REQUIREMENTS FOR OUTPATIENT (OP) CLAIMS

1. Completed/signed OP claim form.
2. Medical certificate in-lieu of doctor’s diagnosis on claim form.
3. BIR-approved invoices for professional fees | hospital bills.
4. For lab expenses, lab request signed by the doctor (photocopy ok).
5. All documents must be original copies (except lab requests).
6. Erasures should 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 claims exceed P10,000, original receipts will be required.

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