2023 MEDICAL INSURANCE PACKAGE No.HEALTH CARE INSURANCEUIC CAREIINFORMATION Insurance companyUnited Insurance Of Company (UIC) Policy holderThe Representative Office Of Sabre International B.V. In Hanoi City Policy numberCPH230004HPD Insurance periodFrom 01.05.2023 to 30.04.2024IIINSURANCE BENEFITSDetailIIIGUIDELINE INSURANCE HandbookDetail Wording policyDeatail EN | Detail VN General guideline claimsDetail Guideline claim processDetailIVFORM Claim FormWord | PDF Accident report formWord | PDFVDIRECT BILLING Direct billing networkDetail Black list networkDanh sách blacklist của UICVIGENERAL EXCLUSION CLAUSEWording policy: for PA (Page 4 – 6) ; for healthcare (page 19 – 21)Quy tắc bảo hiểm: Tai nạn (Trang 4 – 6) ; Sức khỏe (trang18 – 20) NOTE (DIRECT BILLING AND CLAIM BACK) 1. DIRECT BILLINGDirect billing with INS’s network (TPA)Inpatient treatment (illness/diseases/child-bilth)Out patient (illness/diseases)Dental treatment (diseases) 2. CLAIM BACKOfficial medical facilities at VietnamHospitallization treatment (illness/diseases/accident/child-birth)Outpatient (illness/diseases/ accident)Death/ disablement (illness/diseases/accident/child-birth) (*) TimelineSubmit claim back: within 180 days since treatment dateTo proceed claim: 10 – 15 working daysPayment for claimback: 03 – 05 working days CONTACT bolttech (Medical benefits) Mrs. Nguyễn Hồng MinhEmail: minh.nguyen@bolttech.ioMobile: 0943 457 005 Mrs. Phạm Thị Quỳnh MaiEmail: mai.pham@bolttech.ioMobile: 0904 990 910 bolttech (Claim support) (*) NORTHMr. Dương Hùng ChiếnEmail: chien.duong@bolttech.ioMobile: 0904 990 910 (*) SOUTHMr. Phan Cao KhangEmail: khang.phan@bolttech.ioMobile: 0976 682 399 Pacific Prime Insurance Brokers (Overall Client Support) AddressCross Street Exchange #14-0518 Cross StreetSingapore 048423 ContactTel: +65 6346 3781 (ext 1111)Email: sabre@pacificprime.com