(Inpatient or Outpatient)

You will only need to file for reimbursement if you seek treatment as a Private Patient and pay up front, versus seek treatment as an HMO Patient and not pay at all, because:

1) you want to be treated by a non-accredited doctor; and/or 2) you want to be treated in a non-accredited hospital/clinic.

To get reimbursed, fill out the proper claim form, complete all the requirements, and submit all the documents.

For pick-up of your claims documents in Manila, please call Sheila (888-0001 ext. 846).

Outside Manila, please send via LBC to:GRA (attention: Purple Cow) 15/F

Chatham House, Salcedo Village, Makati City

The standard wait period for reimbursement of claims is fifteen (15) working days.

ReimbursementReimbursement

Submit accomplished ‘Out-Patient Claim Form’To be accomplished & signed by the Employee AND

the attending physicianTo be submitted to HR

ORIGINAL of the following should be submitted:Official Receipt(s);Prescription for the diagnostic test(s);Medical Certificate in the absence of Out-Patient

Claim Form but insured still has to accomplish the Out-Patient Claim Form

OutpatientOutpatient Claim Checklist Claim Checklist

Submit accomplished ‘Hospitalization Claim Form’ Part 1 - by the insured Part 2 - by the authorized HR officer Part 3 - by the ATTENDING physician

ORIGINAL of the following should also be submitted: Official Receipt(s) bearing ‘BIR Permit Number’

Hospital bills, Professional Fee(s) Medicines bought outside the hospital but were consumed

during confinement

Statement of Account (SOA) Itemized list of expense, Charge Slips

Police Report, when necessary

InpatientInpatient Claim Checklist Claim Checklist