「医疗现金保」赔偿申请表.PDF

「醫療現金保」賠償申請表 MEDICASH LIFETIME CLAIM FORM 致：生人壽保險有限公司 To: Hang Seng Life Limited 保單號碼 Policy No. 超卓「醫療現金保」終身保險計劃－「每日住院現金」、「手術現金」及「手術後療養現金」賠償申請 Claim Application for MediCash Lifetime Insurance Plan PLUS – Daily Hospital Cash Benefit, Surgical Cash Benefit Post Surgery Income 「醫療現金保」終身保險計劃－「每日住院現金」及「手術現金」賠償申請 Claim Application for MediCash Lifetime Insurance Plan – Daily Hospital Cash Benefit Surgical Cash Benefit 注意事項： 1. 受保人／保單持有人必須填寫第一部份；而第二部份（醫療報告）則由主診醫生填寫。 Part I to be completed by Life Insured/Policyholder; Points to note: whereas Part II (Medical Report) to be completed by the attending physicians/surgeons. 2. 請提供醫院單據正本，出院紙（如適用）及病理報告（如適用）。 Please submit the original receipt(s) from hospital, discharge summary (if any) and pathological report (if any). 3. 受保人必須於出院後起計的60 日內及在本保障有效期內提出索償。除非申請人有合理原因證明無法在該段期間內提出索償，及在合理情況 下盡早申索，否則生人壽保險有限公司將不負責支付有關賠償。 The Life Insured should submit the claim within 60 days after date of discharge from hospital and while this Policy is in force. Unless it is shown that it was not reasonably possible to make such a claim, and that a claim was made as soon as was reasonably possible, Hang Seng Life Limited will not be liable to settle the related claim. 第一部份：受保人／保單持有人填寫 Part I: To be completed by the Life Insured/Policyholder 保單持有人姓名 Name of Policyholder 身份證／護照號碼 I.D. Card/Passport No. 受保人／病人姓名 Name of Life Insured/Patient 身份證／護照號碼 I.D. Card/Passport No. 受保人／病人的出生日期 Date of Birth of Life Insured/Patient 聯絡電話 Telephone No. ( 日間 Day time) 住院及手術— 由受保人／病人填寫Hospitalisation Surgery — to be completed by the Life Insured/Patient (1) a) 若因疾病