FAQ - Accident & Hospitalisation Claim
1. What is the procedure for making an Accident or Hospitalisation Claim?
Please click here to view the instruction page for the procedure on making an Accident Claim.
Please click here to view the instruction page for the procedure on making a Hospitalisation Claim.
2. Do I need to submit a medical report?
For claims that are less than $1,000 or less than the deductible amount for Supremehealth/Maxhealth/Premier Health Plan(PHP) with deductible, the Company may consider waiving the medical report if there is sufficient documentary evidence to show the cause of disability/illness, period of disability/illness and hospitalisation. If necessary, a medical report would still be required for claims that are less than $1,000 and the cost of the medical report will be borne by the Claimant.
For claims that are more than $1,000, the original medical report must be submitted together with the claims documents for processing.
For Supremehealth/Maxhealth/Premier Health Plan(PHP) with Deductible claim, the medical report is necessary only if the claim amount exceeds the deductible amount.
3a. If the Life Assured has consulted a Chinese Physician and issued Medical Certificates (MC) and medical bills/receipts/hospital bills, can he claim under Accident Riders?
No. Accident Riders only cover MC and medical expenses from qualified Western physician (Please refer to policy contract for definition of physician). Accident Riders do not cover treatment provided by a Chinese physician.
3b. What about standalone Personal Accident (PA) plans?
No. Accident Standalone PA plans do not cover any benefits arising from the treatment by a Chinese Physician including MC & medical expenses. (Please also refer to policy contract for definition of Physician). The only exception is the medical expenses benefit under the Golden Protector Plan (GPP). Under GPP, a claimant could submit a claim for medical expenses for consultation by a registered Chinese bonesetter or acupuncturist arising from an accident. The maximum limit under medical expenses by a Chinese bonesetter or acupuncturist is $600 per period of insurance. All Chinese bonesetters/acupuncturists must be registered with the Ministry of Health.
4. Can the Life Assured claim under the Golden Protector Plan (GPP) if he/ she had a fall as a result of stroke?
No. Benefits are only payable under Golden Protector Plan (GPP) if the losses suffered are a result of an accident.
5. If the Life Assured underwent a Day surgery, can he claim under Hospital & Surgical Protector (HSP)/Premier Health Plan (PHP)/Supremehealth/Maxhealth?
Day Surgery performed in a specialist clinic or Hospital may be paid after assessment of the claim. However, Day Surgery performed by a General Practitioner is not payable.
6. If the Life Assured has consulted the A&E Dept in a Hospital due to an illness (acute or otherwise) but was not hospitalised, will the claim be payable?
No. HSP/PHP/Supremehealth/Maxhealth claim is only payable if the Life Assured is hospitalised or has undergone a surgery in a specialist clinic or hospital due to an illness/accident. However, A&E consultations without hospitalisation will be payable if it is due to an accident/injury and must be treated by a qualified western physician (Please refer to policy contract for definition of physician).
7. If the Life Assured go to an Accident & Emergency Department in a hospital due to an illness e.g. high fever or food poisoning, can he claim under the Hospital & Surgical Protector (HSP)/Premier Health Plan (PHP)?
No. Emergency outpatient treatment only covers accidental injuries (Please refer to policy contract for definition of Emergency Outpatient Treatment).
8. What are the policy exclusions found under the Premier Health Plan (PHP)?
Please click here to view the list of policy exclusions found under the Premier Health Plan (PHP).