Get Outpatient Claim Form - Axa - One Protect

Filing an outpatient claim can be a straightforward process when guided by clear instructions. This comprehensive guide provides step-by-step support for completing the Outpatient Claim Form - AXA - One Protect online.

Follow the steps to fill out your claim form accurately.

1. Click ‘Get Form’ button to access the Outpatient Claim Form online and open it for editing.
2. Begin by entering your policy number and your One Protect ID in the designated fields at the top of the form.
3. Complete section A if you are submitting a claim under a group policy. Provide the full name of your employer.
4. Fill in section B with details about the policyholder or employee, including their full name, identification number (NRIC/FIN/Passport No.), nationality, date of birth, gender, contact number, and email address.
5. If the patient is a dependent, proceed to section C. You will need to provide similar details as in section B, including the relationship to the policyholder.
6. If applicable, complete section D for accident-related claims. Include the date, time, and place of the accident as well as a description of how it occurred and the injuries sustained.
7. In section E, provide details of any outpatient claims. This includes the date of consultation, symptoms presented, and whether hospitalization occurred due to the illness or accident.
8. Section F is for dental claims. Include the date of the consultation, symptoms, and details regarding the dental treatments received and their associated costs.
9. If applicable, fill in section G about pre/post-natal expenses, indicating whether the pregnancy was naturally conceived.
10. In section H, disclose if you have claimed from any other insurers or parties for the same medical bills. This is important to avoid duplicate reimbursement.
11. Provide payment details in section I, including whether benefits should be payable to the policyholder, third party, or claimant, and how payment should be made.
12. In section J, read and complete the declaration, providing signatures as necessary. Note that a guardian’s signature is required if the patient is a minor.
13. Finally, review all entered information for accuracy. You can then save the changes, download, print, or share the form as required.

Complete your Outpatient Claim Form online today for a seamless claims experience.