Who is the Policy Owner?
The Policy Owner is the person who has the legal title to a policy.
Can new riders/benefits be attached to my policy after it is issued?
Inclusion of riders will depend on the plan type of the basic policy, the policy duration and the availability of riders at the time of application. Supplementary benefits [e.g. Accident and Hospital benefits] can be included any time after the policy is issued. Applications for inclusion of riders/supplementary benefits are subject to underwriting and a policy fee of RM30.00 will be levied for inclusion of riders. Our underwriters may call for medical report if medical evidence is required. Medical costs, if incurred, will be borne by the policyholder.
Q: What are the services provided by HSD for customers with Hospitalization & Surgical policy?
A: HSD provides round-the-clock (24 hours and 7 days/week) Guarantee Letter facility for eligible customers requiring hospitalization and or/surgery, processes reimbursement of medical claims and handles enquiries related to medical policy.
Q: How do I contact HSD?
A: You can call the Healthcare Hotline number at 1-300-1300-18 or sent an email through e-Partner (ICM) or to healthcareservices@greateasternlife.com for assistance.
Q: How does customer use the Health Care Card for hospital admission?
A: Upon admission to the Panel Hospital, customer can present their Health Care Card and NRIC to the hospital’s admission counter for Guarantee Letter arrangement.
Q: How long before customer’s admission that they must inform HSD?
A: To provide sufficient time for HSD to process the Guarantee Letter for admission, it is recommended for customer to request their attending doctor to complete Part II, which is the Admission Section of the Guarantee Letter Request Form and send the completed form to HSD as soon as possible.
Q: What is the process for Guarantee Letter arrangement?
A: Hospital will assist to process the necessary documentation for Guarantee Letter request and send it to HSD for validation. Once it is confirmed that customer’s hospitalization fulfills the policy’s terms and conditions, Initial Guarantee Letter (IGL) will be issued and sent to the hospital for their handling.
If customer’s Guarantee Letter request is not approved, the Decline Guarantee Letter (DGL) will be sent to the hospital. Hospital will advise customer to pay for their medical expenses and submit the claim to GELM for reimbursement consideration.
An SMS will be sent to the servicing agent (if mobile number is registered with CAD) and customer (if customer provides their mobile number in the GL Form) to notify them of the Guarantee Letter status.
Q: How long is the Guarantee Letter valid for after it has been approved?
A: The Guarantee Letter is valid for 30 days from the date of issuance.
Q: In what circumstances/condition that Guarantee Letter will be declined?
A: The decision to decline Guarantee Letter may due to the following reasons below but it is not an exhaustive list:
Note: You may contact the Healthcare Hotline for more specific information on the decline reason.
Q: Will the hospital accept the Health Care Card as a guarantee for admission deposit?
A: No, the Health Care Card is meant for the Panel Hospital to identify customer with GELM medical policy and cannot be used as a guarantee for hospital deposit.
Q: If Guarantee Letter has been approved, does customer still need to pay any admission deposit?
A: Yes, most hospitals will request for deposit payment as part of the admission requirement. However, the deposit payment will be refunded by the hospital after deducting the non-covered charges such as coinsurance/deductible, telecommunication fee, extra meals, miscellaneous expenses, service tax, braces, special aids etc (if any).
Q: Can the customer still enjoy the room and board discount rate if Guarantee Letter was declined?
A: No, hospital discount is not a policy entitlement so customer has to pay the published rate as advised by the hospital.
Q: How long does customer need to wait at the hospital after the doctor has certified that they are fit for discharge?
A: Normally, the attending doctor has to complete the medical report (Discharged Section) before hospital billing staff can prepare the hospitalisation bills. The whole process takes about a few hours subject to the hospital’s available resources.
Q: How long does HSD take to process the Discharge/Final Guarantee Letter (FGL)?
A: Upon receiving the complete document from the hospital, HSD will process the FGL within 75 minutes for straightforward cases. However, if the documentation or information received is incomplete, it may take longer or until the necessary documentation has been received to process the FGL.
Q: Where can customer get the list of Panel Hospitals or Specialist?
A: The list of panel hospitals and specialist is available in e-Partner under HSD or GELM website at www.greateasternlife.com.my. Please note that list of panel hospitals and specialist is subject to change and the latest listing can be viewed at both e-Partner and the website.
Q: Why not all specialists in the Panel Hospitals are GELM’s panel specialist?
A: There are some specialists (doctors) within the appointed panel hospitals who are not included in the list of panel specialists for various reasons. Therefore, Guarantee Letter facility is not available for any admission or treatment by non-panel specialist.
Q: What if customer was admitted to a non-panel hospital or specialist, can they still submit their claim?
A:Yes, customers who choose to be treated at a non-panel hospital or specialist can settle their medical expenses and submit their claim for reimbursement consideration according to the policy’s terms and conditions.
Q: Can customer use their Health Care Card for hospital admission overseas?
A:No. The Health Care Card is only applicable to GELM Panel Hospitals in Malaysia. Customer has to pay the medical expenses and submit their claim for reimbursement consideration according to policy’s terms and conditions after they return from overseas.
Q: What are the documents required for reimbursement of claims?
A:The documents required are as follow:
Note: Please refer to the requirement listed in the Health Claims Checklist for other type of claims
Q: Where can I get the required forms?
A:You can obtain the forms from company’s website, e-Partner or Agent’s Counter at Menara Great Eastern or branches.
Q: Where can I submit the claims document?
A: You can submit the documents through the Health Claims Drop-box at Level 1 of Menara Great Eastern or Agent’s Counter at branches.
Q: Can I submit photocopy of hospital bill or receipt in case my customer is unable to provide or lost these documents?
A: 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.
Q: If my customer has submitted their claim to another insurance company, can they also claim from GELM?
A: 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.
Q: For reimbursement of pre and/or post-hospitalization claim where Guarantee Letter has been issued to cover customer’s hospitalization, what are the documents I need to submit?
A: The documents required are:
Q: How does customer or agent know if the document submitted is incomplete?
A: 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.
Q: What is Reasonable & Customary charges?
A: 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.
Q: What if my customer is not happy with their claim settlement/decision?
A: 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.
Q: How long does it take for the Company to process a claim?
A: The estimated timeframe to process a claim is within 10 - 14 working days upon receiving the complete claim documents.
Q: Am I entitled to this benefit?
A: You are entitled to this benefit if your policy document is attached with Endorsement No. 259 (CAP)
Q: What is the contact number for car assistance?
A: You may contact the 24 hours service hotline at 03-76604799.
Q: What is covered in the Car Assistance Program?
A: The services offered in this program are:
Note: Please refer to the Endorsement No. 259 (CAP) for more details on this program.
Q: How can I register or change customer’s car registration number?
A: You may submit a written request through Health Servicing Drop Box at Level 1 of Menara Great Eastern or Agent’s Counter at the nearest branches.
Q: Can customer use this service if they did not register their car registration number?
A: No, customer has to register their car registration number with GELM before they are eligible for this service.
Q: Can customer submit their car towing fee for reimbursement?
A: No, customer must contact the service hotline to arrange for towing services.
Q: What is the contact number for Emergency Medical Assistance?
A: You may contact the 24 hours Service Centre Hotline at 03-4259 8853 (same number for Executive Second Opinion).
Q: What is covered in the Emergency Medical Assistance?
A: The key benefits are listed below. However, for more details on this benefit, you may refer to policy Endorsement No. 249 (SAssist) or contact Supreme Assist.
For customer who travels outside Malaysia for a period not exceeding 120 consecutive days on any one trip, the benefits are:
For customer who travels within Malaysia for a period not exceeding 120 consecutive days on any one trip, the benefits are:
Q: What is Executive Second Opinion (ESO)?
A: Executive Second Opinion is an arrangement where customer can obtained a second opinion on their diagnosis and treatment from an approved medical institution in the United States in the form of a documented report. Customer then has the option to request for a telephone consultation not exceeding one hour from the specialist. The Second Opinion service does not include treatment and only applies to the diagnosis of those medical conditions and eligibility is as defined in the policy document under Endorsement no. 278.
Q: How many times can the customer use the Executive Second Opinion service?
A: One time per covered condition per policy year and limited to three times per lifetime.
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