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  • CLAIMs FAQ

    General Questions

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    How can I make an outpatient or hospitalisation claim?

    Please complete the related claim form, and send it to us with the original medical receipt(s) and letter of referral (if applicable) within 90 days of the medical service. (Address: Corporate Solutions Department, 12/F, AIA Financial Centre, 712 Prince Edward Road East, Kowloon)


    How long does it take to process an outpatient or hospitalisation claim?

    After receiving all the necessary documents, it generally takes us 7 working days to process a claim. You can also check the status of your claims on our Employee Benefits Website.


    Where can I find information about doctors in AIA network?

    You can search for network doctors’ information on our Employee Benefits Website. 


    How can I get back the original medical receipt?

    Please note your request for returning your original receipt in the blank area of the claim form when making the claim. 


    If I lose the original medical receipt, how can I make a claim?

    Please complete the Declaration for Loss of Original Receipt and send to us together with the certified true copy of the receipt from the related medical service provider, and the claim form.


    Outpatient Claims

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    What is a valid referral letter?

    A referral letter must be issued by a registered doctor of western medicine and is valid for 180 days. It means the patient has to receive the medical service no later than 180 days after the referral letter is issued.


    Is a letter of referral required for pediatric or gynaecological services?

    Yes, you need to submit a letter of referral issued by a registered doctor for all specialist services. 


    Can I make a claim for outpatient services in a government hospital?

    Yes, please make the claim by following the general procedure with the required documents below: 

    • Sick leave certificate issued by the hospital;  and 

    • Receipt from the hospital, on which you can note the diagnosis, e.g. high blood pressure, gastritis etc. 


    If I have a minor surgery without staying in hospital overnight, can I make a claim?

    Yes, we will pay for your surgical costs under your Hospitalisation Benefit. 


    Hospitalisaton Claims

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    What is an “adjustment factor”?

    Adjustment factor is a percentage applied to the calculation of the benefit amount.

    1. Under the medical benefit (e.g. StepUp Medical Protection Plan, Journey Protect Medical Plan):
      If the Insured is confined in a type of room in a hospital which is at a higher level than the room type corresponding to the plan level chosen, the benefit amount will be paid according to the benefits schedule of the plan, and the adjustment factor stated below will also apply:

      Room Type Entitlement

      Received Treatment in

      Adjustment Factor

      Ward

      Semi-Private

      50%

      Ward

      Standard Private

      25%

      Ward

      VIP / Deluxe / Suite

      0%

      Semi-Private

      Standard Private

      50%

      Semi-Private

      VIP / Deluxe / Suite

      0%

      Standard Private

      VIP / Deluxe / Suite

      50%


    2. Under the Supplementary Major Medical (SMM) Benefit:
      If the insured’s average daily room and board charges incurred during hospitalisation are higher than the daily room and board limit set forth in the benefits schedule of the plan, the adjustment factor will apply and calculate as follows:

      Adjustment factor = Daily room and board limit set forth in benefits schedule / Average daily room and board charges incurred during hospitalisation

      The adjustment factor applied to the calculation of SMM Benefit (if applicable) will be as follows:
      SMM Benefit = [eligible expenses x adjustment factor – deductible amount per disability] x coinsurance

    If I am referred by a doctor out of the network for hospitalisation, can I enjoy inpatient credit facility?

    In that case, you will need to pay for the hospital charges first, and then send us the claim form and original receipts to make a claim.


    Overseas Treatments

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    Can I claim for overseas treatments?

    Yes, please complete the related outpatient or hospitalisation claim form, and send it to us with the original medical receipt(s) within 90 days of the medical service. (Address: Corporate Solutions Department, 12/F, AIA Financial Centre, 712 Prince Edward Road East, Kowloon)


    What should I do in case of emergency hospitalisation overseas?

    For overseas emergency, please call our AIA International Assistance Service (AIAS) on (852) 2200 6399 for 24-hour worldwide support.


    Maternity

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    Can I claim the maternity expenses under gynaecology specialist benefit, clinical benefit, or basic diagnostic testing benefit?

    No, you can only claim the maternity expenses under Maternity Benefits.  If there is no Maternity Benefits under your coverage, you cannot claim the related expenses. 


    Others

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    If the charges exceed my benefit amount, how should I pay for the difference?

    You can either send us a cheque or pay by PPS. Please refer to your Shortfall Letter for payment details.


    I lost my AIA HealthCard. What can I do?

    You can report the loss to the HR department of your company. The fee for a replacement card is HK$50.


    Contact aia
    Hong Kong
    • Customer Service Centres:
      • Prior booking is highly recommended - Customer Service Centre will serve customers who have made appointment with priority. Customers could book service via our mobile application AIA Connect (Profile > Contact AIA > Customer Service Centre Enquiry Appointment Service) or book it via our corporate website ( https://www.aia.com.hk/en/help-and-support/individuals/appointment-form.html).

    Hong Kong

    Hotlines

    Individual –
    (852) 2232-8888

    Corporate Solutions –

    • Group: (852) 2200-6333
    • MPF/ORSO/Macau Pension:
      • Employer: (852) 2100-1888
      • Employee/Self-employed: (852) 2200-6288

     

    Customer Service Centres

    Hong Kong Island
    AIA Wealth Select Centre
    12/F, AIA Tower,
    183 Electric Road,
    North Point, Hong Kong

    Kowloon
    Suite 1313, 13/F,
    AIA Kowloon Tower,
    Landmark East, 100 How Ming Street,
    Kwun Tong, Kowloon, Hong Kong

    Mon-Fri: 8:45am – 6pm
    (Open through lunch)
    Sat, Sun & Public Holidays Closed 

    Macau

    Hotlines

    Individual –
    (853) 8988-1822

    Corporate Solutions –

    • Group: 0800 516
    • MPF/ORSO/Macau Pension:
      • Employer: 0800 183
      • Employee: 0800 272

     

    Customer Service Centre

    1903, AIA Tower,
    Nos. 251A-301, Avenida Comercial de Macau, Macau

    Mon-Fri: 08:45am – 5:15pm
    (Open through lunch)
    Sat, Sun & Public Holidays Closed

    Contact aia
    Hong Kong
    • Customer Service Centres:
      • Prior booking is highly recommended - Customer Service Centre will serve customers who have made appointment with priority. Customers could book service via our mobile application AIA Connect (Profile > Contact AIA > Customer Service Centre Enquiry Appointment Service) or book it via our corporate website (https://www.aia.com.hk/en/help-and-support/individuals/appointment-form.html).

    Hong Kong

    Hotlines

    Individual –
    (852) 2232-8888

    Corporate Solutions –

    • Group: (852) 2200-6333
    • MPF/ORSO/Macau Pension:
      • Employer: (852) 2100-1888
      • Employee/Self-employed: (852) 2200-6288

     

    Customer Service Centres

    Hong Kong Island
    AIA Wealth Select Centre
    12/F, AIA Tower,
    183 Electric Road,
    North Point, Hong Kong

    Kowloon
    Suite 1313, 13/F,
    AIA Kowloon Tower,
    Landmark East, 100 How Ming Street,
    Kwun Tong, Kowloon, Hong Kong

    Mon-Fri: 8:45am – 6pm
    (Open through lunch)
    Sat, Sun & Public Holidays Closed

    Macau

    Hotlines

    Individual –
    (853) 8988-1822

    Corporate Solutions –

    • Group: 0800 516
    • MPF/ORSO/Macau Pension:
      • Employer: 0800 183
      • Employee: 0800 272

     

    Customer Service Centre

    1903, AIA Tower,
    Nos. 251A-301, Avenida Comercial de Macau, Macau

    Mon-Fri: 8:45am – 5:15pm
    (Open through lunch)
    Sat, Sun & Public Holidays Closed

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