AIA guide

This Member Guide only provides general reference to our administrative procedures. For terms and conditions of your policy, please refer to the policy contract documents. This guide provides useful information about how you can enjoy the benefits and services provided by this comprehensive employee benefits scheme.

Life & Accident Claim

Please report all claims incurred in writing to us within 90 days from the date of loss. Claimant will then be advised to submit the required claim documents.

In the event of claims involving bodily injury, the claimant should complete the “Group Accident Claim Form” and submit to us with relevant Medical Reports.

Claim will be assessed upon receipt of claim documents. If further information is required, we will issue a letter to the Policyholder / claimant to request for such information. After assessment, we will notify the Policyholder / claimant of our decision in writing.

Hospitalization Benefits Claims

Please complete the “Group Medical Insurance – Hospitalization & Surgical Claim Form”. Part I of the form is to be completed and signed by the claimant. Part II is to be completed and certified by the surgeon or attending doctor.

The completed form, together with the original hospital bills and/or receipts and other necessary supporting documents, should be submitted to us through the Policyholder within 90 days from the claim incurred date.

All approved medical claims will be reimbursed through autopay to the member’s nominated bank account or by cheque payable to the member.

Non-Network Outpatient Benefit Claims

Please complete the “Group Clinical Benefit Claim Form” for outpatient benefits and attach the original medical bills.

The completed form and the necessary supporting documents must be submitted to us through the Policyholder within 90 days of incurring the medical
expenses.

A referral letter from a registered General Medical Practitioner is required for claims relating to Physiotherapy, Chiropractic Treatment, Specialist Consultation, and X-Ray and Laboratory Test.

All approved medical claims will be reimbursed through autopay to the member’s nominated bank account or by cheque payable to the member.

Network Consultation

Please access to medical care through a Network Doctor and present your HealthCard to clinic staff.

You are required to pay applicable Copayment, if any, stated on the HealthCard. The HealthCard is only valid for the period you are covered under the Policy. There is
no expiry date imprinted on your HealthCard. Therefore, please take good care of it as it will last through all the years of your covered period. Please refer to policy contract and applicable benefit summary for details of coverage.

Credit facility will not be provided if member is unable to present the HealthCard. The HealthCard(s) should be returned to AIA upon termination of employment.

General Exclusions

• First year suicide (for Group Life only)
• Pre-existing conditions for which the insured member received medical treatment, diagnosis, consultation or prescribed drugs during the 12 months preceding
the effective date of his coverage, unless the insured member affected by these conditions has been insured under the scheme continuously for 12 months
• Services which are not medically necessary
• Cosmetic procedures
• Any claim arising as a result of HIV/AIDS
• Health services relating to maternity, family planning, infertility, dental , mental illness treatment, vision and hearing aids
• Self-inflicted injuries or suicide
• Congenital Anomalies
• Injuries arising from war

The final list of exclusions is subject to the Group Policy issued by AIA.