Page 85 - MEDICAL AND HEALTH INSURANCE
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MEDICAL AND HEALTH INSURANCE
2. REGISTRATION
Claim registration is one of the important transactions for insurance business. Claim
officer need to register the claim notification received within 7 working days from the
date notification received. Claim department need to issue acknowledgement letter
and request for full documents if there are incomplete documents. This is also to
ensure sufficient reserve is provided as per company's reserving policy.
3. FULL DOCUMENTATION REQUIRED AS PROOF OF CLAIMS
Insurance company needs a few documents such as claim form with medical report,
original invoices /bills and receipts, referral letter, if any and police report, if due to
motor vehicle accident.
4. CLAIMS ASSESSMENT PROCESS
Processes of claims against benefit entitlement using set parameters of the policy. It
needs further medical information if necessary. Insurance companies also need to
check the reasonable and customary charges. Insurance company will check if
premium has been settled, especially on group medical and health insurance policy
policies. After that, they will determine the liability and submit for payment approval.
5. PAYMENT
Payment normally issued by cheque and produced by financial department. Insurance
company will notify payee of the payment if via e-payment.
6. CLAIMS RECOVERY
It raises Debit note for recovery on non-guaranteed disability or non-eligible expenses
during hospitalization whereby guarantee letter was issued for the admission.
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