Claims FAQ

 

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.

 

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

 

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.

 

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

 

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. 
   
3. 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

 

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.

 

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)

 

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

 

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.

 

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

 

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