Medium

Available on

Apple Android Windows

Individual Life Outpatient & Dental Benefits Claim Form (Hong Kong) Mobile App

This app enables the claimant to file for Outpatient and Dental Claims Benefits using their mobile device. Expertly designed to capture all the relevant details including description of symptoms, first consultation date, outpatient benefits, dental benefits and more.

  • Lendlease
  • The Cooperative
  • PG&E
  • oxy
  • Red Bull
  • Mirvac

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Take a peek inside the Individual Life Outpatient & Dental Benefits Claim Form (Hong Kong) Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico integer

    Policy Number

  • Ico textbox

    Name of Proposed Insured/Insured

  • Ico textbox

    I.

  • Ico integer

    Area Code

  • Ico textbox

    Agency/Broker Name

  • Ico textbox

    Agent/Broker Code

  • Ico statictext

    Operations Team:

  • Ico textbox

    Agent/Broker’s Name

  • Ico integer

    Agent/Broker’s Tel.

  • Ico checkbox

    New Claim

  • Ico checkbox

    Further Claim

  • Ico checkbox

    Pending Claim

  • Ico checkbox

    Review/Appeal

  • Ico dropdown

    Are you making any other insurance or compensation claim as a result of this treatment?

  • Ico statictext

    If yes, please provide the below information.

  • Ico textbox

    Name of insurance company/organization:

  • Ico textbox

    Policy No.

  • Ico dropdown

    Any relationship between the Registered Medical Practitioner/ Medical Services Provider and Insur...

  • Ico textbox

    If so, please state the relationship.

  • Ico statictext

    Please complete questions 1 to 5 if consultation was due to accident

  • Ico date

    1. Date of accident

  • Ico multiline

    2. Where and how did it happen

  • Ico multiline

    3. Part of body injured and type of injury

  • Ico multiline

    4. Present occupation (if more than one, state all) and exact nature of occupational duties

  • Ico multiline

    5. Name and address of business or employer

  • Ico statictext

    Please complete questions 6 to 9 if consultation was due to illness

  • Ico multiline

    6. Give a brief description of symptoms

  • Ico textbox

    How long have these symptoms existed prior to the first consultation?

  • ...and More!

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