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No reimbursement of outpatient claims if: Claim(s) submitted after 90 days from the date of consultation / visit. Insufficient of required information. Please send this completed claim form with attachment(s) to: Bank of China Group Insurance Co. Ltd. – Medical Insurance Dept. 9/F., Wing On House, 71 Des Voeux Road Central, Hong Kong.
GMD-CF/OP-2019-V00 團體醫療保險 Group Medical Insurance - 門診醫療索賠申請書Outpatient Benefit Claim Form 投保單位 Policyholder Name： 保單號碼 Policyholder Number： 受保員工姓名 Name of Employee: 所屬部門 Department : 受保員工編號 Insured
Claim(s) submitted after 90 days date of consultation / visit. Insufficient of required information. Please send this completed claim form with attachment(s) to: Bank of China Group Insurance Co. Ltd. – Health Insurance Dept. 9/F., Wing On House, 71 Des Voeux Road Central, Hong Kong. Customer Service Hotline: 3187 5100.
IMD-CF1-2014-V01 醫療保險 Medical Insurance --- - 門診醫療索賠申請書門診醫療索賠申請書Outpatient Benefit Claim Form 投保人單位 Policyholder Name ： 保單號碼 Policy Number ： 受保人姓名 Name of Insured Person 索償人姓名 (如不是受保人) ...
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nstructions. Subm mit claim form with orig ginal receipt(s), referraal letter (if applicable) a and all supporting docu uments to the Insu rance Company. Claim ms must be submitted tto the Insurance Comp pany within 90 days fro om incurred date / con nsultation. Receipt(s) will w not be returned unleess requested.
