TO

GROUP AGENCY MANAGERS
UNIT MANAGERS
CAREER AGENTS
AGENTS
ISSUED BY:
HEAD TPA & MEDICAL
EMPLOYEE BENEFITS & MEDICAL
TITLE:
HOSPITAL & SURGIGAL AND HOSPITALIZATION BENEFIT CLAIM REQUIREMENTS
OBJECTIVE: TO INFORM AGENCY MEMBERS ON CLAIM REQUIREMENTS FOR HOSPITAL & SURGICAL AND HOSPITALIZATION BENEFIT CLAIMS
Please ensure that the following documents are enclosed when claims are submitted:
A) Hospital & Surgical claims (pre hospitalization, inpatient and post hospitalization): i) Insurance company claim form / face sheet (currently Subang Jaya Hospital is using it) /
medical report;
ii) Original Receipt and Medical bill
iii) Items stated on the medical bill such the following:
*Laboratory report
- ECG / stress test / echocardiogram report
- EEG
- Histopathology report/biopsy report
- Imaging e.g. x-rays, IVU, MRI, CT scan, etc report);
iv) Detailed breakdown of itemized billing
B) Hospitalization benefits claim:i) Discharge summary (not just a discharge note);
ii) Medical bill (not just a receipt) to determine the duration of hospitalization;
The insurer reserves the right to request for more information if it is deem necessary.
These changes are not new but have been in existence in the policy for the claim procedure. At present, time has been wasted on requesting and verification of items, procedures and diagnosis. To expedite the claim payout, hasten the claim process and to facilitate the flow of work it has been suggested to enforce it. The cooperation of all parties concerned will be most valuable.
Thank you.
Yours sincerely,
(Originally Signed)
Dr Liew
Head – TPA & Medical