团体住院及手术保险赔偿申请书.PDFVIP

Group Hospitalization Surgical Insurance Claim Form 團體住院及手術保險賠償申請書 INSTRUCTIONS 說明 1. Part A of this application must be completed by the employee and signed by the patient and 1. 此申請書之甲部必須由僱員填寫及病人簽署，而乙部則須由僱 Part B by the employer (Policy Owner) if applicable and then submitted within 90 days of 主(保單持有人)填寫如適用，並於付款後九十天內遞交。 incurring such expenses. 2. If a surgical procedure or operation has been performed during the hospitalization, Part C must 2. 如住院期間曾施行外科手術，丙部須由外科醫生填寫。如無需 be completed by the surgeon. If no surgical procedure or operation is involved, Part C must be 施行外科手術，丙部則由主診醫生填寫。 completed by the attending physician. 3. 丙部必須由註冊之執業醫生填寫，否則該索償將不予受理。此 3. No claim will be admitted unless Part C is duly completed by a registered medical practitioner. 外，本公司概不負責任何有關填寫此申請書之費用。 The Company will not be responsible for any fee required for the completion of this application or any follow up cost thereafter. 4. 專科賠償，必須附上轉介信。 4. Referral letter must be attached for claim for specialist consultation. 5. 僱員可隨時登入 .hk 之永明金 5. Employee may logon to Group Insurance e-Services at .hk to 融團體保險 e-Services 查閱閣下已被處理的賠償記錄。 check your processed claim record.