Medical Reimbursement

Requirements:

• • Fully accomplished Claims Reimbursement Form.
  • Cover letter or incident report (stating the reason for filling of reimbursement)
  • Original copy of official receipt from facility and doctor
  • Medical certificate stating chief compliant and final diagnosis
  • Statement of account
  • Itemized breakdown of charges or charged slips
  • Clinical abstract
  • History of present illness
  • Results of laboratory or diagnostic examinations
  • Discharge summary
  • For surgical cases: Operative Technique
  • For maternity claim: Certificate of live birth or marriage contract
  • For accidents: Police report
  • For accidents: Subrogation form
  • For vehicular accidents: Driver’s license, LTO OR/CR (if member is the driver/owner)

Requirements:

• • Fully accomplished Claims Reimbursement Form.
  • Cover letter or incident report (stating the reason for filling of reimbursement)
  • Original copy of official receipt from facility and doctor
  • Medical certificate stating chief compliant and final diagnosis
  • Itemized breakdown of charges or charged slips
  • Results of laboratory or diagnostic examinations
  • For emergency cases: Emergency room record
  • For surgical cases: Operative Technique
  • For accidents: Police report
  • For accidents: Subrogation form

1.  Standard processing of reimbursements is 15 working days after receipt of the complete documents; it includes evaluation of the bills, investigation, approval of doctor, premium payment verification with Revenue Management Department and check preparation.  All claims without outstanding premium balance will be released within the 15-working day period.
2.  Reimbursements that were initially given an action/disapproved memo will be processed 7 working days after receipt of the complete documents
3. Grace period: Please take note that all claims for reimbursement MUST be submitted or forwarded to either of the following:
   (a) Online via AC Portal Form, or
   (b) Email: reimbursementreceiving@medicardphils.com, or
   (c) In-person: MediCard Head Office within 30 calendar days after availment or discharge from the facility.  Failure to do so shall invalidate the claim, except if it can be shown in writing that it was not reasonable/possible to furnish all the necessary documents in availing reimbursement.
4. Claims that were initially given an action memo MUST be complied with the necessary requirements not later than 30 calendar days from the date of the memo.