Medical Card Claim

通常住院有三种方式
1. 直接用医药卡入住私人医院
政府医院是不能用医药卡的，保客须自付后，才凭单向公司索偿。
 
直接进院的流程通常会是：
Step 1：
保客先出示医药卡给医院，医院会向保险公司核实保单是否有效。

Step 2：
医生要填写保客需要住院原因并呈交给公司。（这过程可能会花很长时间，因为须要医生有空写报告）

Step 3：
当一切妥善后，资料没问题，公司就会出 Guarantee Letter(GL)，那么保客就能进院了。

2. 先住院后自己付费后，之后向保险公司索赔
这种情况多是在政府医院 或 Non-Panel Hospital 才会遇到。
当然某些情况下，Panel Hospital也是会要先自付，比如医药卡生效不够两年，保险公司是会 Investigate 的。调查完毕没问题后，保客就凭单索偿。

3. 预先向私人医药提出申请
比如医生说决定下星期某天保客要动手术，那么保客可以通过医院预先申请那天的 Guarantee Letter(GL)，一旦批准，那么就可以那天马上进院了。

出院流程：
主要是等待医生填写呈交“出院报告”，等公司出 Final Guarantee Letter，那么就能出院了

Due to company will update form version from times to times,
kindly download latest version direct from Gesica or Epartner.

–  Health Claims Requirement Checklist
    (Check List)

–  Hospitalisation & Surgical -Claimant’s Statement
    (Fill in by CLIENT)

–  Hospitalisation & Surgical-Attending Physician’s Statement
   (Fill in by DOCTOR)

CTC = Certified True Copy

如果是没用医药卡住院的话（先自付后索赔），请准备以下文件：

Mandatory Documents
– CTC Of Life Assured’s NRIC & Policyowner
– CTC Of Absolute Assignee’s NRIC (if different from Life Assured)
– Health Claims Requirement Checklist

Fill In By DOCTOR
– Hospitalisation & Surgical-Attending Physician’s Statement

Fill And Prepare By CLIENT
1. Hospitalisation & Surgical -Claimant’s Statement

– Original bill(s)/tax invoice(s) and Original receipt(s)
  (including deposit and refund receipt, if any)

– Itemised Breakdown: if
  (a) pharmacy charges >20% of total bill/tax invoice,
  (b) laboratory charges >10% of total bil/tax invoice.

– CTC of Laboratory Test Result, X-Ray, MRI/CT scan, Ultrasound, Histopathology report (if any)

– Claim settlement details from third party (other insurer/employer) if claiming balance

– For Overseas claims:
  (a) CTC of passport indicating Biodata, Dates of Departure from Malaysia and Arrival overseas,
  (b) Original detailed admission bill/tax invoice and receipt (translation of foreign language to English, if deemed necessary)

如果之前是已用医药卡住院的话，请准备以下文件：

Mandatory Documents

– CTC Of Life Assured’s NRIC & Policyowner
– CTC Of Absolute Assignee’s NRIC (if different from Life Assured)
– Health Claims Requirement Checklist

Fill And Prepare By CLIENT
–  Original bill(s)/tax invoice(s) and Original receipt(s)
   (including deposit and refund receipt, if any)

–  Itemised Breakdown,
   (1) Pre Post Hospitalisation：
        E-sub Bill/tax invoice- each bill/tax invoice < RM3000
        (detail listing of consultation fee, medication, test/investigation charges etc)

   (2) Pre Post Hospitalisation：
        Submit ORIGINAL Bill/tax invoice- each bill/tax invoice if medicine > RM3000
        (detail listing of consultation fee, medication, test/investigation charges etc)
        

准备以上的文件直接交至公司，无须填表格或签名，唯须顺序排好医药单的日期。
                                                                              +
Health Claims Requirement Checklist – 需要勾Pre 或 Post Hospitalisation
NRIC COPY – 之前交过一次就不用交了     

Mandatory Documents

– CTC Of Life Assured’s NRIC & Policyowner
– CTC Of Absolute Assignee’s NRIC (if different from Life Assured)
– Health Claims Requirement Checklist

Fill In By DOCTOR
– If total bill(s) >= RM 1000
– Hospitalisation & Surgical-Attending Physician’s Statement

OR

– If total bill(s)/invoice(s) < RM 1000
  Attending doctor to endorse the diagnosis (with signature and stamping)
  and confirm the date of accident

Fill And Prepare By CLIENT
1. Hospitalisation & Surgical -Claimant’s Statement

– CTC of hospitalisation bill//tax invoice

– For Reimbursement Claim-Original bill(s)/tax invoice(s) and Original receipt(s)
   (including deposit and refund receipt, if any)

Mandatory Documents

– CTC Of Life Assured’s NRIC & Policyowner
– CTC Of Absolute Assignee’s NRIC (if different from Life Assured)
– Health Claims Requirement Checklist

Fill In By DOCTOR
– Hospitalisation & Surgical-Attending Physician’s Statement

Fill And Prepare By CLIENT
1. Hospitalisation & Surgical -Claimant’s Statement

– CTC of hospitalisation bill//tax invoice

– For Reimbursement Claim-Original bill(s)/tax invoice(s) and Original receipt(s)
   (including deposit and refund receipt, if any)