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Claims Procedure

Claims Procedure

Please follow the guidelines below to help process your claims promptly and efficiently.

All claims documentation (see different requirements below) should be submitted to Pacific Prime or Safety Insurance within 6 months after the treatment date, or, if cover is canceled within the insurance year, within 6 months after the end of insurance cover. After this time Safety Insurance is not obliged to settle the claim.

If you visit a medical facility that is not in the Direct Settlement network in Thailand, you must submit the claim form with the original receipt and medical certificate for the treatment. An unofficial receipt or invoice will not be enough for Safety Insurance as they can only reimburse visits and treatments done in legally licensed as an institute to provide treatment under the laws of the country in which it is located.

Before you make a claim, it is important to ensure that your plan covers the treatment you are seeking. For a summary of your medical cover, please refer to the Table of Benefits.

Inpatient and Daycare Claims

In the event of hospitalization, Aetna NZI will, where possible and with sufficient notice, arrange for direct settlement with medical providers. 48 hours pre-authorization is needed if the treatment is selective (if you know in advance that you need an operation), pre-authorization is obtained by contacting Assistance Team at 001 800 442 221 (24hr hotline)

From the rest of the World: call collect or direct on +44(0) 1252 351 200

Local Bangkok Office: +66 (2) 662 8296 or email [email protected] if you require any further assistance.

In the event of an emergency, when you have to be at the hospital for immediate treatment, please engage the hospital staff to contact us directly on the admission date.

Remarks: Please note that the above is a brief overview of the claims procedure. For Aetna NZI UltraCare plan's complete policy wording on the claims handling and administration procedure, please see the link to the Out-patient Direct Settlement Network, the Claims Procedure and Claim Form

Non-Cashless benefit (if any):

  • Dental treatment
  • Wellness (Checkup)
  • Maternity benef

Emergency Hospitalization

In the event of an emergency, when you have to be at the hospital for immediate treatment, please engage the hospital staff to contact us directly on the admission date.

Assistance Service Center at: 001 800 442 221 (24hr hotline)

Within the USA: 1 866 840 9747

From the rest of the World: call collect or direct on +44(0) 1252 351 200

Out-patient Claims

Direct-billing facility or Cashless system:

Check on our hospital contracted list enclosed in policy package for direct settlement provider directory for your preferred provider to visit. Once you reached the hospital, show your member card to the staff, fill in the necessary documentation and obtain “cashless” settlement for treatments and pay for any un-direct/co-insurance billing expense before you leave.

Pay and Claim basis:

If you receiving treatment from non-contracted providers, you simply need to submit them Claim Form along with original receipt and doctor’s report and seek for claim reimbursement.

We recommend the following steps in making an out-patient or dental claim:

  1. Whenever you visit a general practitioner, dentist, physician or specialist on an out- patient basis, please make sure you take a Claim Form with you.
  2. Fill in the section that is assigned to you, then date and sign the Claim Form.
  3. Make sure that your doctor provides all relevant medical information, including diagnosis, in the specified section and then dates, signs and stamps the Claim Form.
  4. However, if your invoices contain details of the diagnosis as well as the nature of the treatment, there is no need for your treating doctor to complete this section of the Claim Form.
  5. Attach all original supporting documentation, invoices and receipts to the Claim From (e.g. general practitioner/physician invoices, pharmacy receipts with related prescriptions (if available), and send it to Pacific Prime or post to Aetna NZI at the address indicated on your Claim Form. It is your responsibility to keep all copies of all correspondence with you (in particular, copies of claim forms and medical receipts). Aetna NZI will not be held responsible for correspondence lost in the post.
  6. Please note that you must submit the official receipt and the medical certificate, with the claim form.
  7. Remember that a separate Claim Form will be required for each person claiming and for each medical condition being claimed for.
  8. Specify on the Claim Form the currency in which you wish to be paid, otherwise the benefit due to you will be paid in the currency of the invoice (where possible).

Please note that the incurred costs will be reimbursed within the limits of your policy, after taking into consideration any required Treatment Guarantee.

Claim Status

Completed Claims take 15 business days for reimbursement. Once your reimbursement is transferred to your designated bank account, claims team will send you a Remittance letter confirmation by email together with Explanation of Benefits (EOB).