Claims

Death Claim
Total and Permanent Disability (TPD) claim
Living Assurance/Early-Payout Critical Care (EPCC) Claim
Accident Claim
Medical/ Hospitalisation claim

Death Claim

What is the procedure for making a Death Claim?
Please click here to go to ‘make a claim’ for the procedure on making a Death Claim.
What is the Doctor’s Statement?
The Doctor’s Statement is a form provided by Great Eastern Life, to be completed by the doctor who attended to the deceased person for his last illness before his death. If death occurred in Brunei, the claimant can submit all the relevant documents except the Doctor’s Statement. Claims Department will review the claim and advise if the Doctor’s Statement is required. The Doctor’s Statement must be completed if death occurred abroad due to an illness.

How will the death claim proceeds be paid?

Type of Policy	Who we pay to
Estate Policy (no beneficiary named)	Grant of Probate or Grant of Letters of Administration is required.
Third Party Policy	policyholder
Absolute/Conditional Assignment Policy	Assignee

Who is considered the Proper Claimant?
Proper Claimant refers to the executor, widower, widow, parent, child, brother, sister, nephew or niece of the deceased.

What is the Grant of Probate or Grant of Letters of Administration and how does the estate apply for it?
A Grant of Probate is issued by the Courts to confirm the appointment of the executor(s) named in the deceased’s will.

A Grant of Letters of Administration is issued by the Courts to name the legal representatives who are entitled to deal with the deceased’s estate.

Both can be applied through a lawyer, who will draw up and submit a petition to the High Court for approval. It may take up to six months for the court to grant an approval, depending on the complexities of the deceased’s estate.

Total and Permanent Disability (TPD) claim

What is the procedure for making a Total and Permanent Disability (TPD) claim?
Please click here to go to ‘make a claim’ for the procedure on making a Total and Permanent Disability Claim.
How will the Total and Permanent Disability (TPD) Benefits be paid?
Should the insured person become totally and permanently disabled while the policy is in force, the Company will waive the payment of all future basic life premiums and pay the Disability Benefit in 10, five or three annual instalments, or one lump sum, depending on the terms and conditions stated in the policy contract.

*Please refer to the policy contract for the instalment payments and the date of the instalments due as different contracts have different terms and conditions.
Why is a medical report required before payment of every TPD instalment?
A medical report is required before each TPD instalment is made because, under the contract for TPD, if the assured ceases to be totally and permanently disabled, the Company will discontinue all further annual payments. Therefore, there is a need to confirm that the policyholder is still totally and permanently disabled before each instalment is paid out.
For endowment policies, what happens when there are TPD instalments due after the policy maturity date?
On the maturity due date, the Company will pay in one lump sum to the policyholder the balance of the TPD instalments.
If the insured person passes away in the midst of his TPD instalments, what will happen to the rest of the unpaid TPD instalments?
The unpaid TPD instalments will be paid in one lump sum to the estate of the deceased.
What happens if the insured person recovers from his TPD before he has received the full TPD benefits?
It is stated in the contract that if the insured person ceases to be TPD, the Company will discontinue further TPD benefits payments and the policy shall continue under such terms and conditions as the company may decide.

Living Assurance/Early-Payout Critical Care (EPCC) Claim

What is the procedure for making a Living Assurance/EPCC claim?
Please click here to go to ‘make a claim’ for the procedure on making a Living Assurance Claim.
Will the Living Assurance/EPCC claim be paid to the policyholder immediately?
There is a three-month waiting period for the following major illnesses/surgeries (i.e. the major illness or the illness for which surgery is required will be covered only three months after the date of issue of the policy/rider or reinstatement of the policy/rider):
    • Cancer/Major Cancers
    • Heart Attack
    • Angioplasty & other Invasive Treatments for Coronary Artery
    • Coronary Artery By-pass Surgery

If the claim is admitted, the payment of claims will be made to the policyholder.
What is a Doctor’s Statement?
The Doctor’s Statement is a form provided by Great Eastern Life, to be completed by the doctor who attended to the insured person for his illness. The policyholder has to request the attending doctor to complete the Doctor’s Statement and the fee for the completion of the Doctor’s Statement will be borne by the policyholder. Should the Claims Department require additional medical reports, the medical report fee will be borne by the Company. In addition, all relevant laboratory and test results need to be submitted.
If an existing insured person is planning to reside overseas, how will the Living Assurance be affected?
The Living Assurance benefits provide a worldwide cover. However, the insured person’s condition must be certified by a qualified physician practising Western medicine. The Company reserves the right to ask the insured person to be reviewed by an appointed physician.

If a special endorsement (Endorsement No. 100) is included in the insured person's policy, e.g. for foreigners and PRs, the insured person is required to be diagnosed in Singapore, Malaysia or Brunei. However, the Company will still consider the medical evidence if the illness is diagnosed in other countries. If the medical evidence is sufficient, the Company may choose to pay the claim on goodwill basis without admitting liability. Otherwise, the Company reserves the right to ask the insured person to be reviewed by an appointed physician.
What should the policyholder do if he does not know which Major Illness to claim under?
If the policyholder does not know the exact diagnosis of his condition or does not know which Major Illness it falls under, the policyholder may show the policy with the Major Illnesses’ definitions to his attending doctor and seek the doctor’s opinion whether the condition fulfils any of the Major Illnesses. If it does, the policyholder should request the attending doctor to complete the Doctor’s Statement of that particular Major Illness.

Accident Claim

What is the procedure for making a Personal Accident Claim?
Please click here to go to ‘make a claim’ for the procedure on making a Personal Accident Claim.
Do I need to submit a medical report?
For claims of more than $1,500, the Doctor’s Statement must be completed by the attending doctor and submitted to us. The Doctor’s Statement is furnished at the expense of the claimant.

For claims of less than $1,500, the Doctor’s Statement need not be submitted. The Company may waive the
1. medical report if there is sufficient documentary evidence, e.g. a Doctor’s Memo or Inpatient Discharge
2. summary report to show the cause of hospitalisation/disability and period of disability
If the insured person underwent day surgery, can he/she claim under Hospital & Surgical Protector (HSP)/Premier Health Plan (PHP)?
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.
If the insured person has consulted the A&E department of a hospital due to an illness (acute or otherwise) but was not hospitalised, will the claim be payable?
No. PHP claim is only payable if the insured person 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-trained physician (Please refer to policy contract for the definition of ‘physician’).
If the insured person goes to the A&E department of a hospital due to an illness, e.g. high fever or food poisoning, can he/she claim under the Premier Health Plan (PHP)?
No. Emergency outpatient treatment only covers accidental injuries (Please refer to policy contract for the definition of ‘Emergency Outpatient Treatment’).

Medical/ Hospitalisation claim

What is Deductible and Co-insurance?
Deductible is the fixed amount of expenses (per policy year) that is not payable under the Premier Health Plan and which will be borne by the policyholder before any benefit becomes payable.

Co-insurance is the share of the eligible expenses (10%) incurred in excess of the Deductible and which is borne by the policyholder.

Please refer to the table below for illustration:

Total eligible hospital bill	$10,000
Deductible	- $ 3,500
	$ 6,500
Co-insurance ($6,500 x 10%)	- $ 650
Net Amount payable	$ 5,850

What is Day Surgery?
Day surgery refers to the situation where a patient undergoes an operation in a hospital or a government/restructured specialist medical centre, performed by a duly qualified physician and involving local or general anaesthesia. The surgical expenses include the fees and charges for anaesthetics and oxygen and their administration, and use of operating theatre and facilities. Surgery excludes Accidental Dental Treatment. Day surgery done in a clinic or polyclinic is not covered.
What is Room & Board?
Accommodation in a hospital, including meals and general nursing, during confinement as a bed-paying patient. Deluxe rooms, luxury suites or other special rooms that cost more than a standard single room are excluded.
What is Final Expenses Benefit?
This is a waiver of deductible and co-insurance. This benefit will come into effect upon the insured person’s death during hospitalisation or after discharge from the hospital. The deductible and co-insurance that applies to the eligible expenses will be waived. The deductible and co-insurance, which must be incurred during the same period of insurance in which death occurs, will be reimbursed up to the limits for the plan type insured, provided that death is a result of the cause of the hospitalisation. If the insured person’s death is a result of self-inflicted injuries, suicide or attempted suicide, whether sane or insane, the final expenses benefit will not be claimable.
Does Premier Health Plan (PHP) cover goods and services tax (GST)?
No. PHP does not cover GST.
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. Our hospitalisation plans do not cover for outpatient treatment at A&E Dept. due to an illness. However, if the Life Assured has undergone a surgical procedure in the A&E Dept. as a result of an illness, it would be covered.
If the Life Assured has consulted the A&E Dept. in a Hospital due to an accidental injuries but was not hospitalised, will the claim be payable?
Yes. Emergency outpatient treatment covers accidental injuries and this is only applicable to Hospitalisation Plans that have a benefit on Emergency Outpatient Treatment due to Accident.
How do I submit my hospitalisation claim under my Premier Health Plan?
You need to submit the original final hospital bill to Great Eastern.
Under what circumstances do I need to submit the original final hospital bill for claim?
The original bills will have to be submitted for the following claims:
    • pre/post hospital bills before and after hospitalisation
    • overseas bills
    • claims filed under Premier Health Plan
How do I claim for my pre and post-hospitalisation bills?
You need to state the policy numbers on the original final bills and submit to us at Great Eastern office. Please note that certified true copy, duplicate, photocopied bills are not acceptable.
Who can I contact if I require further assistance?
You can contact your servicing distribution representative or email your enquiry to us at wecare-bn@greateasternlife.com. Alternatively, you can call our Customer Service Officer at 2233118.