Admin

2012

6pg

(Inpatient or Outpatient)

★ You will only need to file for reimbursement if you seek treatment as a Private Patient and pay up front, versus seek treatment as an HMO Patient and not pay at all, because:

★ 1) you want to be treated by a non-accredited doctor; and/or★ 2) you want to be treated in a non-accredited hospital/clinic.

★ To get reimbursed, fill out the proper claim form, complete all the requirements, and submit all the documents.

★ For pick-up of your claims documents in Manila, please call Lala (888-0001 ext. 835).

★ Outside Manila, please send via LBC to:

GRA (attention: Purple Cow) 15/F Chatham House, Salcedo Village,

Makati City

★ The standard wait period for reimbursement of claims is fifteen (15) working days.

ReimbursementReimbursement

Submit accomplished ‘Out-Patient Claim Form’

To be accomplished & signed by the Employee AND the attending physician

To be submitted to HR

ORIGINAL of the following should be submitted:

Official Receipt(s);

Prescription for the diagnostic test(s);

Medical Certificate in the absence of Out-Patient Claim Form but insured still has to accomplish the Out-Patient Claim Form

OutpatientOutpatient Claim Checklist Claim Checklist

★ Submit accomplished ‘Hospitalization Claim Form’✔ Part 1 - by the insured

✔ Part 2 - by the authorized HR officer

✔ Part 3 - by the ATTENDING physician

★ ORIGINAL of the following should also be submitted:✔ Official Receipt(s) bearing ‘BIR Permit

Number’ ✔ Hospital bills, ✔ Professional Fee(s)✔ Medicines bought outside the hospital but were

consumed during confinement

✔ Statement of Account (SOA)✔ Itemized list of expense, Charge Slips

✔ Police Report, when necessary

InpatientInpatient Claim Checklist Claim Checklist