P P PJl. Geusan Ulun No. 41Hospital & Clinic (0261) 201021 P

TasikmalayaRS Jasa Kartini P PJln. Otto Iskandardinata No. 15Hospital & Clinic (0265) 331 641

State/Province: Jawa Tengah

CepuRS PKU Muhammadiyah Cepu P P P PJl. Ronggolawe No. 137Hospital & Clinic (0296) 421 727 P

CilacapRS Pertamina Cilacap P PJl. Setiabudi, Tegal kamulyanHospital & Clinic (0282) 531 633

RSI Fatimah Cilacap P PJl. Ir. Juanda 20Hospital & Clinic (0282) 545 213 P

GombongRS Palang Biru Gombong P P P PJl. Kartini no 37Hospital & Clinic (0287) 471 290 P

KlatenRS Islam Klaten P P P PJl. Raya Yogya Solo Km 2Hospital & Clinic (0272) 322 252 P

KudusRS Mardi Rahayu Kudus P P P PJl. R. Agil Kusumadiya, No. 110Hospital & Clinic (0291) 434 707 P

MagelangRS Harapan Magelang P P P PJl. P Senopati No. 11Hospital & Clinic (0293) 364 033 PRSIA Gladiool P P P PJl. Kenanga No. 4-6Maternity & Children (0293) 362702 P

PatiKeluarga Sehat Hospital P P P PJl. P. Sudirman No. 9, MargorejoHospital & Clinic (0295) 386111 P

PekalonganRS Siti Khodijah Pekalongan P PJl. Bandung 39 - 47 PekalonganHospital & Clinic (0285) 422 845 PKlinik Diagnostik "CITO"

PekalonganPJl. KH. Mas Mansyur No.33Clinic - Not 24 Hours (0285) 422 458

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Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 14: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Jawa Tengah

PemalangRSU Santa Maria Pemalang P P P PJl. Pemuda No. 24Hospital & Clinic (0284) 321251 P

PurwodadiRS Panti Rahayu Purwodadi P P P PJl. R Suprapto 06Hospital & Clinic (0292) 421087 PRS Permata Bunda Purwodadi P P P PJl. Hayam Wuruk No. 24, GroboganHospital & Clinic (0292) 422839 P

PurwokertoRS St. Elisabeth Purwokerto P PJl. Jend. Gatot Subroto No. 44,

Purwokerto

Hospital & Clinic (0281) 631 761 P

RSU Bunda Purwokerto P P P PJl. Pramuka 249Hospital & Clinic (0281) 635 424

RembangRSU Rembang P PJl. Taman Bahagia No. 16 RembangHospital & Clinic (0295) 691 444 P

SalatigaRSU Ananda Salatiga P P P PJl. Ki Penjawi 7Hospital & Clinic (0298) 324141 PRSU Puri Asih Salatiga P P P PJl. Jendral Sudirman No. 169Hospital & Clinic (0298) 323209 P

SemarangKlinik Bina Sehat P PJl. Kalimas Raya No.29Clinic - 24 Hours (024) 354 9000

Klinik Diagnostik " CITO" Setiabudi PJl. Setiabudi G 62 K-LClinic - Not 24 Hours (024) 7461645

Klinik Diagnostik " CITO" Solo PJl. Dr. Rajiman 349Clinic - Not 24 Hours (0271) 714 455

Klinik Puri Husada P PJl. Puri Anjasmoro H5/45AClinic - Not 24 Hours (024) 760 0360

RS Banyumanik PJl. Bina Remaja 61Hospital & Clinic (024) 747 1519 PRS Hermina Pandanaran-Semarang P P P PJl.Pandanaran No.24Hospital & Clinic (024) 8442525 PRS Islam Sultan Agung Semarang P PJl. Raya Kaligawe Km. 4Hospital & Clinic (024) 658 0019

RS Panti Wilasa "Dr. Cipto" P P PJl. Dr. Cipto No. 50Hospital & Clinic (024) 354 6040

RS Panti Wilasa Citarum P P PJl. Citarum No. 98Hospital & Clinic (024) 3542224 PRS Permata Medika Semarang P P P PJl. Mr. Moch Ichsan 93 -97, NgaliyanHospital & Clinic (024) 762 5005 PRS Roemani Muhammadiyah

SemarangP P P PJl. Wonodri No. 22Hospital & Clinic (024) 844 4623 P

RS St. Elisabeth Semarang P P P PJl. Kawi No. 1Hospital & Clinic (024) 831 0076 PRS Telogorejo P P P PJl. KH. Ahmad DahlanHospital & Clinic (024) 844 6000 PKlinik Diagnostik "CITO" Dr. Cipto PJl. Dr. Cipto 14AClinic - Not 24 Hours (024) 351 5374

Klinik Diagnostik "CITO" Indraprasta PJL. Indraprasta 81AClinic - Not 24 Hours (024) 355 6853

SoloRS Dr. Oen Solo Baru P P P PKomp. Perumahan Solo Baru,

Kec.Grogol. Kab. Sukoharjo

Hospital & Clinic (0271) 620 220 P P

RS Panti Waluyo P P P PJL.Jend. A. Yani No.1-2Hospital & Clinic (0271) 712 077 P

SukoharjoRS Nirmala Suri P P PJl. Raya Solo Sukoharjo, Km. 9Hospital & Clinic (0271) 593 814

SurakartaRS Dr. Oen Surakarta P P P PJl. Brigjen Katamso No. 55, SurakartaHospital & Clinic (0271) 643 139 PRS Islam Surakarta (YARSIS) P PJl. Jend. A. Yani Pabelan, SurakartaHospital & Clinic (0271) 710 571

RS Kasih Ibu Surakarta P PJl. Slamet Riyadi 404, SurakartaHospital & Clinic (0271) 714 422 P

TegalKlinik Diagnostik "CITO" Tegal PJl. Gajahmada No. 79Clinic - Not 24 Hours (0283) 353 402

RS Mitra Keluarga Tegal P P P PJl. Sipelem No.4, Kemandungan TegalHospital & Clinic (0283) 394 999 PRSI Harapan Anda P PJl. Ababil No.42, TegalHospital & Clinic (0283) 358 244 P

TemanggungRS Ngesti Waluyo P PJl. Parakan, Kab. TemanggungHospital & Clinic (0293) 596 008 PRS PKU Muhammadiyah

TemanggungPJl. Raya Kedu KM. 2, KalisatHospital & Clinic (0293) 596704 P

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Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 15: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Jawa Timur

BanyuwangiRS Al Huda Banyuwangi P P P PJl. Diponegoro No. 65, GentengHospital & Clinic (0333) 8420333 PRS Islam Fatimah Banyuwangi P PJl. Jember No.25, Kabat - BanyuwangiHospital & Clinic (0333) 421 451 P

BojonegoroRSUD Dr. R. Sosodoro

Djatikoesoemo BojonegoroP P P PJl. Dr. Wahidin No. 40Hospital & Clinic (0353) 881193 P

GresikRS Petrokimia Gresik P P P PJl. Jendral Ahmad Yani No. 69Hospital & Clinic (031) 3978658 PRS Semen Gresik P P P PJl. RA. Kartini No. 280Hospital & Clinic (031) 397 3477 P

JemberRS Bina Sehat P P P PJl. Jaya Negara No. 7Hospital & Clinic (0331) 422701 PRS Perkebunan / PTPN X Jember P P P PJl. Bedadung No 2Hospital & Clinic (0331) 487 104

RSU Kaliwates Jember P P P PJl. Diah Pitaloka No. 1Hospital & Clinic (0331) 483505 P

KediriRS Baptis Kediri P P P PKotak Pos 1, Jl Brigjen Pol IBH

Pranoto

Hospital & Clinic (0354) 684 172

LumajangRS Wijaya Kusuma Lumajang P P P PJl. A. Yani No. 149Hospital & Clinic (0334) 891325 P

MadiunRS Santa Clara Madiun P P P PJl. Biliton No. 15Hospital & Clinic (0351) 462 688 PRSI Siti Aisyah Madiun P P P PJl. Mayjend Sungkono No. 38Hospital & Clinic (0351) 464822 P

MaduraRS Larasati P P P PJl. Mandilaras No. 74, PamekasanHospital & Clinic (0324) 328305 P

MalangApotik & Klinik Griya Bromo P PJl. Bromo No. 7Clinic - Not 24 Hours (0341) 341818

RS Baptis Batu P PJl. Raya Tlekung No. 1 Junrejo, BatuHospital & Clinic (0354) 594 161

RS Islam Aisyiyah Malang P P PJl. Sulawesi 16Hospital & Clinic (0341) 326 773

RS Islam Malang P P P PJl. Mayjen Haryono 139Hospital & Clinic (0341) 551356 PRS Manu Husada Malang P P P PJl. Sultan Agung No. 12Hospital IPD Only (0341) 320 376 PRS Marsudi Waluyo Singosari P P P PJl. Raya Mondoroko Km.9Hospital & Clinic (0341) 458 974 PRS Panti Nirmala P P P PJl. Kebalen Wetan No.8Hospital & Clinic (0341) 362 459 PRS Panti Waluya Sawahan Malang PJl. Nusa Kambangan 56Hospital IPD Only (0341) 362 017 PRS Wava Husada P P P PJl. Panglima Sudirman 99 A, KepanjenHospital & Clinic (0341) 393000 PRSIA Hermina

Tangkubanprahu-MalangP P P PJl. Tangkuban Perahu No. 33Maternity & Children (0341) 325082 P

RSIA Melati Husada P P P PJl. Kawi No. 32Hospital & Clinic (0341) 325249 PRSU. Lavalette Malang P P P PJl. W.R. Supratman No. 10Hospital & Clinic (0341) 470 805 P

MojokertoRS Gatoel Mojokerto P PJl. R. Wijaya 56 MojokertoHospital & Clinic (0321) 322 329 PRS Kartini Mojosari P P P PJl. Airlangga 137 MojosariHospital & Clinic (0321) 592261 PRS Reksa Waluya P P P PJl. Mojopahit No.442 MojokertoHospital & Clinic (0321) 322 170 PRS. Emma Mojokerto P P P PJl. Raya Ijen No. 67Hospital & Clinic (0321) 328 737 PRSI Arofah Mojosari P P P PJl. Gajah Mada No. 1 MojosariHospital & Clinic (0321) 596 900 P

PasuruanRSI Masyithoh Bangil P P PJl. A. Yani No. 6, BangilHospital & Clinic (0343) 741018 P

ProbolinggoRS Dharma Husada Probolinggo P P P PJl. Soekarno Hatta No. 10Hospital & Clinic (0335) 422176 P

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Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 16: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Jawa Timur

SidoarjoKlinik Citra Gading Medika PJl. Brigjen Katamso A408-409, RewwinClinic - 24 Hours (031) 8679727

RS Anwar Medika P P P PSemawut Balongbendo, SidoarjoHospital & Clinic (031) 897 2052 PRS Delta Surya P P P PJl. Pahlawan No.9Hospital & Clinic (031) 896 2531

RS Mitra Keluarga Waru P P P PJl. Jend S Parman No. 8 WaruHospital & Clinic (031) 8542111 P PRS Siti Khodijah Sepanjang P P PJl. Pahlawan 260 SepanjangHospital & Clinic (031) 788 1130 PRSI Siti Hajar Sidoarjo P PJl. Raden Patah No. 70Hospital & Clinic (031) 8921 233 P

SurabayaKlinik dr. Ipung PJl. Ngagel Jaya Tengah 115Clinic - Not 24 Hours (031) 5024612

Klinik Sentra Medika Surabaya PJl. Raya Tenggilis No. 91-93, SurabayaClinic - 24 Hours (031) 8438777

Pramita Utama Diagnostic Centre

SurabayaPJl. Dharmawangsa 66Clinic - Not 24 Hours (031) 502 0552 P

RS Adi Husada Undaan Wetan P P P PJl. Undaan Wetan No. 40-44Hospital & Clinic (031)5321256-59 PRS Darmo Surabaya P P PJl. Raya Darmo 90Hospital & Clinic (031) 567 6253

RS Islam A.Yani Surabaya P P P PJl. Jend. A. Yani No. 2-4Hospital & Clinic (031) 8284505 PRS Islam Jemursari Surabaya P P P PJl. Raya Jemur Sari No. 51-57Hospital & Clinic (031) 8471877 PRS Katolik Vincentius A Paulo/RKZ

SurabayaP P P PJl. Diponegoro 51Hospital & Clinic (031) 567 7562

- Clinic located at Jl. Ciliwung 42 with cashless services available Monday to Saturday (8:00 AM - 11:00 AM) only. After hours outpatient services refered to ER

RS Mitra Keluarga Surabaya P P P PJl. Satelit Indah II, Darmo Satelit

Surabaya

Hospital & Clinic (031) 734 5333 P P

RS Spesialis Husada Utama P P P PJl. Prof. Dr. Moestopo No. 31-35Hospital & Clinic (031) 5018335 PRS Surabaya Internasional P P P PJl. Nginden Intan Brt Bl.BHospital & Clinic (031) 599 3211 P PRS William Booth Surabaya P P P PJl. Diponegoro, No 34Hospital & Clinic (031) 567 8917 PRS. Muji Rahayu P PJl. Manukan Wetan 68 - 68AHospital & Clinic (031) 740 4132 PRSAL Dr. Ramelan PJl. Gadung No.1Hospital IPD Only (031) 843 8153

RS PHC Surabaya P P P PJl. Prapat Kurung Selatan No. 1,

Tanjung Perak

Hospital & Clinic (031) 329 4801 P

Siloam Hospitals Surabaya P P P PJl. Raya Gubeng No. 70, SurabayaHospital & Clinic (031) 503 1333 P P

State/Province: Kalimantan Barat

PontianakRS ProMedika Pontianak P PJl. Gusti S. Lelanang Blok EA No. 2-5,

Pontianak Mall

Hospital & Clinic (0561) 7390 82 P P

RSIA Anugerah Bunda Khatulistiwa P P P PJl. A. Yani IHospital & Clinic (0561) 581818 PRSU Santo Antonius Pontianak P P PJl. Wahid Hasyim No. 294Hospital & Clinic (0561) 732 101

RSUD Dr. Soedarso P P PJl. Adi SuciptoHospital & Clinic (0561) 737 701

SingkawangRS Vincentius Singkawang P P PJl. Pangeran Diponegoro No. 5Hospital & Clinic (0562) 631 008 PRSU Harapan Bersama P P P PJl. P Belitung No. 61Hospital & Clinic (0562) 631791 P P

State/Province: Kalimantan Selatan

Balikpapan BaruPanacea Clinic P P P PKomp.Mal Fantasi Blok AB 2 No.18-20Clinic - Not 24 Hours (0542) 877898

- Please Note: You must telephone Global Assistance before arrival at this Hospital so arrangements can be made

BanjarmasinKlinik Spesialis Sari Mulia

BanjarmasinPJl. P. Antasari No. 139 B, BanjarmasinClinic - Not 24 Hours (0511) 325 4341

RS Islam Banjarmasin P P PJl. Letjend S. Parman, Gg. Purnama

No.1

Hospital & Clinic (0511) 3354896

RS Sari Mulia Banjarmasin P P P PJl. P. Antasari No. 139, BanjarmasinHospital & Clinic (0511) 325 2570 PRSK Bedah Banjarmasin Siaga PJl. A. Yani No. 149 KM. 3.5Hospital & Clinic (0511) 325 3111

Released: 12 May 2010, 1:53:56PM Page 16 of 21

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Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 17: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Kalimantan Selatan

TanjungRS Pertamina Tanjung P P P PJl. Gas Murung PudakHospital & Clinic (0526) 2022 550

State/Province: Kalimantan Timur

BalikpapanBalikpapan Dental Health Center P PJl. Jend. Sudirman Komp. Pantai Mas

Permai A/28

Dental Clinic (0542) 426 461

RS Balikpapan Baru P P P PJl. MT. Haryono, Komp. Balikpapan

Baru, Blok A-3A No 7-9

Hospital & Clinic (0542) 877 330 P

RS Balikpapan Husada P P P PJl. M.T Haryono No.9 Ring Road

Balikpapan

Hospital & Clinic (0542) 720 6509 P

RS Harapan Mulia Balikpapan P PJl. Wiluyo Puspoyudo No. 26-30Hospital & Clinic (0542) 441572 PRS Pertamina Balikpapan P P P P PJl. Jend Sudirman No.1Hospital & Clinic (0542) 734020 P PRS Restu Ibu Balikpapan P P PJl. A. Yani No. 85Hospital & Clinic (0542) 422304

RSIA Permata Hati Balikpapan P P PJl. Imam Bonjol No. 01, BalikpapanMaternity & Children (0542) 413 932 P

BontangRSUD Taman Husada Bontang P P P PJl. S Parman No. 1Hospital & Clinic (0548) 3036990 P

Kutai KartanegaraKlinik Maju Sejahtera Handil PJl. Moh. Hatta No. 17, Handil 3Clinic - 24 Hours (0541) 6918 91

SamarindaRS Dirgahayu Samarinda P P PJL. Gunung Merbabu No.40Hospital & Clinic (0541) 742116

RS Haji Darjad Samarinda PJl. Dahlia No. 4Hospital IPD Only (0541) 732 698 PRS Islam Samarinda P P P PJl. Gurame No. 18Hospital & Clinic (0541) 7415 10 PRSUD A. Wahab Sjahranie P P P PJl. Palang Merah IndonesiaHospital & Clinic (0541)738118 P

SangattaRS Prima Sangatta PJl. Yos Sudarso I No. 1Hospital & Clinic (0549) 24555 PRS Sangatta Occupational Health

CentreP P P PJl. Yos Sudarso IV, No. 1Hospital & Clinic (0549) 23417 P

RSU Meloy Sangatta P P P PJl. Yos Sudarso II No. 101Hospital & Clinic (0549) 2026258 P

TarakanPertamedika Hospital Tarakan P P P PJl. Mulawarman No. 14Hospital & Clinic (0551) 31403 P

State/Province: Kepulauan Riau

BatamKlinik Umum & Gigi Casa Medical

utamaP PJl. Imam Bonjol Komp.Bumi Indah B/4,

Nagoya

Clinic - Not 24 Hours (0778) 458 813

Klinik Umum Casa Astek Sekupang PKomp.Pertokoan Cipta Puri CC/3 Tiban

Selatan

Clinic - Not 24 Hours (0778) 702 0317

Klinik Umum Casa Batu Aji PKomp.Batu Aji Centre B/ 3 Batu AjiClinic - Not 24 Hours (0778) 702 0326

Klinik Umum Casa Medical

BengkongPKomp. Taman Indah Sentosa Blok

F/19, Sei Panas

Clinic - Not 24 Hours (0778) 371 002

Klinik Umum Casa Medical Jodoh PJl. Duyung Batu Ampar (Rumah Susun

Jamsostek), Batam

Clinic - Not 24 Hours (0778) 431 974

RB&Klinik Budi Rosari P P PJl. Mahkota Simpang No. 1, Bengkong

Mahkota

Maternity Only Hospital (0778) 427854 P

RS Awal Bros Batam P P P PJl. Gajah Mada Kav. IHospital & Clinic (0778) 431 777 P PRS Harapan Bunda Batam P P P PJL. Seraya 1Hospital & Clinic (0778) 458 808

RS Santa Elisabeth Batam P P P PJln. Anggrek Blok IIHospital & Clinic (0778) 457357 PRSU Casa Medical Centre P PJl. Jend. A. Yani No.8 Muka Kuning,

Batam

Hospital & Clinic (0778) 371 002

State/Province: Lampung

Released: 12 May 2010, 1:53:56PM Page 17 of 21

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PT Global Asistensi Manajemen Indonesia (GAMI)

Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 18: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Lampung

RS Advent Bandar Lampung P P P PJl. Teuku Umar No. 48Hospital & Clinic (0721) 703 459 PRS Bumi Waras P PJl. Wolter Mongonsidi No. 235, Teluk

Betung

Hospital & Clinic (0721) 254499 P

- Outpatient cashless services only available for GP and Emergency Room treatments

RS Immanuel Way Halim P PJl. Soekarno-Hatta, Tromol Pos I,

Bandar Lampung

Hospital & Clinic (0721) 704 900 P

State/Province: Maluku

AmbonRSU Al Fatah Ambon P P P PJl. Sultan Babullah No. 2Hospital & Clinic (0911) 343428 P P

State/Province: Nanggroe Aceh Darussalam

Banda AcehRS Harapan Bunda Banda Aceh PJl. Teuku Umar No. 181-223Hospital & Clinic (0651) 48114

RS Permata Hati Banda Aceh P P P PJl. Sultan Iskandar Muda No. 217Hospital & Clinic (0651) 742 8872 PRS Teungku Fakinah PJl. Jend.Sudirman 27-29Hospital & Clinic (0651) 41454

RSU Bulan Sabit Merah Indonesia P P P PJl. Sultan Malikul Saleh, LamlagangHospital & Clinic (0651) 638701 P

LhokseumaweRS TK IV IM.07.01

Lhokseumawe(RS TNI AD)PJl. SamudraHospital & Clinic (0645) 40300

RSU Bunda Lhokseumawe PJl. Darussalam No. 16, Aceh UtaraHospital & Clinic (0645) 46924 PRSU Bunga Melati PJln. Samudera Baru No. 3 Keude Aceh

- Lhokseumawe

Hospital & Clinic 0645 - 44821 P

RSU Kasih Ibu Lhokseumawe P P P PJl. Merdeka No. 17 Simpang BlangHospital & Clinic (0645) 48713 PRSU Sakinah P PJl. Antara No. 30Hospital & Clinic (0645) 45534 P

State/Province: Nusa Tenggara Barat

LombokPermata Hati Maternity Clinic P PJl. Majapahit No. 8 MataramMaternity & Children (0370) 631 999 P

MataramKlinik Lawang Gali P P P PJl. Sudirman No. 2, Sumbawa BesarClinic - 24 Hours (0371) 2709693 PRS Biomedika PJl. Bung Karno No 143Hospital & Clinic (0370) 645137 PRSB Exonero P PJln. Pemuda No. 16Maternity Only Hospital (0370) 636454 P

State/Province: Nusa Tenggara Timur

RutengRS St. Rafael Cancar P P PJl. Santurafael Cancar,

Manggarai,Ruteng

Hospital & Clinic (0385) 22944 P

State/Province: Papua (Irian Jaya)

TimikaKlinik & RB Hadeli Sari Timika P P PJl. Cendrawasih SP.II, TIMIKAHospital & Clinic (0901) 322541 PKlinik Dian Timika P PJl. Yos Sudarso No. 54 TimikaClinic - 24 Hours 081354089988

State/Province: Papua Barat

SorongPrima Medical Centre P PJl. Ahmad Yani No. 24Clinic - 24 Hours (0951) 333666

Released: 12 May 2010, 1:53:56PM Page 18 of 21

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Health Benefits Administration & Risk Management

PT Global Asistensi Manajemen Indonesia (GAMI)

Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 19: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Riau

DuriKlinik Dr. Agung P PJl. Jend. Sudirman No. 34, Mesjid

Jamil

Clinic - Not 24 Hours 08127574025

Klinik Permata Hati II PJl. Jend. Sudirman No.55, Simp.

Padang

Clinic - 24 Hours (0765) 91155

RS Permata Hati Duri P P PJl. Jend. Sudirman No.37 DuriHospital & Clinic (0765) 598 101 PRS Thursina Duri P P P PJl. Jend. Sudirman No.65, RiauHospital & Clinic (0765) 5977 73 P

PekanbaruEka Hospital Pekanbaru P P P PJl. Soekarno Hatta Km.6,5Hospital & Clinic (0761) 6989999 P PRS Awal Bros Pekanbaru P P P PJl. Jend. Sudirman no.117Hospital & Clinic (0761) 47333 P PRS Santa Maria Pekanbaru P P P PJl. Jend. Ahmad Yani No.68,

Pekanbaru

Hospital & Clinic (0761) 222 13 P

RS. Pekanbaru Medical Centre P P P PJl. Lembaga Pemasyarakatan,

Pekanbaru

Hospital & Clinic (0761) 848 100 P

RSB Budhi Mulya P P P PJl. Sisingamangaraja No. 25Maternity Only Hospital (0761) 22815 PRSI Ibnu Sina Pekanbaru P P P PJl. Melati No. 60, PekanbaruHospital & Clinic (0761) 24242 P

State/Province: Sulawesi Barat

PolewaliRSUD Polewali P P P PJl. Dr. Ratulangi No. 50Hospital & Clinic (0428) 21451 P

State/Province: Sulawesi Selatan

MakassarRS Bhayangkara Andi Mappa

OudangP PJl. letjen Pol. Andi Mappa Oudang No.

63, Makassar

Hospital & Clinic (0411) 872 514

RS Dr. Wahidin Sudirohusodo P PJl. Perintis Kemerdekaan Km.11,

Tamalanrea

Hospital & Clinic (0411) 584675/7 P

RS Islam Faisal P PJL. A. Pangerang PettaraniHospital & Clinic (0411) 871 942

RS Labuang Baji P PJl. Ratulangi No. 81, Somba OpuHospital & Clinic (0411) 872 120

RS Stella Maris P P P PJL. Somba Opu No. 273Hospital & Clinic (0411) 871 391 PRS TK. II Pelamonia P PJl. Jend. Sudirman No. 27, MakassarHospital & Clinic (0411) 324 710

Pare-pareRS Fatima Pare-pare P P P PJl. Ilham 3Hospital & Clinic (0421) 21847 P

State/Province: Sulawesi Tengah

LuwukRSB Irene P PJl. RA Kartini No. 25Maternity Only Hospital (0461) 21202 PRSUD Luwuk P P P PJl. Imam Bonjol KM. 3Hospital & Clinic (0461) 21820 P

PaluRS "Woodward" Palu P P PJl. L.H. Woodward no.1Hospital & Clinic (0451) 421 769

State/Province: Sulawesi Utara

BitungRSAL BITUNG P PJl. Yos Sudarso No. 26, BitungHospital & Clinic (0438) 21264

RSUD Bitung P PJl. Manembo-nembo, BitungHospital & Clinic (0438) 38066

ManadoRS Advent Manado P P P PJl. 14 Februari No. 1 Teling AtasHospital & Clinic (0431) 847950 P PRS Pancaran Kasih P PJl. Sam Ratulangi XIII, ManadoHospital & Clinic (0431) 865 800

RSI Sitti Maryam P PJl. Pegiden Raya no. 53, TumintingHospital & Clinic (0431) 851 577

RSU Prof.dr.R.D.Kandou Manado P P PJl. Raya TanawangkoHospital & Clinic (0431) 838203

Released: 12 May 2010, 1:53:56PM Page 19 of 21

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Health Benefits Administration & Risk Management

PT Global Asistensi Manajemen Indonesia (GAMI)

Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 20: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Sumatera Barat

Bukit TinggiRSI Ibnu Sina Bukit Tinggi P P P PJl. Batang AgamHospital & Clinic (0752) 21208 P

PadangRS Khusus Bedah Ropanasuri

PadangP PJl. Aur No. 8Hospital & Clinic 0751-31938

RS Selaguri Padang P P P PJl. Jend. Ahmad Yani No. 26, PadangHospital & Clinic (0751) 33010 PRS Yos Sudarso P P PJl. Situjuh No.1Hospital & Clinic (0751) 33230

RSI Ibnu Sina Padang P P P PJl. Gajah Mada, Gunung PangilunHospital & Clinic (0751) 444712 PRSI Siti Rahmah Padang P P P PJl. Raya By Pass KM 15Hospital & Clinic (0751) 463059 PRSU C-BMC Padang P P P PJl. Proklamasi no. 37, PadangHospital & Clinic (0751) 23164 P

State/Province: Sumatera Selatan

PalembangRS Islam Siti Khadijah Palembang P P P PJl. Demang Lebar Daun, PakjoHospital & Clinic (0711) 356 008

RS R.K. Charitas Palembang P P P PJl. Jend. Sudirman No.1054Hospital & Clinic (0711) 350 426

PrabumulihRS AR Bunda Prabumulih P P PJl. Angkatan 45Hospital & Clinic (0713) 322 954 PRS Pertamina Prabumulih P P P PJl. Kesehatan No.100, KompertaHospital & Clinic (0713) 382 742

State/Province: Sumatera Utara

BinjaiRSU Artha Medika Binjai P P P PJl. Samanhudi No. 22Hospital & Clinic (061) 8827277 P

MedanGleni International Hospital P P P PJl. Listrik No. 6Hospital & Clinic (061) 456 6368 P P

- We have received patient complaints re this hospital. The hospital tells us it occurs because some of their doctors demand cash payment. They tell us they cannot control this. If you want to avoid possible problems consider using another facility.

Klinik Spesialis Bunda Medan P PJl. Sisingamangaraja No.17Clinic - Not 24 Hours (061) 732 1666

Medan Medical Center PJln. Haji Agus SalimClinic - Not 24 Hours (061) 4535 522

RS Advent Medan P P P PJl. Gatot Subroto KM. 4, Medan - BinjaiHospital & Clinic (061) 452 4875 P PRS Haji Medan P PJl. RS Haji Medan EstateHospital & Clinic (061) 661 9520

RS Horas Insani P PJl. Medan Km. 2,5, Pematang SiantarHospital & Clinic (0622) 433 444

RS Islam Malahayati P P P PJl. Diponegoro No. 2Hospital & Clinic (061) 4518766 PRS Methodist Medan P P P PJl. MH. Thamrin Medan 105Hospital & Clinic (061) 736 9000 PRS Permata Bunda Medan PJl.Sisingamangaraja No 7Hospital IPD Only (061) 736 2777 PRS Santa Elisabeth Medan P PJl. H. Misbah No. 7Hospital & Clinic (061) 414 4737

RS Sari Mutiara P P P PJl. Kapten Muslim No.79Hospital & Clinic (061) 845 1812 PRSU Dewi Maya P P P PJl. Surakarta No. 2Hospital & Clinic (061) 455 1333 PRSU Materna Medan P PJl. Teuku Umar No. 9 - 11Hospital & Clinic (061) 451 4222

RSU Sarah Medan P P P PJl. Baja Raya No. 10Hospital & Clinic (061) 452 8744 P

Padang SidempuanRSU Ester Kabanjahe P P P PJl. Veteran No. 21, Kabanjahe, Kab.

Karo

Hospital & Clinic (0628)20714

State/Province: Yogyakarta

Released: 12 May 2010, 1:53:56PM Page 20 of 21

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Health Benefits Administration & Risk Management

PT Global Asistensi Manajemen Indonesia (GAMI)

Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]

Page 21: List Provider, 12 May 2010

Facility Name Type TelephoneAddress IP MOptDCDBOM

State/Province: Yogyakarta

BP&RB PKU Muhammadiyah

WatesP P PJl. KHA. Dahlan No. 11, Wates, Kulon

Progo

Hospital & Clinic (0274) 773430 P

Jogja International Hospital P P P PJl. Ring Road Utara No. 160Hospital & Clinic (0274) 4463535 P PKlinik Diagnostik " CITO " Bantul PJl. Raya Bantul km.10, Melikan Lor

Bantul

Clinic - Not 24 Hours (0274) 7101015

RS Bethesda P P P PJl. Jendral Sudirman, No. 70Hospital & Clinic (0274) 586 688 PRS Happy Land Medical Centre P P P PJl. Ipda Tut Harsono No. 53, TimohoHospital & Clinic (0274) 550060 PRS Ludira Husada Tama P P P PJl. Wiratama No.4, TegalrejoHospital & Clinic (0274) 620 333 PRS Panti Nugroho P PJl. Kaliurang Km. 17, PakemHospital & Clinic (0274) 895 186

RS Panti Rini P P PJl. Solo Km. 12,5, KalasanHospital & Clinic (0274) 496 022

RS PKU Muhammadiyah

YogyakartaP P PJl. KH Ahmad Dahlan No. 20Hospital & Clinic (0274) 512 653

RS. St. Elizabeth Bantul P PJl. Ganjuran, Sumber Mulya, BantulHospital & Clinic (0274) 367 502

RSUD Wates P P P PJl. Tentara Pelajar KM. 1 No. 5, Wates

- Kulonprogo

Hospital & Clinic (0274) 773169 P

Klinik Diagnostik "CITO" Yogyakarta PJl. Atmosukarto 4Clinic - Not 24 Hours (0274) 563 656

v

If you would like a Healthcare Provider added to our Network, please fax us at (021) 782 9332 or email our team at

[email protected].

We are always happy to add quality healthcare providers to our Network, especially where we do not have alternate providers available.

Experiencing a Problem? If you or your employees experience any problems in accessing services at any one of the Healthcare Providers

included in our List, call your Customer Service Hotline immediately. The number is on the back of your Membership Card. If you call us

while you are still at the hospital or clinic - we most likely can help you immediately.

You can also email us at [email protected] and we will investigate any concern you might have with one of our

Network Providers. Remember, to help us in our discussions with the Healthcare Provider, we need to know the date, time, location and

name of the Provider Staff who created the problem. Perhaps it is a new Receptionist at the Provider's Admissions Desk that needs training -

the only way we can work together with our contracted Providers to ensure you are provided the best service, is to have as many details as

we can from you about any problem you have in accessing service from our Network Providers. Don't forget to let us know about any

concerns you might have with medical practices or treatments also.

For udpates to our Provider List or for information on our other services, please check our website www.Global-Assistance.net or check with

your HR Department.

Released: 12 May 2010, 1:53:56PM Page 21 of 21

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Health Benefits Administration & Risk Management

PT Global Asistensi Manajemen Indonesia (GAMI)

Graha Simatupang Tower 1D 8th Floor, Jl. Letjend. T.B. Simatupang Kav 38, Jakarta 12540, Indonesia

Telephone +62 21 782 8040 Fax: +62 21 782 9332 Email [email protected]