Claim procedure information

A. Claim File

Medical claims

1. Direct Billing Services:

Please visit website at “Customer Center”– “Find A Medical Provider” or the link here to get the list of Direct Billing Facilities which provide Cashless Services to customers of Pacific Cross Vietnam;
Please show Coverage Card issued by Pacific Cross Vietnam and ID card (or Passport) when visiting Clinic/Hospital which is in the list of Medical Providers for Direct Billing Services;
Please complete page one of Notification of Claim form; check Invoice to ensure all information is accurate and sign on Invoice after receiving all services.
The application of direct billing services cannot be guaranteed by Pacific Cross Vietnam in every claim situation. Policy holders and policy members are advised when seeking medical treatment to have an alternative means of payment prepared in case direct billing services are unavailable. For more information on how direct billing services are administered, please contact us at inquiry@pacificcross.com.vn

2. Pay first & Claim back: A claim can be made with the following supporting documentation:

Notification of Claim form: completed by Claimant and Attending Physician;
Medical Report: completed by Attending Physician;
Copy of all lab tests reports;
Prescriptions;
Official original Receipts with detailed and breakdown of charges. For treatment in Vietnam where the invoice is over 200,000VND, a VAT invoice (red receipt) is a government requirement. In case a VAT invoice is not possible, we have to limit the claim reimbursement to a maximum of 200,000VND. This applies to all pay and claim situations, but not necessary when direct billing service is used. In case of an Electronic VAT Invoice, client must ask medical providers to convert e-invoices into paper. The valid converted VAT invoice requires such information as converter’s full name, signature, converted date, legal seller’s electronic signature and the invoice tittle must be “Hóa Đơn Chuyển Đổi Từ Hóa Đơn Điện Tử”.

Further documents may be required for claims involving Accidents / Alternative Treatments below:

Claims for accident:

Claims for Physiotherapy/ Chiropractice/ Accupunture/ Chemotherapy/ Radiotherapy:

Treatment Plan: completed by Attending Physician (as form);
Progress Report: completed by Attending Physician (when a new treatment plan is required after finishing the previous treatment plan).

In-patient Claim:

Note: Pacific Cross Vietnam may require further documents which is necessary for the claim to be processed and completed.

3. Dental claim (optional benefit):

Oral Examination Report: completed by Attending Physician/Dentist, required for submission of the first dental claim;
Dental Examination Report: completed by Claimant and Attending Physician/Dentist;
Official original Receipts with detailed and breakdown of charges.

4. Personal Accident claim (optional benefit):

Claim Form-Death: completed by Beneficiary;
Attending Physician’s Statement for Death Claim: completed by Hospital/Attending Physician giving details on the nature of the injury, extent and period of disability;
Police Report;
Official original Receipts with detailed and breakdown of charges;
Copy of Declaration of Death.

Travel claims: a claim file includes following documents:

Further documents will be required for following claims:

1. Claim for Baggage Delay:

2. Claim for Travel Delay:

Official Document from Carrier stated clearly the cause, date, time and duration of flight delay.

3. Claim for Personal Accident:

Policy Report;
Incident Report: completed by claimant;
Attending Physician’s Statement for Death Claim: completed by Hospital/Attending Physician giving details on the nature of the injury, extent and period of disability;
Copy of Declaration of Death.

4. Claim for Medical expenses:

B. Timelines for claim submission

Travel Claim: within 30 days from the policy expiry date;
Personal Accident Claim: as soon as possible and not exceed 45 days from the incurred date;
Healthcare Claim should be sent to us as soon as reasonably practicable and in any event we should be notified within 30-days of the loss or claim;
For additional documents submission this should be done within 90-days after a loss or claim is incurred;
Failure to submit a claim will not affect the claim if it was not possible or reasonable to submit it on time, in any event it must be submitted within 365 days or it will be disallowed.

C. TIMELINES FOR CLAIM RESPONSE:

Pacific Cross Vietnam will adjudicate the claim within 5 working days from the date of receiving all required documentation and information.

D. CLAIM PAYMENT:

In cash or by transfer in Vietnam Dong;
Claimant will show ID card or Passport to receive cash at our office;
Authorized person must obtain Authorized Letter and copy of passport of Claimant to receive claim payment.

E. REJECTION:

Denial letter will be sent to Claimant stating clearly the reason of rejection.

Any further questions, please contact us via:

inquiry@pacificcross.com.vn

(+84 28) 3821 9908