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RPT Hos OPGL

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Sidahu Amran
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31 views1 page

RPT Hos OPGL

Uploaded by

Sidahu Amran
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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OUTPATIENT SPECIALIST TREATMENT GUARANTEE LETTER

Our Ref : ALAFOP03210089 Claim No : ALAFCOP03210082


Issue Date : 26 Mar 2021 Issued by : sartilla
Time : 01:20:44 PM
Patient Information
Patient Name : ROSIDAH BINTI OTHMAN Patient IC : 730224065220
Relationship : Self
Hospitalization Information
Consultation Date : 26 Mar 2021 Diagnosis : DM, Acute bell's palsy
Hospital : PAHANG MEDICAL CENTRE
Guarantee Amount (RM) : 500.00
Attending Doctor : DR TENGKU SYED MUHAMMAD NAQUIB
Validity Period : 26 Mar 2021 - 01 Apr 2021 Coverage Type : Outpatient Specialist
(Please submit a completed Outpatient Specialist Claim Form when submitting original invoices)
If exceeded guarantee amount, please call MiCare for Top Up. Top Up is subject to the available balance.

Insurance Policy Information


Company Name : ALAM FLORA SDN BHD - ASO Employee Name : ROSIDAH BINTI OTHMAN
Bill To : ALAM FLORA SDN BHD - ASO C/O MICARE SDN BHD
Benefit Group : G1 System ID : ALAF002118

MiCare Sdn Bhd hereby guarantees to bear the medical and surgical expenses for the above treatment incurred by the
aforesaid patient at your hospital. The guarantee of outpatient treatment is valid only for the above stated treatment provided
by your hospital during the aforesaid specified date(s).

This guarantee letter is ONLY applicable for Outpatient Specialist care and NOT for hospitalization and will only
cover for ONE Outpatient Treatment inclusive of the following items:
1) The Attending Physician's Consultation fees, Treatment and Procedure which medically related to the above treatment
only.

2) X-ray, Ultrasound, Scanning, Laboratory Test, which medically related to the above treatment only.
This guarantee letter DOES NOT COVER the following items and shall be borne by the patient:
1) Vitamins and any drugs not related to the treatment of the aforesaid diagnosis.

2) Any test not related to the treatment of the aforesaid diagnosis.

Please Note:
1) The Patient understands that this letter does not supersede or vary the terms and conditions.
2) If there is any other medical update, hospital to contact MiCare Sdn Bhd immediately at 1-800-88-2678 for further review.
We will not accept excess charges without further reference to MiCare Sdn Bhd.
Please post the original itemized bill, Guarantee Letter, and Outpatient Specialist Claim Form duly completed to:
MiCare Sdn Bhd
No. 22, Block A, Jalan Astaka U8/84,
Seksyen U8, Bukit Jelutong,
40150 Shah Alam, Selangor Darul Ehsan,
(Attention: Claims Department)

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