How to Make Claim

How to Make Claim

In order to enjoy a high level of service, together with efficient claims settlement, it is important to follow the correct procedures when making your claim. If you are unsure as to whether your condition will be covered by your health insurance plan, please contact one of our advisers before seeing your doctor.

Using your membership card at our network hospitals or clinics

If you are admitted to a hospital which is on our hospital list, tell them that you are a BUPA Health Insurance member and show them your membership card. The hospital will contact us by fax or telephone to recheck your cover and eligibility for benefit. Hospitals which recognize our card will send your bills directly to us for settlement. However, you will be asked to pay for any charges in excess of your benefit levels or any non medical expenses before you leave the hospital.

If you attend a hospital or clinic which is not on our list

If you attend a hospital or clinic not shown on our list you will normally be asked to pay your bills yourself. To obtain reimbursement, you will need to obtain a doctor’s certificate showing diagnosis of condition treated together with an itemized medical expenses bill, original receipt and copy of your membership card. You will also be required to submit the Attending Physician’s Report completed by your treating doctor for the case of hospitalization at non-network hospital. You can either post these to us or bring them to us in person at BUPA Health Insurance, 9^th Floor Q-House Convent Building, 38 Convent Road, Silom, Bangrak, Bangkok 10500 Tel. 0-2234-7755 ext. 835

For claims with no further investigation required will take not more than 7working days. Normally BUPA Health Insurance pays your claim by cheque. However, you may request for “Electronic Money Transfer” for claim reimbursement by filling the form available in this handbook. The completed form must be submitted to BUPA Health Insurance together with the full set of claim reimbursement document.

Remarks : Please note that the supportive documents for claim reimbursement must be submitted within 90 days after discharging from the hospital. After that time we cannot guarantee payment.

Points to remember when making a claim

· We will only pay for treatment you receive while you are a member of your company.

· Payment of your claim will be under the rules and table of benefits of the health insurance plan, subject to any changes agreed with the Policyholder that apply to you at the time you receive the treatment.

· We will only pay for treatment costs and expenses actually incurred by you.

· We will only pay eligible claims if the Policyholder has paid us all the premium due under the agreement.

· We do not have to pay a claim if you or your dependants are breaking any terms or conditions of your membership

· Copy of the receipt will not be accepted for claims reimbursement.

Charges

Please note that we will only pay if the charges are reasonable and customary. By reasonable we mean that the charges are not more than those normally charged by the majority of hospitals or clinics for such treatment or services. By customary we mean that the charges are ones that are normally made by the majority of hospitals or clinics and that they are appropriate to the diagnosis

Excess payments

In the unlikely event that you incur charges in excess of your benefits or the expenses are from ineligible benefits and you do not settle these directly with the hospital or in the event of the treatment for your pre-existing conditions that we are made aware later, we will invoice you separately. Failure to settle these charges within the due date specified in the invoice may result in the cancellation of your membership card.

Recovery

Enjoy your recovery in the knowledge that BUPA Health Insurance will provide prompt settlement of your claim. If you have any questions regarding your claim or your plan please contact one of our advisers who will be pleased to help.