门诊索偿申请表（3页）.pdf-业务单证-保险资料库

门诊索偿申请表（3页）.pdf

索偿手续 CLAIM PROCEDURE

1. 此申请表须填写有关资料及签署，并于接受治疗后60日

内连同收据正本交回中国交银保险有限公司理赔部。如逾期递交或所需资料不全，索偿申请将不受办理。

Claim Form should be

completed & signed before submitted to

China BOCOM Insurance Co., Ltd. together with

original bill(s)/receipt(s) within 60 days

from date of consultation / treatment. NO

reimbursement will be made for late submission

or with insufficient information.

2. 须附详细医疗费用账单暨收据正本。提供治疗日期，病者姓名，病症名称，收费项目及主诊医生之印鑑及签署。

Original bill(s) and receipt(s) for

the claimed expenses must be

attached showing the date of treatment, patient’s name,

diagnosis, breakdown of services charge and the

attending registered medical practitioner’s stamp and signature.

3. 索偿专科诊治、 X- 光／医学检验，嵴医或物理治疗等费用，须附主诊医生之处方或介绍信副本。

分享到：