HOW TO CLAIM TUTORIAL

HOW TO CLAIM TUTORIAL

HOW TO CLAIM TUTORIAL CONTENTS Medilink Direct Billing Network Out of Network (Pay and Claim) Medical Claims Filling Instructions Dental Claims Filling Instructions

DIRECT BILLING NETWORK MEDILINK

INTRODUCTION MEDILINK DIRECT BILLING NETWORK Integra Global provides its members residing in China, Hong Kong, Singapore and Malaysia a Direct Billing Network through MediLink. All our members who reside in these countries receive an additional MediLink Card that enables access to medical providers within the network. By presenting your MediLink Card to your medical provider at the time of your medical visit all eligible medical expenses are handled directly through the provider and MediLink. There is no additional paperwork or additional claims filing. For you this means no or minimal cash outlay and no claims filing and waiting for reimbursement. Direct Billing is the most convenient way for you to access the benefits of your Integra Global Health Plan.

The Medilink Direct Billing Network is only available in the following countries: cb HONG KONG CHINA SINGAPORE MACAU MALAYSIA THAILAND & VIETNAM (SELECTED PROVIDERS)

INSTRUCTIONS HONG KONG 1. Select a Medilink Provider from the Direct Billing List or by accessing the list online http://www.medilink-global.com.cn/forms/index.aspx. 2. Contact Medilink (at least 1 day) in advance to schedule an appointment. 3. At the front desk, present your MediLink Card along with your Integra Global membership card and a photo ID. 4. See your Provider. 5. In the event of a deductible or co payment, please pay this amount to the provider at the time of your visit. 6. No further payment or paperwork necessary. Provider will be paid by Integra Global directly.

INSTRUCTIONS CHINA 1. Select a Medilink Provider from the Direct Billing List or by accessing the list online http://www.medilink-global.com.cn/forms/index.aspx. 2. At the front desk, present your MediLink Card along with your Integra Global membership card and a photo ID. 3. See your Provider. 4. In the event of a deductible or co payment, please pay this amount to the provider at the time of your visit. 5. No further payment or paperwork necessary. Provider will be paid by Integra Global directly.

INSTRUCTIONS SINGAPORE 1. Select a Medilink Provider from the Direct Billing List or by accessing the list online http://www.medilink-global.com.cn/forms/index.aspx. 2. At the front desk, present your MediLink Card along with your Integra Global membership card and a photo ID. 3. See your Provider. 4. In the event of a deductible or co payment, please pay this amount to the provider at the time of your visit. 5. No further payment or paperwork necessary. Provider will be paid by Integra Global directly.

NEED ASSISTANCE? Email: assist@lamphealthcare.cn Medilink Hotline: +86 400 880 8820 (office hours) Medilink Hotline: +86 010 6552 5313 (24 hours) Service Office: +86 400 8850 570 / +86 512 62725689 (office hours) IMPORTANT INFORMATION In order to facilitate Direct Billing you must present your MediLink Card to the medical provider otherwise no direct payment can be established.

DO I HAVE TO USE A PROVIDER IN THE MEDILINK NETWORK? The MediLink Direct Billing Network is provided to you for your convenience but you are not restricted to use the in-network providers only. You can choose any recognized healthcare provider who is not part of the Direct Billing Network, and pay for the treatment initially yourself, then submit a claim to us for reimbursement of the eligible charges. *Please make sure to pre-authorise any necessary procedures.

OUT OF NETWORK We work with all hospitals, doctors, clinics and all laboratories as long as they are properly licensed and qualified to treat your condition.

MEDICAL INSTRUCTIONS PAY AND CLAIM FILLING 1. Choose your provider in your geographic area of coverage. 2. Determine if you require Pre-Authorisation. 3. Visit your provider. 4. Fill out the Integra Global claim form. 5. Scan and upload your receipts with the claim form to your computer. 6. Submit your claim form along with your receipts to integraglobal@lampinsurance.com

Chester House Harlands Road Haywards Heath West Sussex RH16 1LR Telephone: +44 (0)1444 444957 Facsimile: +44 (0)1444 450872 HEALTH INSURANCE CLAIM FORM IMPORTANT: Please complete form in full, failure to do so may delay payment of claim. Proof of claim must be submitted within 90 days of first of accident of illness. In order for your health claim to be considered for reimbursement, you must complete and sign this claim form. Please mail or fax this completed claim form with itemized bills and receipts to the address or fax listed above. When mailing, please tape small receipts to on a letter or A4 paper. Please do not staple receipts to claim form. A separate claim form should be used for each patient and each medical condition. Documents and signed claim forms can be scanned and emailed to: healthcare@lampinsurance.com SECTION A: Member and Patient Information Certificate Number: Policy Holder s Name: Policy Holder s D.O.B (dd/mm/yyyy) Name of Employer: Mailing Address: Street Address: City: Country: State /Province: Postal/Zip Code: Patient s Name: Patient s Date of Birth: (dd/mm/yyyy) E-mail address: Gender: Male Female Patient s relationship to Insured: Self Spouse Child Other SECTION B: Claim Information Please indicate: Date of illness (first symptom)/injury (accident)/pregnancy (last menstrual period: (dd/mm/yyyy) Date of first consultation: (dd/mm/yyyy) The following information must be completed by either Member or Provider. Foreign language claims: Member, please complete in English Date of Service dd/m/yyyy Place of Service * Provider Name, Address & Phone Number of Provider Fully describe treatment for each date given Diagnosis Charges & Currency Type of Service ** * Place of service ** Type of Service Code 21 (IH) = Inpatient Hospital 8I (IL) Independent Laboratory 1 Medical 5 Anesthesia (Duration required) 22 (OH) Outpatient Hospital 2 Surgery 6 Assistance Surgery 11 (OV) Doctors Office 3 Consultation 7 Other Medical Service 12 (HV) Patient s Home 4 Diagnostic Laboratory

DENTAL INSTRUCTIONS PAY AND CLAIM FILLING 1. Choose your provider in your geographic area of coverage. 2. Determine if you require Pre-Authorisation. 3. Visit your dental provider. 4. Fill out the Integra Global Dental claim form. 5. Scan and upload your receipts with the claim form to your computer. 6. Submit your claim form along with your receipts to integraglobal@lampinsurance.com

Chester House Harlands Road Haywards Heath West Sussex RH16 1LR Telephone: +44 (0)1444 444957 Facsimile: +44 (0)1444 450872 DENTAL INSURANCE CLAIM FORM IMPORTANT: Please complete form in full, failure to do so may delay payment of claim. Proof of claim must be submitted within 90 days of first of incident. In order for your dental claim to be considered for reimbursement, you must complete and sign this claim form. Please mail or fax this completed claim form with itemized bills and receipts to the address or fax listed above. When mailing, please tape small receipts to a letter or A4 paper. Please do not staple receipts to claim form. Documents and signed claim forms can be scanned and emailed to: healthcare@lampinsurance.com SECTION A: Member and Patient Information Certificate Number: Policy Holder: Policy Holder s D.O.B (dd/mm/yyyy) Street Address: Mailing Address: State/Province: City: Postal/Zip Code: Country: Patient s Name: Patient s D.O.B: (dd/mm/yyyy) Email Address: Patient s relationship to Insured: Self Spouse Gender: Male Female Child Other SECTION B: Claim Information REIMBURSEMENT: Payments are made in USD dollars unless other currency is requested and are subject to USD Exchange Rate of date service rendered. ASSIGNMENT OF BENEFITS: Yes No (Yes, for direct payment to dental practitioner or hospital) I hereby authorise payment to the dental practitioner or hospital as indicated on receipts. I understand that I am financially responsible for charges not covered by the policy. Payment will be made by Wire Transfer. Please note your bank or other intermediary bank may assess a fee for the receipt of a wire transfer and that these fees are not reimbursable under this plan. Please note that wire transfer may also be processed in other currencies, to request a different currency please indicate: Beneficiary Name(s) (as it appears on the account): Bank Account No: Bank Name: Bank Address: Bank Tel. No: Account Currency: Swift Code/BIC: IBAN#: SECTION C: Policy holder or authorized person s Signature and Release (Parent or Guardian, if claim is for minor). I certify, to the best of my knowledge, that this Claim Form does not contain any false, misleading or incomplete information. I authorise the release of all records or other information that may be necessary to determine benefits payable. POLICY HOLDER OR AUTHORISED SIGNATURE: DATE: (dd/mm/yyyy)

WHEN DO I NEED A PRE AUTHORISATION? All hospital stays (inpatient), outpatient surgery, medical transportation (except for local emergency transportation) or medical procedures over US$500 must be pre-authorised. By pre-authorising your planned medical treatment we can set-up a direct-payment arrangement with the provider so that you do not have to submit any paperwork or claims forms. For hospital stays and outpatient surgery, please notify us well in advance so that payment guarantees to the hospital can be arranged. In the event the expense is less than US $500, you can pay the provider directly and submit a Claim Form and copy of the invoice to us for reimbursement directly to your bank account. All claims forms and invoices may be scanned and emailed or faxed to us. We do not require originals or hard copies from you.