Individual Claim E Self-Service and Form Library

Hospitalization

E Self-Service  

Form Application

  • HK-CL-ICLA02
    Hospitalization Claim Form
     E Self-Service

  • HK-CL-CLA21
    MasterCare Medical Plan Direct Billing Pre-approval Form
  • HK-CL-ICLA25
    Hospitalization Direct Billing Pre-Approval Form (Applicable For Non Mastercare Medical Plan)
  • HK-CL-CLA20220630
    Application Form For VHIS Claimable Amount Estimate
  • HK-CL-ICLA32
    Icare Medical Insurance Plan／Health Guard Hospital Care Benefit Plan -Application Form For Claimable Amount Estimate

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/ CORONARY ARTERY DISEASE REQUIRING SURGERY / ANGIOPLASTY
     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

  • HK-CL-ICLA27
    critical illness claim form – brain damage
     E Self-Service
  • HK-CL-ICLA28
    critical illness claim form – carcinoma-in-situ or early malignancies
     E Self-Service
  • HK-CL-ICLA29
    critical illness claim form – benign brain tumour
     E Self-Service
  • HK-CL-ICLA30
    critical illness claim form –autism
     E Self-Service
  • HK-CL-ICLA31
    critical illness claim form – kawasaki disease
     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

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