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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 This email address is being protected from spambots. You need JavaScript enabled to view it.
       
  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:

    • Police Report (for traffic accident);
    • Incident Report: completed by Claimant (for all other accidents);

    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:

    • Discharge Certificate.

    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: 

CLAIMS DOCUMENT REQUIRED FOR TRAVEL PLAN
Claimant please inform us your claims via phone calls or email within 30 days from expiry date of Travel Policy Package.
GENERAL DOCUMENT
  • Fulfilled claims form.
  • Travel Certificate.
  • Health Insurance Card (if applied).
  • Copy of full Passport, Visa.
  • Copy of Boarding Pass.
  • Information of reservation/booking.
SPECIFIC DOCUMENT
  1. “Baggage and personal effects” benefit:
  • Incident report (describe date and time, place, cause of loss/damage) verified by carrier/local Police Department/authorized organizations. Claimant must immediately report and loss/damage to the proper authorities having jurisdiction at the place of loss or damages (within 24 hours).
  • Confirmation in writing of carrier or other liable parties on amount recoverable.
  • List of lost/damage items, including details of description, specification, quantity, actual cash value and amount of loss or damage.
  • Document to prove the value of lost/damaged items (such as original invoices).
  • Original quotations/invoices for preparation or replacement or re-issuance (Passport, Visa) with relevant date.
  • Document to prove the replacement is essential.
  1. “Baggage delay” benefit:
  • Travel itinerary.
  • Property irregularity report from carrier (Baggage Claim form).
  • 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. “Curtailment of trip/Trip cancellation charges” benefit:
  • Estimated schedule of original trip.
  • Breakdown report of the portion of the original trip that was not utilized.
  • Document confirming amount refunded and relevant cancellation charges by carrier.
  • Ticket purchase invoice.
  • Invoice of any amount paid in advance (pre-paid).
  • Hotel invoice and statement for accommodation.
  • Invoice of replaced vehicle for transportation.
  • Health record/Death certificate/Court report or Center for Disease Control and Prevention (CDC) 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.
  1. “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.
  1. “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.
  1. “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.
  • Writ, 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:
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Phone: (+84 28) 3821 9908

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