How to request for Letter of Guarantee (LOG) For elective/pre-planned hospital admission(s) in Singapore, the insured can request for a Letter of Guarantee (LOG) from AXA by providing the following completed LOG forms at least 5 working days prior to the date of admission. Please note that if we do not receive the completed forms within the stipulated time frame, insured member may be required to settle his/her incurred medical expenses and submit a claim for evaluation. Please download the LOG form that consist of: • Part 1 refers to the Authorization for Release of Medical Information Form to be completed by the patient. • Part 2 refers to the Pre admission form to be completed by the Treating Doctor Additional documents may be requested for further assessment on a case to case basis. This would include but not limited to Referral Letter, Diagnostic test/report and/or other relevant documents such as Hospital Financial Counseling/Admission Forms. For emergency Hospital admission(s) in Singapore, we will help to liaise with the hospital for the LOG forms once notified. If completed LOG forms are not received prior to the discharge, insured member will be required to settle the incurred hospital expenses and submit a claim for evaluation. For cases wherein the LOG is not approved, the insured member will be also required to settle the incurred hospital expenses and submit a claim for evaluation. Please refer to the Hospital and Day Surgery Centers in Singapore which accept our LOG. Government/Restructured Hospital • Changi General Hospital • KK Women's and Children's Hospital • National University Hospital • Singapore General Hospital • Tan Tock Seng Hospital Private Hospital and Day Surgery Centers • Fortis Surgical Hospital • Gleneagles Hospital • Mount Alvernia Hospital • Mount Elizabeth Hospital • Mount Elizabeth Novena Hospital • Novena Surgery Pte Ltd • Pacific Surgical & Endoscopy Centre • Parkway East Hospital • Raffles Hospital • Thomson Medical Centre For Overseas Hospital • LOG facility is only applicable for International Exclusive Plan Hospital & Surgical Claim Frequently Asked Questions (FAQs) 1. When can I get my claim reimbursement? Once we have received your fully completed claim form and complete information/documents, we will assess the claim and send any payments due as soon as possible. This will usually take about 14 working days, subject to the nature and complexity of the claim. Should we require more information, or if your claim is not eligible for the benefit, we will contact you to explain our position. In these instances, the assessment may take longer than 14 days. 2. Can I submit my claim direct to your company if I have a Broker/Agent representing me? All claims must be sent to the intermediary first unless otherwise. 3. What is the grace period to submit a claim? Claims must be lodged within 30 days from the date of occurrence. Please notify us in writing if the timeline cannot be met. 4. I am claiming from 2 insurance companies. What is the procedure? Please indicate in the claim form that you are lodging the claim from another insurer. Please submit a copy of the settlement advice and tax invoices in order for us to reimburse the balance. The reimbursement should not exceed the total amount that you have incurred. 5. How much can I claim from my policy? This depends on the benefit entitlement in your policy. Please refer to the Schedule of Benefits. 6. If I am overseas for a period of time, is there any extension to submit my claim? Yes, we will grant an extension period of up to 90 days for your claim submission upon your return. In any case, please notify us in writing if you are overseas or if there is likely to be a delay in your claim submission. 7. I have multiple admissions in hospital. How do I submit the claim? Each admission or surgery must be accompanied by a claim form and a medical report. Claim forms are not required for follow-up visits to the same doctor/hospital. 8. What is the minimum number of hours to be confined in hospital in order to lodge a claim? For day surgery cases, there are no minimum hours to be eligible for claim. However, for non-surgical admissions, when you are charged for a full day room and board, you can submit the claim for assessment. 9. When I utilize my Medisave/Medishield Ingrated Plan to pay for my treatment, how will my claim be reimbursed? Payment made by Medisave will be refunded to the respective Medisave Account holder and Medishield Integrated Plan. Service Team handles all claims calls and operates as a One-Stop Claims Status Enquiry and Advice Centre and the team is fully trained to provide clear information, explanations and appropriate advice to the customers. 12. What are the essential points to note when submitting a Health Claim? Step 1: Complete the claim form Complete the appropriate claim form depending on the type of claim to be made namely: a) Out-Patient Claim b) In-Patient Claim The following information MUST be provided: 1) member’s ID card/passport number 2) policy/membership numbers 3) name of policyholder 4) name of claimant 5) details of illness/injury 6) diagnosis Step 2: Obtain original documents, medical reports & invoices In case of hospitalization or medical-related claims, please submit all: a) Original medical receipts together with itemized invoices and bills b) Original or photocopies of Medical report issued by the attending registered physician c) Other appropriate documents as the case may be: For admission to Government/Restructured Hospitals 1. A copy of the Day Surgery Authorization Form signed by the patient before surgery. 2. A copy of the Referral Letter from a General Practitioner, if any. 3. The original final Summary Bill and Original Detailed Final Hospital Bill. 4. Original Outpatient Bills/Receipts for any Pre-Hospitalisation / Pre-Surgery and Post- Hospitalisation follow-up bills for expenses incurred. 5. A copy of the Inpatient Discharge Summary given to the patient upon discharge. For admission to a Private Hospital 1. A copy of the Day Surgery Authorization Form signed by the patient before surgery. 2. A copy of the Referral Letter from a General Practitioner, if any. 3. The original final Summary Bill and Original Detailed Final Hospital Bill. 4. Original Outpatient Bills/Receipts for any Pre-Hospitalisation / Pre-Surgery and Post- Hospitalisation follow-up bills for expenses incurred. 5. Medical Certification of Treatment to be completed by the attending physician/surgeon. Step 3: Submit the completed claim form and required documents to: AXA Insurance Singapore Pte Ltd Health Claims Department 8 Shenton Way #27-01 AXA Tower Singapore 068811 .