Forms and documents you will need
Medical claim basic documentary requirements
Claimant Statement
Download the Claimant Statement
Policy Contract
The policy contract consists of the Application for Insurance, the Policy Data Page, the Sales Illustration Form and Policy Booklet.
Two (2) valid identification cards of INSURED
Two (2) valid identification cards of POLICYOWNER
Two (2) valid identification cards of BENEFICIARY/IES
Medical records
Admission and Discharge Summary, Clinical Summary and Abstract, Patient History Sheet
Attending Physician Statement
Download the Attending Physician Statement Form
Accidental Medical Reimbursement
1. Incident report for minor incident
The statement should be from the insured or any witness/witnesses to the incident.
2. If major accident:
-
Certified true copy of the Final Investigation report of Police Authorities or NBI;
-
Original or certified true copy of Sworn Statement or Affidavits on file of at least two witnesses to the incident or Affidavit of at least two persons cognizant of the circumstances surrounding the Insured’s violent death;
-
Certified true copy of Medico-Legal Report/Autopsy Report, if any;
-
Driver’s license and vehicle registration if the Insured was driving a vehicle at the time of death;
-
Duly certified copy of the criminal Complaint filed in court, if any; or
-
Fiscal’s Resolution, if any.
3. Original official receipts related to the treatment of the injury and photocopy of the prescription
This should cover the expenses incurred within 30 days from the date of the accident
Hospital Income
Hospital Statement of Accounts
The statement must show admission and discharge date and time.