REQUIREMENTS FOR INPATIENT (IP) CLAIMS

1. Completed/signed IP claim form.
2. Hospital Statement of Account (photocopy ok).
3. BIR-approved invoices for professional fees | hospital bills.
4. Meds bought outside from non-availability must have the corresponding Rx. 
5. All documents must be original copies (except Statements of Account).
6. Erasures should be be countersigned by the authorized signatory.

*The above list of requirements is not final: ETIQA reserves the right to request additional docs on a case-to-case basis.

**If any claim exceed P10,000, original receipts will be required.

*** Submit claim form and all supporting documents to PURPLE COW through https://go2.purplecow.ph/SubmitClaims.