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Filing a medical claim

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Forms and documents you will need

Standard requirements
  1. Hospitalization and Reimbursement Claim form 

    Download Hospitalization and Reimbursement Claim form

  2. Attending Physician’s Statement

    Download Attending Physician's Statement - Hospitalization and Reimbursement Claim

  3. One (1) valid government-issued photo ID of the claimant

Additional mandatory requirements based on type of claim
  1. For Daily Hospital Income/Intensive Care Unit

    1. Hospital Statement of Account with admission and discharge date

    2. Clinical Abstract

  2. For Accidental Medical Reimbursement

    1. Incident Report/Police Report describing the accident

    2. Official receipts related to the treatment of the injury and within 30 days from date of accident

    3. Prescription of the medicines used during treatment

  3. For Surgical Expense Benefit

    1. Record of Operation

    2. Original official receipts for surgeon’s fee, anesthesiologist’s fee, operating room fee, and recovery room fee

  4. Other conditional requirements

    1. For Dengue

      1. Any of the following confirmatory laboratory test results on Dengue:

        1. Dengue Virus Antigen Detection (NS1); or

        2. Dengue IgM (MAC-ELISA); or

        3. Thrombocyte count less than 100,000/mm², with hospital confinement as shown by:

          • admission summary and discharge clinical abstract summary, and

          • duly certified statement of account of hospitalization

    2. For Typhoid

      1. The diagnosis must be confirmed by the Life Insured’s attending physician, accompanied by any of the following confirmatory tests for Typhoid and Paratyphoid Fever:

        1. Widal test for S typhi O values of more than or equal to 1/200;

        2. Stool, Urine, Blood or Bone Marrow culture to detect Salmonella enterica serotype Typhi (S. typhi), or value> 7 from the results of the tubex test; or

        3. Typhidot test

    3. For Measles

      1. The diagnosis must be confirmed by the Life Insured’s attending physician, accompanied by the following confirmatory test for Measles:

        1. Measles (Rubeola) IgM antibody

    4. For Malaria

      1. Peripheral smear for Malaria parasites (MP test)

        1. Measles (Rubeola) IgM antibody

    5. If the claimant is or the event happened outside the Philippine

      1. All forms and proofs of claim obtained outside the Philippines must be in English and apostilled or duly authenticated by the Philippine Embassy or Consul of the country where the event happened.

      2. Medical records from a hospital located abroad do not require authentication by the Philippine Embassy located in the foreign country. Apostille mark or stamp for medical records is accepted.

    6. If  the claimant is a legal entity

      1. Secretary’s Certificate confirming the board resolution authorizing the company representative.

      2. General Information Sheet.

      3. One (1) valid government-issued photo ID of the representative