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How to file a claim successfully

IMPORTANT NOTICE:
  • You must bring with you a notification of Inpatient/Outpatient Claim Form to be signed by the attending Physician
  • You must inform us as soon as possible when you going to have an elective surgery or if you are in an emergency
  • All claims must be submitted within 90 days from the date of services rendered, otherwise your claim will be rejected.

How to reach Claims and Emergency contacts

Filing a claim

Outpatient claims
Please submit al original bills together with official receipts or the scanned copies and make sure the following information/documents is/are included:

a) "Notification of Inpatient/Outpatient Claim Form" with Name of patient, Member No. and Policy No.
b) Doctor/Service provider name and address including the country where service was rendered
c) Date of treatment/visit with diagnosis or name of injury
d) Detailed breakdown of charges/services with actual charges paid with official receipts
e) Referral letter by the Attending Physician for physiotherapy, diagnostic laboratory tests, x-rays and prescribed medicine is required

Note: Photocopies or computer printouts furnished by your service provider will not be accepted. For U.S.A. service provider, HCFA-1500 Forms with doctor's signature will be accepted
Claims for Physiotherapy / Chiropractics / Acupuncture / Chemotherapy / Radiotherapy
Please enclose the following documents to you claim

- Treatment Plan Form: completed by Attending Physician (as form)
- Progress Report: completed by Attending Physician (when a new treatment plan is required after finishing the previous treatment plan).
Dental claims
Please submit:
a) Original bills and official receipts or the scanned copies
b) A completely filled in "Dental Claim Form". The dentist is required to mark the area of oral treatment on the dental chart
c) Itemized charges
d) A completed oral examination report is required for submission of the first dental claim
Direct billing claims
Please visit Medical Provider Network to get the map of Direct Billing Facilities which provide Cashless Services to customers of Pacific Cross Insurance.

Remember: show a valid Coverage Card issued by Pacific Cross Insurance and photographic ID (or Passport) when visiting a Clinic/Hospital which is in the list of Medical Providers for Direct Billing Services.

Please complete page one of the Notification of Claim Form; request a chance to check your Invoice to ensure all information is accurate and, if possible, sign the Invoice after receiving all medical services.
Hospital claims
Please submit al original bills together with official receipts or the scanned copies and make sure the following information/documents is/are included:

a) Acompletely filed in "Notification of Inpatient/Outpatient Claim Form"
b) Name of patient, Member No. and Policy No.
c) Date of hospital admission and discharge
d) Diagnosis of disability requiring the hospitalization and name of surgical procedures performed (if any)
e) Itemized charges/detailed breakdown of charges
Personal accident claims
Please submit:
a) Original bills and official receipts or the scanned copies
b) Hospital/Physician's reports giving details on the nature of the injury and the extent and period of disability, police report where relevant and if death shal have resulted, a completed "Calmi Form - Death", "Attending Physician's Statement for Death Claim", a copy of the death certificate and the relevant coroner's report
Death claims
Discharge Certificate. Note:
Pacific Cross Insurance may require further documents which is necessary for the claim to be processed and completed.
- Death Claim Form: completed by the Beneficiary
- Attending Physician’s Statement for Death Claim, completed by Hospital/Attending
- Police Report
- Official original Receipts with detailed and breakdown of charges.
- Copy of Declaration of Death or Death Certificate.
Travel claims
Travel Claims: A claim file includes following documents:Travel claim form: completed by Claimant;Travel Certificate;Boarding Pass;Copy or scan of all pages of Passport;Copy of air ticket booking;Official original Receipts with a detailed breakdown of charges.Further documents will be required for the following claims:

1. Claim for Baggage Delay:
Irregularity Report;Luggage Delivery Report;Official original Receipts with a detailed breakdown of charges.

2. Claim for Travel Delay:An Official Document from the transportation Carrier clearly stating the cause, date, time and duration of the flight delay.

3. Claim for Personal Accident:Police Report;Incident Report: completed by claimant;Attending Physician’s Statement for Death Claim: completed by Hospital/Attending Physician giving details on the nature of the injury or the extent and period of disability;Copy of Declaration of Death or Death Certificate

4. Claim for Medical expenses:Medical Report: completed by Attending Physician;Copy of all lab tests and or reports;Prescriptions;Official original Receipts with a detailed breakdown of charges.

Note: Pacific Cross Insurance may require further documents which is necessary for the claim to be processed and completed.
Timelines for claim submission
Timelines for claim submission:

- Travel Claim: within 30 days from the policy expiry date
- Personal Accident Claim: as soon as possible and not exceed 45 days from the incurred date
- Health insurance claims should be sent to us as soon as reasonably possible and in any event notification of a claim should be given within 90 days of the loss or incursion of expense.

Failure to submit a claim will not affect the claim if it was not possible or reasonable to submit it on time, in any event claims must be submitted within 365 days of loss or incurred date in order to be accepted by the company.

Timelines for claim response: Pacific Cross Insurance will adjudicate claims within 5 working days from the date of receiving all required documentation and information.
Claim payment & rejection
Claim payment: By transfer in US$. Local currency reimbursement is available in some territorries, but cannot be guaranteed.

For scanned and imaged copies of claim files, please send to
claimsubmission@pacificcross.com
For any further question or clarifications, please contact us via inquiry@pacificcross.com
Self-payment & claim
A claim can be made with the following supporting documentation:

- Notification of Claim form: completed by Claimant and Attending Physician
- Medical Report: completed by Attending Physician;Copy of all lab tests and/or reports Prescriptions
- Official original Receipts with an itemized or detailed breakdown of charges.

This applies to all pay and claim situations, but is not necessary when direct billing service is used.

Further documents may be required for claims involving Accidents or Alternative Treatments. See details below:
IMPORTANT NOTICE:

As our computer system operates in English, you will receive reimbursement quicker if the claim documents are in English.

If the claim documents are not sufficient for claim adjudication, Pacific Cross Insurance Company Limited or its Third Party Administrator reserves the rights to request for the original documents in case the scanned copies are received or further information or a "Notification of Inpatient/Outpatient Claim Form" from the claimant to facilitate the claim assessment process.

Help, Assistance

You need help and guidance, click on it

As part of the enrollment with your insurance coverage, an Insured Person has access to emergency medical services:

To access the assistance program, simply call the numbers of the Operation Center listed on the Insurance Coverage Card. The Company is responsible for the cost of all assistance services on the provision that the services are provided and or arranged by Pacific Cross Insurance (hereinafter called “PCI”). PCI will answer the phone call 24/7/365 and based on the need will provide the services and consultations needed, either directly or through an International Emergency Services Assistance Company, currently EMA Global. PCI uses an international professional Emergency Assistance Services company to ensure the services rendered are of the highest international level of professionalism and quality, to ensure the expertise is medically sound and verifiable. The services can be given in any language anywhere in the world.

Scope of services


Medical assistance

Telephone Medical Advice

PCI will arrange for the provision of medical advice to the Insured Person over the telephone.

Medical Service Provider Referral

PCI shall provide to the Insured Person, upon request, with the name, address, telephone number and, if available, office hours of physicians, hospitals, clinics, dentists and dental clinics (collectively “Medical Service Providers”). PCI shall not be responsible for providing medical diagnosis or treatment.

Although PCI shall make such referrals, it cannot guarantee the quality of the Medical Service Providers and the final selection of a Medical Service Provider shall be the decision of the Insured Person. PCI, however, will exercise care and diligence in selecting the Medical Service Providers.

Arrangement of Hospital Admission

If the medical condition of the Insured Person is of such gravity as to require hospitalization, PCI will assist such Insured Person in the hospital admission.

Monitoring of Medical Condition During and After Hospitalization

PCI will monitor the Insured Person’s medical condition during and after hospitalization, subject to any and all obligations in respect of confidentiality and relevant authorization.

Delivery of Essential Medicine

PCI will arrange to deliver to the Insured Person essential medicine, drugs and medical supplies that are necessary for an Insured Person’s care and/ or treatment but which are not available at the Insured Person’s location. The delivery of such medicine, drugs and medical supplies will be subject to the laws and regulations applicable locally. The Insured Person is responsible for any delivery costs incurred.

Delivery of Essential Medicine

PCI will arrange to deliver to the Insured Person essential medicine, drugs and medical supplies that are necessary for an Insured Person’s care and/ or treatment but which are not available at the Insured Person’s location. The delivery of such medicine, drugs and medical supplies will be subject to the laws and regulations applicable locally. The Insured Person is responsible for any delivery costs incurred.

Guarantee of Medical Expenses Incurred during Hospitalization

PCI can assist the Insured Person by guaranteeing on behalf of the Insured Person medical expenses incurred during an Insured Person’s hospitalization when the hospital expenses exceed US$2,500.

Arrangement of Emergency Medical Evacuation (covers actual cost)

PCI will arrange for the provision of air and/or surface transportation, medical care during transportation, communications and all usual ancillary services required to move the Insured Person to the nearest hospital where appropriate medical care is available.

PCI will arrange for the provision of appropriate communication and linguistic capabilities, mobile medical equipment and medical escort crew.

Arrangement of Medical Repatriation

PCI will arrange for the return of the Insured Person to the Country of Residence following the Insured Person’s Emergency Medical Evacuation and subsequent hospitalization outside Country of Residence.

PCI will arrange for the provision of appropriate communication and linguistic capabilities, mobile medical equipment and medical escort crew.

Arrangement of Transportation of Mortal Remains

Based on the specific plan you have the schedule of benefits will outline the mortal remains provision. For those plans that have this mortal remains benefit, PCI will arrange for the transportation of the Insured Person’s mortal remains to the airport of the Country of Passport or Country of Residence.

Arrangement of Compassionate Visit (covers one economy class return airfare)

PCI will arrange for one economy class return airfare for a relative or a friend of the Insured Person wishing to join the Insured Person who, when traveling alone, is hospitalized outside the Country of Residence for more than five (5) days.

Arrangement of Return of Minor Children (covers one-way economy class airfare)

PCI will arrange for one-way economy class airfares for the return of minor children below 16 years old to the Country of Residence if they are left unattended as a result of the accompanying Insured Person’s hospitalization or Emergency Medical Evacuation. Escort will be provided, when necessary.

Arrangement of Accommodation (covers US$150 per day up to maximum of 5 days)

PCI will arrange for the hotel accommodation of the Insured Person related to an incident requiring Emergency Medical Evacuation, Emergency Medical Repatriation or hospitalization before the Insured Person is fit to fly.

In case an Insured Person is traveling 150km away from Place of Residence for no more than 90 consecutive days; and traveling not for the purposes of obtaining or seeking any medical or surgical treatment, the Insured Person has access to emergency travel assistance services:


Travel assistance

Inoculation and Visa Requirement Information

PCI shall provide information concerning visa and inoculation requirements for foreign countries, as those requirements are specified from time to time in the most current edition of World Health Organization Publication “Vacation Certificates Requirements and Health Advice for International Travel” (for inoculations) and the “ABC Guide to International Travel Information” (for visas). This information will be provided to the Insured Person at any time, whether or not the Insured Person is traveling or an emergency has occurred. PCI shall inform the Insured Person requesting such information that BCV is simply communicating the requirements set forth in a document and PCI shall name the document.

Interpreter Referral

PCI will provide the names, telephone numbers and, if possible and requested, hours of opening of interpreters’ office in foreign countries.

Although PCI shall make such referrals, it cannot guarantee the quality of the service provider and the final selection of a service provider shall be the decision of the Insured Person. PCI, however, will exercise care and diligence in selecting the service providers.

Delay/Lost Luggage Assistance

PCI will assist the Insured Person who has lost his/her luggage while traveling outside the Country of Residence by referring the Insured Person to the appropriate authorities involved.

Lost Travel Document Assistance

PCI will assist the Insured Person who has lost his/her passport while traveling outside the Country of Residence by referring the Insured Person to the appropriate authorities involved.

Legal Referral

PCI will provide the Insured Person with the name, address, telephone numbers, if requested by the Insured Person and if available, office hours for referred lawyers and legal practitioners. PCI will not give any legal advice to the Insured Person.

Although PCI shall make such referrals, it cannot guarantee the quality of the service provider and the final selection of a service provider shall be the decision of the Insured Person. PCI, however, will exercise care and diligence in selecting the service providers.

Embassy Referral

PCI shall provide the address, telephone number and hours of opening of the nearest appropriate consulate and embassy worldwide.

In the event of strikes, war, terrorist activities or other social unrest, adverse weather conditions, geological upheavals, the Company and PCI will try to assist but no obligation is assumed under the policy terms and conditions.

Please refer to the Policy Document for details of exclusion.

Guarantee of Payments (GoP)

GOP Procedure:

Submitting required document and information

  • Submitting required document and information:
  • A Notification of Claim Form completed by client and attending physician;
  • A medical assessment report from the attending physician showing diagnosis, medical history, and recommended treatment;
  • Estimated length of stay; Estimated cost;
  • A copy of the Insurance Coverage Card showing the name and policy number;A copy of passport.

Waiting for the Company to issue GOP:

  • After receiving all required document and information, we will respond for a GOPs.

Claim procedure:

  • After giving service to the client, kindly provide us:
  • Original Notification of Claim Form completed by client and attending physician;
  • An operation report;
  • A discharge certificate;
  • Copy of GOP;
  • Original official receipts with detailed breakdown of charges.

Important information:

  • All documents from health care providers have to be on letterhead of the hospital/clinic;
  • Once receiving the necessary forms and clarification, we try and process the claim in 5-working days;
  • Claims are reimbursed by cash or by bank transfer;
  • Pacific Cross Insurance is not responsible for any charges assessed by the banking institutions and this is the client’s responsibility.
Emergency hotline
In case of a situation where the clinic or hospital feels an emergency evacuation may be necessary, it is a requirement to involve our emergency assistance company by using the phone number at the back of the Insurance coverage card.
Hotline for emergency Evacuations:
(+852) 2807 1728
For less urgent, general requests, please call
(+852) 2573 2535 or contact us.