CLAIMS FOR REIMBURSEMENT

The claims for reimbursement shall apply in emergency cases, whether out-patient or in-patient, rendered in non-accredited Hospitals.

Filing of Claims
All claims for reimbursement must be filed using the prescribed claim form (downloadable) and submitted to HC&D Offices within thirty (30) days from the date of availment for out-patient cases, or from date of discharge for in-patient cases.

Required documents when filing for a reimbursement claim:
Admission/Confinement

• Original Official Receipt(s) of Professional Fees
• Original Official Receipt(s) of Hospital Bill
• Hospital Statement of Account (SOA) where member was confined or treated
• Individual charge slips or itemized breakdown of charges to support Hospital SOA
• Admitting history report/Clinical Abstract to be obtain from the Medical Records Section of the Hospital

Out Patient

• Original Official Receipt(s) of Professional Fees
• Original Official Receipt(s) of Hospital Fees
• Copy of Doctor’s request (for the diagnostic test)

For Surgical cases (additional  if applicable)

• Operative report and Histopathological report

Payment of Claims
All benefits that pertain to a Member will be paid by check to the order of Principal Member, unless the Principal Member requests otherwise, or HC&D, in its discretion, considers it preferable to make the payment in another manner. In case of death of a Member, any benefit due but remaining unpaid shall be paid to the first surviving class of the following classes of successive preference of beneficiaries: the Member’s (a) widow or widower; (b) surviving children; (c) surviving parents; (d) surviving brothers and sisters; and, (e) executors or administrators.