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    rptHosOPGL 2

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    amir ashraf mokhtar
    This letter guarantees payment of up to RM500 for outpatient specialist treatment received by Anas Bin Amir Ashraf at KPJ Ampang Puteri Specialist Hospital from September 3 to September 9, 2020 for a diagnosis of bronchial asthma. The guarantee covers consultation fees, treatments, procedures, x-rays, scans, lab tests and drugs related to the stated diagnosis. Items not covered include vitamins, drugs not related to treatment, and tests not related to the diagnosis. Original invoices along with a completed claim form must be submitted to MiCare Sdn Bhd by the specified deadline.

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    rptHosOPGL 2

    Uploaded by

    amir ashraf mokhtar
    42 views1 page
    This letter guarantees payment of up to RM500 for outpatient specialist treatment received by Anas Bin Amir Ashraf at KPJ Ampang Puteri Specialist Hospital from September 3 to September 9, 2020 for a diagnosis of bronchial asthma. The guarantee covers consultation fees, treatments, procedures, x-rays, scans, lab tests and drugs related to the stated diagnosis. Items not covered include vitamins, drugs not related to treatment, and tests not related to the diagnosis. Original invoices along with a completed claim form must be submitted to MiCare Sdn Bhd by the specified deadline.

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    This letter guarantees payment of up to RM500 for outpatient specialist treatment received by Anas Bin Amir Ashraf at KPJ Ampang Puteri Specialist Hospital from September 3 to September 9, 2020 for a diagnosis of bronchial asthma. The guarantee covers consultation fees, treatments, procedures, x-rays, scans, lab tests and drugs related to the stated diagnosis. Items not covered include vitamins, drugs not related to treatment, and tests not related to the diagnosis. Original invoices along with a completed claim form must be submitted to MiCare Sdn Bhd by the specified deadline.

    Copyright:

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

    rptHosOPGL 2

    Uploaded by

    amir ashraf mokhtar
    This letter guarantees payment of up to RM500 for outpatient specialist treatment received by Anas Bin Amir Ashraf at KPJ Ampang Puteri Specialist Hospital from September 3 to September 9, 2020 for a diagnosis of bronchial asthma. The guarantee covers consultation fees, treatments, procedures, x-rays, scans, lab tests and drugs related to the stated diagnosis. Items not covered include vitamins, drugs not related to treatment, and tests not related to the diagnosis. Original invoices along with a completed claim form must be submitted to MiCare Sdn Bhd by the specified deadline.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    OUTPATIENT SPECIALIST TREATMENT GUARANTEE LETTER

    Our Ref : DHFROP09200001 Claim No : DHFRCOP09200001


    Issue Date : 03 Sep 2020 Issued by : mohameddaniel
    Time : 12:15:28 PM
    Patient Information
    Patient Name : ANAS BIN AMIR ASHRAF Patient IC : 181004102991
    Relationship : Child
    Hospitalization Information
    Consultation Date : 03 Sep 2020 Diagnosis : BRONCHIAL ASTHMA
    Hospital : KPJ AMPANG PUTERI SPECIALIST
    HOSPITAL
    Guarantee Amount (RM) : 500.00
    Attending Doctor : DR FADZLINA ABDUL AZIZ
    Validity Period : 03 Sep 2020 - 09 Sep 2020 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 : TELSTRA GLOBAL (MALAYSIA) SDN Employee Name : AMIR ASHRAF BIN MOKHTAR
    BHD
    Bill To : AmMetLife Insurance Berhad C/O MICARE SDN BHD
    Benefit Group : AM250 System ID : DHFR000189

    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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