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Make a hospital income / hospitalisation benefit claim

How to make a hospital income/ hospitalisation benefit claim

For official proof and verification, we would require you to submit the following documents for the type of claim you are making. 

1. Get the following documents

Hospital Income / Hospitalisation Benefit:

  1. Requirement Checklist for Individual & Group Health Claims Submission
  2. Hospitalisation & Surgical - Claimant's Statement / Claim Form For Group Hospitalisation & Surgical Benefit
  3. Hospitalisation & Surgical - Attending Physician's Statement
  4. Certified True Copy of Claimant's NRIC/Passport indicating Biodata
  5. Certified True Copy of Life Assured's NRIC/Passport/Birth Certificate
  6. Direct Credit Facility Form (if not submitted before)
  7. Certified True Copy of hospitalisation bill/tax invoice
  8. For Reimbursement Claim-Original bill(s)/tax invoice(s) and Original receipt(s) (including deposit and refund receipt, if any)

2. Submit documents

You are advised to use Requirement Checklist for Individual & Group Health Claims Submission as a guide on documents requirement for the Medical Claims Submission.

You may submit the claim via the following channels:

a) Online Claim Submission

  • For Policy Owners, click here to log in to e-Connect customer portal. Click My Claim > Online Claims which will navigate you to a new web browser tab. Proceed to click 'Create New Claim' and follow the step by step instructions to complete the submission. You may refer to the eClaims Customer Guide-eConnect for more details.

b) Through your servicing agent

c) At Head Office or the nearest branches. View Location of Head Office and Branches

d) Post the claim forms along with supporting documents to us            

Medical Claim
Menara Great Eastern
Level 4, Healthcare Services Department
No. 303 Jalan Ampang
50450 Kuala Lumpur

Check medical claim status

a) Click here to log in to e-Connect customer portal. Click My Claim > Claim Status or
b) Email us at: healthcareservices@greateasternlife.com

Questions and Answers

Photocopy of hospital bill and receipt is not acceptable as it is part of the policy’s requirement to submit the original hospital bill and receipt for reimbursement of medical claim.

Once the medical claim has been reimbursed by another insurance company, GELM will not compensate the claim again unless the medical expenses are not fully covered by the other insurance company. Then customer can submit the uncovered amount to GELM for consideration according to their policy’s Schedule of Benefits, terms and conditions.

If the claims document is incomplete, HSD will notify customer through pending requirement letter which is sent by mail. A copy of this letter will be published in the e-Partner for servicing agent and Group Sales Manager’s reference.

Reasonable and Customary charges means charges for medical care which is considered reasonable and usual to the extent that it does not exceed the general level of charges being made by others of similar standing in the locality where the charge is incurred. All medical claims are reimbursed up to the Reasonable and Customary charges, including overseas treatments. Excess shall be borne by the Policyholder.

Normally, claim assessment is based on whether the claim fulfills the policy’s contractual benefits and if it is admissible, then the settlement is based on the Schedule of Benefits including the relevant terms of the benefits. If there is any dispute, the customer may submit a letter of appeal and supporting document(if any) to the Healthcare Services Department for reconsideration.

The estimated timeframe to process a claim is within 10 - 14 working days upon receiving the complete claim documents.

Within the first policy year, the insurer has the right to void the policy due to non disclosure, without the need to prove fraud.

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