Accident & Health

A. Hospital Income/Daily Benefit Claims
(DM’s; HCP & GHIX)    

1.	Duly accomplished claim form (Accident & Sickness Proof of Loss Form)
2.	Detailed statement of account
3.	Preferably with CTC (Certified True Copy) of Admitting History
4.	CTC Discharge Summary
5.	Official Receipts of Surgeon’s Fee (if there is coverage of surgical benefit under his/her policy and there is a surgical operation done)

B. Medical Expense Reimbursement Claim
(PA, HE, MM, & GAHI)

1.	Duly accomplished claim form.
2.	Original copy of medical bills (itemized charge slips and professional fees included) and receipts
3.	Official report pertinent to the accident i.e. police report; accident report; etc. if any
4.	Emergency room record
5.	All medical results pertaining to the accident
6.	Prescription of medicines

C.  Disability Claim (PA)

1.	Duly completed claim form.
2.	Certified true copy of admitting history.
3.	Supplementary Medical Report (SMR) indicating physician’s prognosis and time of disability.

D.  Dismemberment Claim (PA)

1.	Duly completed claim form.
2.	Official accident report (e.g. police report; inter-office; accident report; newspaper clippings, etc.)
3.	Certified true copy of admitting history and operating room record (if any)

1.	Duly completed claim form
2.	Duly registered death certificate
3.	Duly registered of birth certificate of the insured
4.	Autopsy Report/Medico Legal statement
5.	Official police report and other related report i.e., interoffice accident report, newspaper clippings, etc
6.	Affidavit of witness/es.
7.	Available photos taken at incident scene.
8.	Proof of relationship of the beneficiary (such as marriage contract, birth certificate, baptismal and etc.)

F. Travel Inconvenience

1.	Letter from Card Member describing situation and related expenses (all claim)
2.	Property Irregularity Report (luggage loss/delay)
3.	Letter from Airline confirming delay (flight delay/missed flight)
4.	Record of charge used for purchase of Airline ticket
5.	Statement of Account where charge for Airline ticket appears and/or Airline ticket
6.	Record of charge forms and receipts for expenses incurred (all claim)