Group insurance claims procedures
At Manulife, we provide a fast and simple group insurance claims process along with the proper safeguards to meet your urgent needs, so you can enjoy outstanding protection as well as peace of mind.
Ways to make your claim
1. Try our eClaims service
Applicable to single receipts not exceeding HKD1,200
2. For receipt above HKD1,200:
Basic requirements
- Group Medical Claim Form
- Check and provide all original medical receipts and copies of bills / invoices (if applicable) with the following information provided:
o Full name of the patient (must be identical with the one on the patient’s HKID card or other recognized personal identification)
o Specific medical diagnosis. Non-specific diagnosis (e.g. medical illness / surgical treatment) is insufficient for claim assessment.
o Consultation / Treatment Date
o Breakdown of charges (consultation fee, medication, laboratory fee etc.)
o The attending Doctor's signature and chop
Additional requirements (if applicable)
- Attach Doctor's referral letter for any diagnostic laboratory test or X-ray, physiotherapy treatment, specialist consultation or prescribed medication from an outside clinic. The referral letter for a laboratory test or x-ray is valid once within 6 months of the date of issuance. Referral letters for other services is valid for 6 months from the date of issuance.
- Dental benefits: If you know your dental benefits (e.g. filling/extraction) are provided on a per tooth basis, please check to see if the number of teeth is shown on the receipt. If the said treatment is done for multiple teeth, please invite the dentist to state the itemized charges for each tooth on the receipt.
- If your claim was processed by another insurer(s), please provide the certified true copy of the receipt and the settlement notice(s) / payment advice(s) issued by the other insurer(s).
- If the claim document is in neither Chinese nor English, kindly request an English translation from the doctor or medical facility. It will help facilitate claim adjudication significantly.
Ways to make your claim
1. Try our eClaims service
Applicable to single receipts not exceeding HKD1,200
2. For receipt above HKD1,200:
Basic requirements
- Group Medical Claim Form
- Check and provide all original medical receipts and copies of bills / invoices (if applicable) with the following information provided:
o Full name of the patient (must be identical with the one on the patient’s HKID card or other recognized personal identification)
o Specific medical diagnosis. Non-specific diagnosis (e.g. medical illness / surgical treatment) is insufficient for claim assessment.
o Consultation / Treatment Date
o Breakdown of charges (consultation fee, medication, laboratory fee etc.)
o The attending Doctor's signature and chop
Additional requirements (if applicable)
- Attach Doctor's referral letter for any diagnostic laboratory test or X-ray, physiotherapy treatment, specialist consultation or prescribed medication from an outside clinic. The referral letter for a laboratory test or x-ray is valid once within 6 months of the date of issuance. Referral letters for other services is valid for 6 months from the date of issuance.
- Dental benefits: If you know your dental benefits (e.g. filling/extraction) are provided on a per tooth basis, please check to see if the number of teeth is shown on the receipt. If the said treatment is done for multiple teeth, please invite the dentist to state the itemized charges for each tooth on the receipt.
- If your claim was processed by another insurer(s), please provide the certified true copy of the receipt and the settlement notice(s) / payment advice(s) issued by the other insurer(s).
- If the claim document is in neither Chinese nor English, kindly request an English translation from the doctor or medical facility. It will help facilitate claim adjudication significantly.
Ways to make your claim
1. Try our eClaims service
Applicable for single hospitalization receipt not exceeding HKD3,000
2. For receipt above HKD3,000:
Basic requirements
- Group Hospitalization & Surgical Claim Form
o Part I (Member information) - completed and signed by Patient / Employee
o Part II (Doctor Statement) - completed, signed and stamped by Attending Physician (Doctor). It should state the date of treatment / hospitalization and diagnosis. If an operation was performed, please advise the name of the operation. (All items must be filled *#). - Statement of Charges / Account
- Original Receipts
Additional requirements (if applicable)
* If hospitalization took place in a public hospital in Hong Kong, a copy of the Discharge Summary with diagnosis issued by the hospital is required. This could replace the Claim Form Part II (Doctor Statement) whenever possible.
# If the Claim Form Part II is not filled in, the claim-related documents (e.g. receipts) must include the name of the diagnosis, treatment and operation, if applicable.
- If the claim has been processed by other insurer(s), please provide the certified true copy of the receipt and the settlement notice(s) / payment advice(s) issued by the earlier insurers.
- If the claim document is in neither Chinese nor English, kindly request an English translation from the doctor or medical facility. It will help facilitate claim adjudication significantly.
Claims submission
Once the claim has been processed, you will receive an alert. Then, you can log in to our Customer Website to check the claim status or view past claim records (up to 1 year) under “Group Life & Health > Claim Inquiry” section (only applicable to eligible members).
Frequently asked questions
What is a valid referral letter for claims?
Claim for Specialist's Visit
A referral letter should be issued by a registered doctor with the exact diagnosis and related specialty. It is valid for 6 months from the date of issuance or the last follow-up visit.
Claim for X-ray / Laboratory Test Fees
A referral letter should be issued by a registered doctor or registered herbalist (if you are entitled to Chinese Medicine Practitioner benefit) with the exact diagnosis and type of X-ray / laboratory test(s) recommended. It is valid for 6 months from the date of issuance and one-off use only.
Claim for Physiotherapy
A referral letter should be issued by a registered doctor with the exact diagnosis. It is valid for 6 months from the date of issuance or the last follow-up visit.
How can I get back the original receipt of claim?
Please note that original receipts of claims will not be returned. You may request for return of certified true copies of receipts by the following procedure:
The claim not yet submitted:
Please check the box for return of a certified true copy of receipt on the or , as appropriate, when submitting the claim.
The claim already submitted:
Please submit a written request for return of a certified true copy of receipt by fax to (852) 2234 5371 or by mail within 30 days after submission of the claim to Manulife.
Are consultations of acupuncture and "Tui Na" covered under Chinese Medicine Practitioner benefit?
Acupuncture is generally covered under Chinese Medicine Practitioner benefit while consultations of "Tui Na", body and foot massage, "Qi Gong" and ear reflexology are not. For details, please refer to the relevant Benefit Provision which is applicable to you.
What is an exclusion?
An exclusion is the circumstances under which a treatment or diagnosis is being excluded from the insurance coverage, i.e. no benefits will be payable to the excluded treatments or diagnosis. You may refer to the back page of the for some of the general exclusions. For details of exclusions in relation to your benefits, please refer to the relevant Benefit Provision and any notices that have been issued to you (if any) as conditions for acceptance of coverage.
What is a "Pre-existing Condition"?
Sicknesses or injuries having occurred prior to the member joining the policy are called "Pre-existing Conditions". Benefits payable for treatment related to pre-existing conditions are generally not covered under the policy during the first twelve months from the date the member joins the plan. The exception to this is no treatment received or recommended during the first three months from the date the member joins the plan, to which the pre-existing condition clause does not apply.
How can I check the panel doctor list?
Visit “Find my doctor” at www.claimsimple.hk and log in with your HKID and Date of Birth, then you can view the applicable panel doctor list.
Got any further questions?
Please contact our customer service by email or phone: (852) 2108 1388 (Hong Kong) or (853) 8398 3838 (Macau)
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