Documents Typically Required by Insurers to Process a Claim

  • At the minimum a completed Claim Form (sometimes signed by the doctor) and the original hospital invoices with detailed breakdown.
  • Copies of prescription are often required and sometimes copies of the investigation reports.
  • Medical report for outpatient treatment, discharge summary for hospitalised patients are usually required. In case of surgery the Surgical Report is generally required
  • Some companies request the photocopy of patient’s ID card/passport and of the patient’s insurance policy

Exclusions from most insurance policies

  • Routine medical examinations and check-ups
  • Dental care
  • Vaccinations
  • Treatment by vitamins
  • Pre-existing and congenital conditions
  • Test or treatment of psychiatric, psychological, mental or nervous disorders
  • Pregnancy,
  • Infertility, sterilisation, contraception
  • Cosmetic procedures and plastic surgery
  • Investigation and treatment of refractive eye defects such as nearsightedness and astigmatism, including refractive eye surgery, spectacles, monocles and contact lenses
  • Venereal diseases and HIV/AIDS
  • Professional sports and motorised racing accidents
  • Sleep disorders, learning difficulties, behavioural or developmental disorders
  • Injuries arising from unlawful/criminal acts
  • Self-inflicted injuries
  • Addictive conditions/disorders and alcohol, drug and solvent abuse
  • Experimental or pioneering medical and surgery techniques.

Please note that this is just a general guide, and your policy may include additional exclusions. On the other hand, annual health checkups, dental care, vaccination and pregnancy care, etc. may be covered under your insurance plan. Please refer to your policy documents for a specific list of exclusions and inclusions.