We have prepared the following guidelines, in order to assist you when filing a claim.


 

Hospitalization

In the event of a planned admission to a hospital on an In-Patient or Day Patient basis, the following steps should be taken. If you fail to follow these conditions, you will be liable to pay a co-insurance share of 25 per cent of the cost of treatment and hospital services incurred.

  • Contact our Medical Helpline at least three working days prior to admission, giving full details of the condition, proposed Treatment (including dates and names of procedure if know) together with the name of the Specialist and Hospital details.
  • The Claims Helpline will advise you if they have sufficient information to confirm the cover. If not, they will advise you what further information is required.
  • The Claims Helpline will verbally confirm your cover.
  • The Claims Helpline will make arrangements with the Hospital for all eligible bills to be settled directly.

Note: In the case of hospital charges guaranteed by us prior to you or your dependants receiving treatment, the Policyholder agrees to reimburse us with the amount of the deductible and any coinsurance specified in the Certificate, at the time we are required to guarantee such hospital charges.

Emergency Hospitalization

In case of an emergency, if you or your dependants are physically prevented from contacting us immediately, you or your dependants or someone designated by you or your dependants must contact our claims helpline within 48 hours. Please give us the telephone, fax or telex number where we can contact you or your dependants or leave messages at any time of day and night. You or your dependants must make no admission, offer, promise or payment without our prior consent. We must be telephoned first. If you fail to follow these conditions, the reimbursement amount will be reduced by 25% for the treatment and hospital services incurred.

Outpatient

If you go to a medical provider inside our direct billing hospital network and show your medical card and ID card to the medical provider, you only need to pay the deductible and co-payment by yourself, and the other expenses will be directly settled between us and the hospital. Please contact our claim helpline before visiting a doctor to ensure that whether the hospital is within our direct billing hospital network.

If you go to a medical provider outside direct billing hospital network, you must pay all the costs in full at the time of receiving the treatment, and then submit a claim to us for reimbursement.

Pre-authorization

Involving one or more of the following situations, you must bear in mind that to comply with the terms and conditions of the insurance we must be contacted 48 hours in advance for our pre-authorization before the situation:

  • Hospitalization admissions;
  • Outpatient surgeries;
  • Outpatient tumor treatments;
  • Kidney failure and peritoneum outpatient dialysis;
  • Accidental dental treatment (for accidentally damaged, untreated and original teeth);
  • Amniocentesis (for pregnant women under 35 years old); - Home nursing care;
  • Other procedures including CT, PET-CT, MRI, Stereotactic Conformal Radiotherapy Gamma Knife (r-knife) for brain surgery;
  • Purchase or rental of crutches, walkers, wheelchairs and basic orthopaedic prostheses and equipment;
  • Any scheduled procedures or any series of treatments or treatments which requires 2 or more treatment sessions /consultations.

CLAIM AND MEDICAL HELPLINES 24 HOURS A DAY, 365 DAYS A YEAR IF YOU REQUIRE HOSPITALIZATION, OUTPATIENT, PRE-AUTHORISATION, CLIAM CONSULTATION, EMERGENCY MEDICAL TRANSFER, PRE-AUTHORISATION OF EXPENSES, REFERRAL TO A MEDICAL PRACTITIONER OR A HOSPITAL OR HAVE ANY OTHER CLAIMS QUERY, PLEASE CALL The claim and medical helpline on: +86 10 51297575 Alternatively fax us on: +86 10 8451 1175 or Email us at: china@euroalarm.com.cn

You'd better take the claim form with you when you go to the hospital. Please ensure that a claim form is fully completed by you or your dependants and the treating physician. Submit this with the original receipts and all other information supporting your claim, including but not limited to x-rays, test results, medical reports etc. If the treating physician reluctantly fills the claim form, you should submit the record of medical history. You should mail your claims to the following address:
Euro-Alarm (Beijing) Co., Ltd.
8/F, Bld. C, East Lake Villas,
35 Dongzhimenwai Dajie,
Dongcheng District,
100027 Beijing, P.R.China

The details of claim procedure please see Policy Wording of TaiPing Worldwide Group Health Plan（2007）.