Individual Claim E Self-Service and Form Library

Hospitalization

E Self-Service  

Form Application

  • HK-CL-CLA21
    MasterCare Medical Plan Direct Billing Pre-approval Form
  • HK-CL-ICLA02
    Hospitalization Claim Form
     E Self-Service

  • HK-CL-ICLA25
    Hospitalization Direct Billing Pre-Approval Form (Applicable For Non Mastercare Medical Plan)

Life

E Self-Service  

Form Application

Accident

E Self-Service  

Form Application

  • HK-CL-ICLA03
    Accident Claim Form
     E Self-Service

TimeLady

E Self-Service  

Form Application

  • HK-CL-ICLA04
    Time Lady Insurance Claim Form
     E Self-Service

Critical Illness

E Self-Service  

Form Application

  • HK-CL-ICLA05
    Critical Illness Claim Form - Cancer
     E Self-Service

  • HK-CL-ICLA06
    Critical Illness Claim Form - Stroke
     E Self-Service

  • HK-CL-ICLA07
    Critical Illness Claim Form - Heart Attack
     E Self-Service

  • HK-CL-ICLA08
    Critical Illness Claim Form - Heart Valve Replacement
     E Self-Service

  • HK-CL-ICLA09
    Critical Illness Claim Form - Others
     E Self-Service

  • HK-CL-ICLA11
    Terminal Illness Claim Form
     E Self-Service

Outpatient

E Self-Service  

Form Application

  • HK-CL-ICLA10
    Individual Out-Patient Claim Form
     E Self-Service

Disability

E Self-Service  

Form Application

  • HK-CL-ICLA12
    Long Term Sick Leave Claim Form
  • HK-CL-ICLA13
    Waiver of Premium / Payor Benefit Claim Form
     E Self-Service

LadyVital

E Self-Service  

Form Application

  • HK-CL-ICLA19
    LadyVital Female Protection Claim Form
     E Self-Service

Others

E Self-Service  

Form Application

  • HK-CL-ICLA23
    Application for Share Happiness Reward
  • Novel_Coronavirus_Vaccine_Side_Effects
    Declaration Form for Coverage against "Novel Coronavirus Vaccine Side Effects" Claim Application
  • PLD
    Policy Lost Declaration
  • HK-CL-ICLA22
    Beneficiary Withdraw Annuity Benefit Form

Self Certification (CL)

E Self-Service  

Form Application

  • CRS-CP(Claims)
    Self-Certification Form – Controlling Person (For Claims Use)
  • HK-CLCRS-Entity
    Self-Certification Form – Entity (For Claims Use)
  • HK-CLCRS-Individual
    Self-Certification Form – Individual (For Claims Use)

Collection of Claim Payment

E Self-Service  

Form Application

  • HK-CL-ICLA18
    Claim Direct Payment Application Form
  • HK-CL-ICLA24
    Claims Cross Border Remittance Service Application Form (Only Applicable For Greater Bay Area CGB’S Account Holder)
  • HK-CS-FIN-08
    Special Payment Arrangement Request Form