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    Call Report

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    Nurhafieza Haron
    This letter guarantees payment of up to RM2500 for Siti Nurhafieza Haron's hospitalization at KPJ Ampang Puteri Specialist Hospital from May 22, 2023 for ACS TRO NSTEMI. It is valid for one admission only. The guarantee is from Great Eastern Life Assurance under policy G1050376 for policyholder OCBC Bank. Certain non-medical items and excluded illnesses will not be covered. The hospital should contact MiCare for approval if bills exceed the eligible expenses.

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    Call Report

    Uploaded by

    Nurhafieza Haron
    58 views1 page
    This letter guarantees payment of up to RM2500 for Siti Nurhafieza Haron's hospitalization at KPJ Ampang Puteri Specialist Hospital from May 22, 2023 for ACS TRO NSTEMI. It is valid for one admission only. The guarantee is from Great Eastern Life Assurance under policy G1050376 for policyholder OCBC Bank. Certain non-medical items and excluded illnesses will not be covered. The hospital should contact MiCare for approval if bills exceed the eligible expenses.

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    This letter guarantees payment of up to RM2500 for Siti Nurhafieza Haron's hospitalization at KPJ Ampang Puteri Specialist Hospital from May 22, 2023 for ACS TRO NSTEMI. It is valid for one admission only. The guarantee is from Great Eastern Life Assurance under policy G1050376 for policyholder OCBC Bank. Certain non-medical items and excluded illnesses will not be covered. The hospital should contact MiCare for approval if bills exceed the eligible expenses.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    58 views1 page

    Call Report

    Uploaded by

    Nurhafieza Haron
    This letter guarantees payment of up to RM2500 for Siti Nurhafieza Haron's hospitalization at KPJ Ampang Puteri Specialist Hospital from May 22, 2023 for ACS TRO NSTEMI. It is valid for one admission only. The guarantee is from Great Eastern Life Assurance under policy G1050376 for policyholder OCBC Bank. Certain non-medical items and excluded illnesses will not be covered. The hospital should contact MiCare for approval if bills exceed the eligible expenses.

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    © All Rights Reserved
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    HOSPITALISATION GUARANTEE LETTER

    Our Ref : G1050376IP05230052 Issued By : maizatulakmam


    Issue Date : 22 May 2023 Insurer : Great Eastern Life Assurance (Malaysia)
    Berhad

    To Hospital : KPJ AMPANG PUTERI SPECIALIST Admitting Diagnosis : ACS TRO NSTEMI (Not cover if Covid-19
    HOSPITAL positive)
    Admission Date : 22 May 2023 Admitting Doctor : Ismail Yaakob

    Policy No : G1050376
    Policyholder Name : OCBC BANK (MALAYSIA) BERHAD
    (G1050376)
    Patient Name : SITI NURHAFIEZA BINTI HARON
    Patient NRIC : 961226115242

    Guarantee Amount : RM2500.00


    Daily Room & Board : 4-Bedded
    Bill To : Great Eastern Life Assurance (Malaysia) Berhad
    C/O MICARE SDN BHD
    This is to acknowledge that MiCare Sdn Bhd on behalf of Great Eastern Life Assurance(Malaysia) Berhad , undertakes to make payment of medical
    related bills relating to the above treatment incurred by the aforesaid patient at your hospital during the specified date.
    This guarantee letter is valid for ONE ADMISSION ONLY.

    This guarantee does not cover the following items and shall be borne by the patient:
    1. Excess daily Room & Board charges.
    2. Television, telephones, tele - services, radios or similar facilities, admission kit/pack, lodger, laundry, personal laundry, cafeteria services, extra
    food and beverages, ID Tag and other in eligible non medical items.
    3. Vitamins, supplements or any drugs not related to the treatment of the admitting diagnosis and supply of drugs exceeding the Follow Up expiry
    dates.
    4. Admission for diseases excluded under the policy.
    5. Charges in connection with outpatient treatment, medical check-up or routine tests, pregnancy related illness (such as childbirth, caesarean
    delivery, abortion, miscarriage, and prescriptions thereof) and cosmetic surgery
    6. Any outpatient dept fees or facility fees is not payable.
    7. Aid, braces, appliances, glasses and refractive equipment, use or acquisition of external prosthetic appliances, hearing aids implanted
    pacemakers and prescriptions thereof. (Except medically necessarily pace maker device recommended by doctor)

    Please Note:
    1) Patient understands that the coverage guaranteed in this Initial Guarantee Letter will be subjected to terms and condition of the policy and
    MiCare Sdn Bhd reserves the right to retract coverage if subsequent information obtained does not fulfil the terms and condition of the policy.
    2) If the total bill for this admission exceeds the eligible expenses, hospital to contact MiCare Sdn Bhd immediately at 03 7839 7813
    for further review. We will not accept excess charges without further reference to MiCare Sdn Bhd.
    Please fax the itemized bill to following number to obtain the Payment Notice before discharging the patient:
    +603-7847 4304 (24 Hours Fax Line)

    Please bill and post the original itemized bill, Guarantee Letter, and Authorized Claim Form duly completed to:

    GREAT EASTERN LIFE ASSURANCE (MALAYSIA) BERHAD (93745-A)


    MENARA GREAT EASTERN LEVEL 16, 303 JALAN AMPANG, 50450 KUALA LUMPUR, MALAYSIA.
    (Attention: Healthcare Services Department)

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