How to file a Claim

Outpatient Claims:

Please submit all your bills together with original receipts and make sure the following information / documents is/are included:

a) Copy of the Pacific Cross Health Insurance Plc. card of the insured, both sides
b) Medical Certificate with Doctor / Service provider name with full address and the country where service
was rendered and Date of treatment / visit with diagnosis or name of injury
c) Detailed breakdown of charges / services with actual charges paid by you with official receipts

Note: Photocopies or computer printouts furnished by your service provider will not be accepted. For U.S .A. service provider, HCFA-l 500 Forms with doctor’s signature will be accepted.

Inpatient Claims:

Please submit all your bills together with original receipts and make sure the following information / documents is/are included:

a) Copy of the Pacific Cross Health Insurance Plc. card of the insured, both sides
b) A completed “Notification of Claim Form”
c) Date of hospital admission and discharge
d) Diagnosis of disability requiring the hospitalization and name of surgical procedures performed (if any)
e) Itemized charges and Final Billing
f) Medical Certificate


Claims for Optional Benefits: (If applicable)
Personal Accident Claims:

You should submit:

a) Original bills and official receipts
b) Hospital / physician’s reports giving details on the nature of the injury and the extent and period of disability, police report where relevant and if death shall have resulted, a copy of the death certificate and the relevant coroner’s report.


Dental Claims:

You should submit:

a) Original bills and official receipts
b) A completely filled in “Claim Form for Dental Benefits”. The dentist is required to mark the area of oral treatment on the dental chart.
c) Itemized charges
d) Medical Certificate


Vision Claims:

You should submit:

Original bills and official receipts Original of Optometrist prescriptive lenses and frames Other supportive documentation (if available)

IMPORTANT NOTES:

If the claim documents are not sufficient for claim adjudication, Pacific Cross Health Insurance Pcl.or its administrators reserve the rights to request further information or a Notification of Claim Form from the claimant to facilitate the claim assessment process. All claims must be submitted to us within 90 days from the date of services rendered. All claims denied, if not contested within 6 months of the notification shall be considered accepted and the claim therefore close. As our computer system operates in English, you will receive reimbursement quicker if the claim documents are in English.