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Claims Reimbursement

In most cases, participating providers will file claims on your behalf with NetCare. If however, you are required to pay for services at the time of the visit and request reimbursement, you must file a claim within 90 days of the date of service to include the following information:

  • Completed and Signed Request for Reimbursement Form
  • Insurance Claim Form completed by the Provider which must include CPT and Diagnosis Code
  • Original Receipts
  • Reimbursements from the Philippines must include detailed medical notes and original receipts
  • Receipts and medical notes in a foreign language must be translated into English. Translations must be detailed for each service rendered including each medication dispensed.
  • Reimbursement for claims from a non-participating provider are subject to the annual plan deductibles and NetCare’s Usual, Customary and Reasonable Charges.

Incomplete claims will be returned to the member. NetCare will not request documents from providers on behalf of the member. Claims filed beyond 90 days of the date of service will become the sole financial responsibility of the member. NetCare will reimburse members based on the Plan benefits within 30 to 45 days of receipt of all completed and required documents

Request for Reimbursement Form
Co-Payment Maximum Claim Form
Prescription Reimbursement Form
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