MEDICAL CLAIMS

Submit duly executed claim form within 30 days from date of service containing the following;

  Name, membership number of client and facility visited

  Reason for seeking reimbursement (since services can be authorized directly by provider without having to pay)

  Bank details.Detailed medical report (for inpatient cases)

  In case it’s a last expense/funeral claim, a copy of burial permit/death notification form will be required

  For reimbursements of overseas claims, letter of approval is normally issued prior to the services and hence a copy of that letter should be attached

  Itemized hospital bill will be required (for inpatient cases)

  Original invoices and receipts of payment made (please keep copies)

MEDICAL CLAIMS

Submit duly executed claim form within 30 days from date of service containing the following;

  Submit duly executed claim form within 30 days from the date of loss ensuring that you answer all questions accurately and provide supporting document(s) as requested for claim processing

  Ensure you provide a detailed description of the incident, loss, accident or illness, including Name of Payee if different from the Policy Holder or Claimant. Take note that issuance of claim form should not be construed as an admission of Liability

  We reserve the right to request for additional information

  By submitting Claims Form to Assemble, you declare that all the particulars stated in the form and document(s) attached in support thereof are true and correct, that no information relevant to this claim has been withheld and that all conditions and stipulations of the policy have been complied with