癌症保障计划-医疗谘询及护理保障赔偿表.PDFVIP

Cancer Care Insurance Plan - Medical Consultation and Caring Benefits Claim Form 癌症保障計劃 - 醫療諮詢及護理保障賠償表 Remarks 備註 : A) Documents required to be submitted with this form: 以下文件請連同此表格一併交回： 1. Original receipt(s) from the doctor/ Chinese medical practitioner/ dietician/ psychologist/ psychiatrist. / / / 醫生 中醫執業醫生 營養師 / 心理學家 精神科醫生之收據正本。 2. Diagnosis must be given and certified by the doctor/ Chinese medical practitioner/ dietician/ psychologist/ psychiatrist. 經由醫生 / 中醫執業醫生 / 營養師 / 心理學家 / 精神科醫生 發出及証明之診斷結果。 B) Please note that if the applied claim is approved, the claim payment will be paid by direct deposit to the bank account specified by the Policyholder or if not available, by cheque and mail to the Policyholder’s correspondence address. 賠償申請一經核准，賠償金額將會直接存入保單持有人所指定的銀行戶口內或如不適用，將以支票並郵寄予保單持有之通訊地址。 C) The claim approvals are subject to the decision of AXA General Insurance Hong Kong Limited 一切索償結果均以安盛保險有限公司的決定為準。 D) Medical Consultation and Caring Benefits become effective for 12 month period starting from the date of diagnosis of Cancer, no reimbursement for claims submitted after 90 days from date of treatment. 醫療諮詢及護理保障於癌症被確診後 12 個月內生效，而於治療日 90 天後遞交之賠償申請將不獲辦理。 E) Do you need to return the Certified True Copy of the original receipt for making claims from any other insurance company? No Yes 您是否需要退回此索償收據之“印鑑正本”以向其他保險公司作出賠償申請？ 否 是   Note 注意 : 1) Certified True Copy will not be returned if the claims are fully reimbursed unless request is for other purpose 如申請已獲全數賠償，正式認證副本將不獲退回。除非正式認證副本需用 作其他用途 2) The originals will