a. If you are under one of our standard International Healthcare Plans, the general claiming procedure described in these FAQswill apply to most treatments. However we may ask you to submit additional documents (i.e. Medical reports or prescription) when claiming for certain benefits.
When is a medical report needed?
You will be asked to attach a medical report when you claim for:
- Doctor’s Visit -Psychiatry Consultation
- Doctor’s Visit - Psychotherapy Consultation
- Doctor’s Visit - Cancer Consultation
- Doctor’s Visit -Speech Therapy
- Doctor’s Visit -Oculomotor Therapy
- Doctor’s Visit - Occupational Therapy
In addition, you’ll also be asked to provide a medical report, X-rays and your treatment plan when claiming for orthodontic treatment.
When are prescriptions needed?
You will be asked to attach your prescription when you claim for:
- Medication and Medical Aids - Medication
- Medication and Medical Aids - Maternity Medication
- Medication and Medical Aids - Vitamins and minerals
- Medication and Medical Aids - Cancer Medication
- Optical - Contact Lenses
- Optical - Glasses
- Maternity Expenses - Maternity Medication
- Cancer Treatment - Cancer Medication
When is a Tax invoice needed?
We will need a tax invoice to process your claim if the treatment you are claiming for took place in China, Brazil or Italy. This tax invoice is the “Fa Piao” in China, “Bollo” in Italy and “Nota Fiscal” in Brazil. But don’t worry – we will let you know if these are required when you submit a claim on MyHealth app or portal.
b.What do I need to consider when claiming for maternity expenses?
The claiming procedure applicable to your policy will be described in your Benefit Guide.
If you are under one of our standard International Healthcare Plans, thegeneral claiming proceduredescribed in these FAQswill apply to pre-natal care claims too, where pre-natal care is included in your cover.
For the delivery, however, you will need to obtain our pre-approval via submission of a Treatment Guarantee Form (available here). Please complete and submit it 4-6 weeks before the estimated delivery date to allow our Medical Team to confirm cover and arrange for direct billing (where possible) with your medical provider of choice.
In case of an emergency, don’t worry: just obtain your medical assistance and call us within 48 hours of the emergency, to inform us of the hospitalisation. We can get the Treatment Guarantee Form details over the phone when you (or your medical provider, or a family member – if you are unavailable to talk on the phone) call us.
Please note that we may decline your claim if pre-approval is not obtained: full details of our Pre-Approval process can be found in your Benefit Guide.
You can access your Benefit Guide via MyHealth Digital Services. Simply login via browser or use the MyHealth app, click on “My Policy” and select your Benefit guide in your “Documents” tab.
c.What do I need to consider when claiming for orthodontic treatments?
The claiming procedure applicable to your policy will be described in your Benefit Guide.
If you are under one of our standard International Healthcare Plans, thegeneral claiming procedure described in these FAQs will apply to orthodontic claims too, where orthodontic treatment is included in your cover.
Please note that we will only reimburseorthodontic treatment that meets the medical necessity criteria described below. As the criteria is very technical, please contact us before starting treatment so we can verify if your treatment meets the criteria.
Medical necessity criteria:
- Increased overjet > 6mm but <= 9 mm
- Reverse overjet > 3.5 mm with no masticatory or speech difficulties
- Anterior or posterior crossbites with > 2 mm discrepancy between the retruded contact position and intercuspal position
- Severe displacements of teeth > 4
- Extreme lateral or anterior open bites > 4 mm
- Increased and complete overbite with gingival or palatal trauma
- Less extensive hypodontia requiring pre-restorative orthodontics or orthodontic space closure to obviate the need for a prosthesis
- Posterior lingual crossbite with no functional occlusal contact in one or more buccal segments
- Reverse overjet > 1 mm but < 3.5 mm with recorded masticatory and speech difficulties
- Partially erupted teeth, tipped and impacted against adjacent teeth
- Existing supernumerary teeth
In addition we will only reimburse the cost you incurred after treatment has taken place.
This means that, if you are paying for your orthodontic treatment in instalments, you can submit your claims monthly or quarterly (depending on the payment frequency you have agreed with your medical provider).
Please make sure that the invoice includes a description of the treatment received and the treatment dates for the period invoiced.
You will need to send us some supporting information to show that your treatment is medically necessary and therefore covered by your plan. The information we ask for may include, but is not limited to:
- A medical report issued by the specialist, stating the diagnosis (type of malocclusion) and a description of the patient’s symptoms caused by the orthodontic problem.
- A treatment plan showing the estimated duration and cost of the treatment and the type/material of the appliance used.
- The payment arrangement agreed with the medical provider.
- Proof of payment of the orthodontic treatment.
- Photographs of both jaws clearly showing dentition before the treatment.
- Clinical photographs of the jaws in central occlusion from frontal and lateral views.
- Orthopantomogram (panoramic x-ray).
- Profile x-ray (cephalometric x-ray).
- Any other document we may need to assess the claim.
You will find the “Orthodontic treatment” definitions and any applicable exclusions in your Benefit Guide, if you wish to check the level of cover provided to you under your policy.
You can access your Benefit Guide via MyHealth Digital Services. Simply login via browser or use the MyHealth app, click on “My Policy” and check your Benefit guide under the “Documents” tab.
d.What do I need to consider when claiming for “In-patient cash benefit”?
If this benefit is included in your policy,it is payable when you receive inpatienttreatment for a medical condition that is covered by us but is free of charge for you, i.e. when the full cost of your treatment is funded by your national health service and noclaim is made or paid by us under any section of this policy. In-patient cash benefit is limited to the amount specified in the Table of Benefits and is payable after you are discharged from hospital.
To claim the “In-patient cash benefit”, please follow thegeneral claiming proceduredescribed in the question above regarding “How do I claim for medical expenses that I have already paid for to my medical provider?"
Note that you also need to attach your admission/discharge notice from the hospital when you send your claim to us (via MyHealth Digital Services).The admission/discharge notice must specify the number of nights spent in the hospital and the treatment received and it must confirm that the treatment received was free of charge.
e.How quickly will I be reimbursed for eligible out-patient treatment?
Please note that the claiming process (including our Service Level Agreement) may vary depending on the product available to you and on the type of insurance contract. We therefore advise you to check your Benefit Guide to confirm the claiming process applicable to your policy.
For example, if you are covered under one of our standard International Healthcare Plans, (and as long as your claim is submitted with all relevant details, documentation, invoices and receipts within six months after the end of the Insurance Year) we will aim to process your claim within 48 hours.
Please note that without the diagnosis, we cannot process your claim promptly, as we will need to request these details from you or your doctor. To help us processing your claim in the quickest time possible, please ensure to include the diagnosis, an eligible copy of each invoice and any supporting documentation on your claim.
You can submit your claims via MyHealth Digital Services online or via app and then follow the status of your submitted claims by logging in to your account.
Please note that we will email or write you to advise when your claim has been processed; if you have submitted your claim via post or email, we will also include a settlement letter and a Statement of Accounts.
Payment instructions are sent to our bank at the same time of claim processing, but please note that it can take up to 10 working days for the payment to reach your bank account (as this depends on the bank’s international transaction timelines).
