Outpatient (OPD) Claim Process
Service Steps
1. Receive treatment at a network hospital.
2. Notify the hospital staff and present your ID card, insurance card, or show the e-card via the Mobile Application.
3. Receive medical treatment.
4. Return home without making an advance payment.*
*The insured is responsible for paying any expenses that exceed the coverage limits or are not covered by the policy conditions (if any).
Service Conditions:
1. The insured can use the cashless claim service at network hospitals from the policy's effective date or after a waiting period of no less than 30 days from the effective date (depending on the contract conditions).
2. Available for the insured with the following coverage:
• Outpatient (OPD) medical expense benefits
• Accidental medical expense benefits within 24 hours
3. The insured pays for excess rights or expenses that do not meet the policy conditions (if any).
Inpatient (IPD) or Day Case Claim Process
Service Steps
1. Notify the hospital staff and present your ID card, insurance card, or show the e-card via the Mobile Application.
2. Fill out the form and sign it / The physician summarizes the medical treatment details, and the related documents are sent to the company for assessment.
3. Claim officers assess the claim and reply to the hospital with the coverage details.
4. The insured pays for expenses exceeding the coverage limits or expenses not covered by the policy conditions (if any).
Service Conditions
1. The insured can use the cashless claim service at network hospitals from the policy's effective date or after a waiting period of no less than 30 days from the effective date (depending on the contract conditions).
2. Available for the insured with the following coverage
• Outpatient (OPD) and Inpatient (IPD) medical expense benefits
• Accidental medical expense benefits within 24 hours
3. The insured pays for excess rights or expenses that do not meet the policy conditions (if any).
4. In the event that the company determines the claim cannot be approved for cashless service at the hospital, the insured must pay in advance. They can then submit a reimbursement claim by sending the documents through an agent/broker or directly to the company via mail.
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