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Claim documents for hospital admission
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Claim documents for hospital income benefit
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Claim documents for pre & post hospitalisation treatment, outpatient treatment
Claim documents for hospital admission
Documents to be provided by Claimant
- Claimant’s Statement (Hospitalisation and Surgical Claim)
Download form - Claimant’s NRIC (Both Sides) / Passport Copy, duly certified (if not submitted previously)
- E-Payment Authorisation Form (if not submitted previously)
Download form
Documents to be collected from hospital
- Medical Report (Hospitalisation Claim)
Download form - Original Receipts
- Original Final Tax Invoices
- Itemised Bills / Detailed Bills indicating:
- Doctor’s Fee
- Medicine Charges (including medicine name, unit price, prescribed quantity and supply duration)
- Test/Investigation Charges - Diagnostic Reports, for example:
- Magnetic Resonance Imaging (MRI)
- X-ray
- Histopathology Examination (HPE)
- Blood Test
- Computed Tomography (CT) Scan
- Coronary Angiogram
- Electrocardiography (ECG) - For Overseas Treatment (not required for Singapore and Brunei) please include:
Proof of Life Assured leaving Malaysia:
- Life Assured’s Passport Copy indicating date of departure from Malaysia
- Boarding Pass
- Travel Ticket DetailsFollowing supporting documents in English:
- Medical Report
- Original Receipts
- Original Final Tax Invoices / Final Bills
- Itemised Bills / Detailed Bills
- Diagnostic Reports
Claim documents for hospital income benefit
Documents to be provided by Claimant
- Claimant’s Statement (Hospitalisation and Surgical Claim)
Please indicate "Hospital Income Benefit" on Claimant's Statement.
Download form - Claimant’s NRIC (Both Sides) / Passport Copy, duly certified (if not submitted previously)
- E-Payment Authorisation Form (if not submitted previously)
Download form
Documents to be collected from hospital
- Medical Report (Hospitalisation Claim)
Download form - Inpatient Bills indicating:
- Date of admission and discharge
- Number of days of Room and Board charged by hospital - Diagnostic Reports for example
- Magnetic Resonance Imaging (MRI)
- X-ray
- Histopathology Examination (HPE)
- Blood Test
- Computed Tomography (CT) Scan
- Coronary Angiogram
- Electrocardiography (ECG)
Claim documents for pre & post hospitalisation treatment, outpatient treatment
Documents to be provided by Claimant
- Claimant's Statement (Outpatient Treatment Claim)
Download form - Claimant’s NRIC (Both Sides) / Passport Copy, duly certified (if not submitted previously)
- E-Payment Authorisation Form (if not submitted previously)
Download form
Documents to be collected from hospital
- Original Receipts
- Original Final Tax Invoices
- Itemised Bills / Detailed Bills indicating:
- Doctor’s Fee
- Medicine Charges (including medicine name, unit price, prescribed quantity and supply duration)
- Test / Investigation Charges - Diagnostic Reports, for example:
- Magnetic Resonance Imaging (MRI)
- X-ray
- Histopathology Examination (HPE)
- Blood Test
- Computed Tomography (CT) Scan
- Coronary Angiogram
- Electrocardiography (ECG) - For Outpatient Accident Treatment only:
- Medical Report (Accident Claim)
Only necessary when total claim amount exceeds RM500. If total claim amount is RM500 or below, diagnosis, date and cause of accident have to be endorsed by the treating doctor on the bills (with signature and clinic’s official stamp)
Download form - For Overseas Treatment (not required for Singapore and Brunei) please include
Proof of Life Assured leaving Malaysia:
- Life Assured’s Passport Copy indicating date of departure from Malaysia
- Boarding Pass
- Travel Ticket DetailsFollowing supporting documents in English:
- Medical Report
- Original Receipts
- Original Final Tax Invoices/Final Bills
- Itemised Bills/Detailed Bills
- Diagnostic Reports
*Note:Outpatient Dengue or Enteric Fever Treatment is only coverable for MediSafe Infinite, MediSafe Infinite Xtra and MediEssential Plans.
