Claim procedure information

A. Claim File
Medical claims
Instruction for claims process
1. Direct Billing Services:
  • Please visit website at “Customer Center”– “Medical Providers” 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:

Please kindly follow the instruction as below:

  1. Collect claim documents:

– Please kindly collect all required documents (*) as the end of this page.

  1. Send the claim documents to PCV via one of these below methods:

2.1. Send the image files:

–  Take a picture/ scan all the claim document with best quality image (**).

–  Send your claim pictures or scanned copy to claimsubmission@pacificcross.com.vn.

–  You will receive an auto-reply confirmed email immediately after that.

2.2. Send the claim document direct to PCV office (Hanoi, Ho Chi Minh) following the address at the bottom of this page.

  1. Receive claim’s result within 5 working days:

(after submitted fulfill claim documents and information as required)

– In the case your claim document does not have enough information/ documents, PCV will send an email to instruct you provide the additional information/ documents for completing the claims process.

——————————————————————————————————————

Notice:

(*) Below are the required documents for claim processing:

– Claim form: picture/ image/photocopy/scan file of claim form that fulfilled all information, signed and sent to PCV.

In case the claimant uses a foreign bank account or authorizes to receive money, please submit the original claim form to PCV

– Medical report/ Medical book/ Test result/ Treatment plan/ Doctor’s indication note: picture/ image/ photocopy.

– Discharge summary (for Inpatient case): picture/ image/ photocopy.

– Prescription: picture/ image/ photocopy.

– Breakdown of charges: picture/ image/ photocopy.

– Legal financial invoice sent to PCV:

+ The original VAT invoice and converted e-invoice in paper.

+ Non-converted e-invoice (.pdf) with code and link for searching.

– Other document(s) or information might be required in specific case.

(**) Pictures or scanned document must be in color and readable. Time of claims processing can be influenced if any file is not able to read. The claimant is asked to retake the clear version.

Please note: Pacific Cross Vietnam (PCV) has the right to re-adjudicate if information on hardcopy and the photo or image PCV received are not coincided.

*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.

A. Claims for Medical
  • Medical summary with relevant diagnosis and indication of treatment issued by registered physician
  • Surgery certificate (if surgery)
  • Discharge certificate (for in-day treatment or inpatient stay)
  • Discharge summary (for inpatient case) (if any)
  • Prescription with diagnosis given by physician;
  • Indication to do lab tests (if any)
  • All subclinical results (including: lab tests, imaging test, x-ray result, etc.) (if any)
  • Other related documents (if any)
PHYSIOTHERAPY/ OSTEOPATHY/ CHIROPRACTIC/ ACUPUNCTURE/ CHEMOTHERAPY/ RADIOTHERAPY
  • Treatment plan indicated by physician;
  • Progress note completed by physician (in case the doctor prescribes a new therapy after completing the previous treatment regimen, or after every 5 sessions)
B. Dental claim (optional benefit):
  • Oral examination report: completed by doctor/ dentist, applied for the first dental claim. This report will be waived if policy is continuously in-force at least 06 months.
  • Dental treatment report: completed by insured person and doctor/ dentist
C. Claims for Personal Accident:
  • Accident report issued by Police Office/ Conclusion of Police (for traffic accident);
  • Driver license/ Vehicle registration certificate (for traffic accident);
  • Minute site inspection (if any);
  • Incident report;
  • Injury certificate (for Disability cases);
  • Death certificate (for Death cases);
  • Autopsy report (for Death cases) (if any);
  • Legal inheritance papers with relevant support documents (for Death cases)
D. Travel claims: a claim file includes following documents:

CLAIMS DOCUMENT REQUIRED FOR TRAVEL PLAN Please inform us your claims and submit related documents via phone calls and email within 30 days from expiry date of Travel Policy Package.

General requirement for all travel benefits

  • Travel certificate;
  • Copy of Boarding Pass (if any);
  • Copy of all pages of Passport, Visa (if any);
  • Copy of air ticket booking (if any);
  • Information of reservation/ booking

Specific requirement for each benefit

  1. MEDICAL EXPENSES

As above – A part

  1. PERSONAL ACCIDENT

As above – C part

  1. BAGGAGE AND PERSONAL EFFECTS
  • Incident report (describe date and time, place, cause of loss/ damage) verified by carrier/ hotel/ local police department/ authorized organizations;
  • List of lost/ damage items (including details of description, specification, quantity, actual cash value and amount of loss or damage);
  • Confirmation in writing of carrier or other liable parties on amount recoverable;
  • Document to prove the value of lost/ damaged items (such as original invoices);
  • Original quotations/ invoices for preparation or replacement of the loss/ damage or re-issuance travel document (Passport, Visa) with relevant date of preparation/ replacement/ re-issuance;
  • Document to prove the replacement is essential

Note: Claimant must immediately report and loss/ damage to the proper authorities having jurisdiction at the place of loss or damages (within 24 hours)

  1. BAGGAGE DELAY
  • Travel itinerary;
  • Baggage Claim form (Property irregularity report from carrier);
  • List of emergency purchase of essential clothing and toiletries and original purchasing invoices;
  • Receipt of acknowledgement on returned baggage from the carrier

Note: only considered if the event took place overseas

 

  1. TRAVEL DELAY
  • Estimated schedule of original trip;
  • Breakdown report of the portion of the original trip that was not utilized;
  • Official document form carrier clearly stated the cause, date, time and duration of flight delay.

 

  1. CURTAILMENT OF TRIP/ CANCELLATION CHARGES
  • Estimated schedule of original trip;
  • Breakdown report of the portion of the original trip that was not utilized;
  • Official document form carrier clearly stated the cause, date, time and duration of flight delay;
  • Ticket purchase invoice (if any);
  • Invoice of any amount paid in advance (pre-paid) (if any);
  • Hotel invoice and statement for accommodation (if any);
  • Invoice of replaced vehicle for transportation (if any);
  • Medical report/ Death certificate/ Court report or Center for Disease Control and Prevention (CDC) and other related documents (if the cancellation comes from Death event/ severe illness or disability/ compulsory witness or isolated in pandemic);
  • Support document to prove relationship between the insured and the relatives (if any);
  1. PERSONAL LIABILITY
  • Report indicating the nature, time, place and circumstance of the incident or event;
  • Estimated claims amount and related document and contact information of any third party;
  • Contact details of the third party;
  • Written, summon or other notice of legal proceeding from any third party or lawyer (if any);
4. “Travel Delay/Mistransit” benefit:

 

  • Estimated schedule of original trip.
  • Information of reservation/ booking (flight information, time of departure, flight number, passenger name,…).
  • Notification from the carrier confirming date and time, duration and reason for the delay.
5. “Medical expenses/Personal accident” benefit:
  • Health record regarding claims of medical expenses/ personal accident (describe the nature and level of disabilities; time and duration of disabilities happen).
  • Appraisal of disabilities verified by authorized organizations.
  • Investigation report verified by Police Department (if any).
  • Death certificate (for Death event).
  • Tests result.
  • Surgery certificate (if treated by surgery).
  • Breakdown of medical charges.
  • Emergency Assistance fee such as ambulance… (accepted by Hung Vuong Insurance).
  • Other original invoices.
6. “Personal liability” benefit:
  • Report indicating the nature, time, place and circumstance of the incident or event.
  • Estimated claims amount.
  • Related document and contact information of any third party.
  • Writting, summon or other notice of legal proceeding from any third party or lawyer (if any).
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: