AIA GHS Claim Form - Version Jan 2022_*editable fields

CLAIM PROCEDURES

Private Hospital - Inpatient Claim

Please assist to submit the following:

a) b) c) d) Duly completed Section 1 of the Claim Form.

Duly completed Section 2 of the Claim Form by the Attending Physician / Surgeon.

All original Final Summary and Detailed Hospital Bill including Pre & Post Hospitalisation tax invoices.

Other additional supporting document (if any) on the medical condition that can assist in the assessment of the

claim:

• Referral Letter from General Practitioner (GP) to Specialist / Hospital

• Any referral form for laboratory / blood test

• Histology Report

Government/Restructured Hospital - Inpatient Claim

Please assist to submit the following:

a) b) c) Duly completed Section 1 of the Claim Form.

All original Final and Detailed Hospital Bill including Pre & Post Hospitalisation tax invoices.

Other additional supporting document (if any) on the medical condition that can assist in the assessment of the

claim:

• Copy of Ambulatory Form / Pre Admission Form

• Copy of Inpatient Discharge Summary

• Referral Letter from General Practitioner (GP) to Specialist / Hospital

• Any referral form for laboratory / blood test

• Histology Report

d) If the incurred hospital bill amount exceeds S$1,000/-, the claimant will have to submit Section 2 of the claim form

to the Medical Records Department of the hospital for the completion by the attending Physician. AIA will

reimburse up to *S$80/- subject to the maximum of "Other Services" benefit as stated in the policy schedule or the

benefit amount stipulated in the specific policy provided the claim is payable.

Important Notes :

1. 2. 3. 4. The claimant is required to submit the claims document within 90 days of discharge from the hospital.

To enable the claim to be processed on a timely basis, please duly complete all the questions in the claim form

and attach all the required documents.

The claim will be returned if the required documents are not provided together with this form.

* The reimbursable amount of S$80/- is subject to AIA’s review and may change accordingly.

FOR PRIVATE HOSPITAL INPATIENT CLAIMS