Individual

Please call Allianz’s Customer HealthCare Administration:

• Helpline : 1-300-88-8322
• Land-Line : +603 2099-1888

For claim status enquiries:

• Login to MyAllianz (claim information will be updated after 24 hours)
• Contact your agent
• Call Allianz’s Contact Centre Hotline 1-300-22-5542 (Monday to Friday, 8am to 8pm)
• Email to customer.service@allianz.com.my

• Claimant’s Statement (Hospitalisation and Surgical Claim)
  Please indicate "Hospital Income Benefit" on Claimant's Statement.
  Download form
• Claimant’s NRIC (Both Sides) / Passport Copy, duly certified (if not submitted previously)
• E-Payment Authorisation Form (if not submitted previously)
  Download form
  
• Updating of e-Invoice Details (if not submitted previously)
  Download form

• Medical Report (Hospitalisation Claim)
  Download form
• Inpatient Bills indicating:
  - Date of admission and discharge
  - Number of days of Room and Board charged by hospital
• Diagnostic Reports for example
  - Magnetic Resonance Imaging (MRI)
  - X-ray
  - Histopathology Examination (HPE)
  - Blood Test
  - Computed Tomography (CT) Scan
  - Coronary Angiogram
  - Electrocardiography (ECG)

• Claimant's Statement (Outpatient Treatment Claim)
  Download form
• Claimant’s NRIC (Both Sides) / Passport Copy, duly certified (if not submitted previously)
• E-Payment Authorisation Form (if not submitted previously)
  Download form
  
• Updating of e-Invoice Details (if not submitted previously)
  Download form

• Original Receipts
• Original Final Tax Invoices
• Itemised Bills / Detailed Bills indicating:
  - Doctor’s Fee
  - Medicine Charges (including medicine name, unit price, prescribed quantity and supply duration)
  - Test / Investigation Charges
• Diagnostic Reports, for example:
  - Magnetic Resonance Imaging (MRI)
  - X-ray
  - Histopathology Examination (HPE)
  - Blood Test
  - Computed Tomography (CT) Scan
  - Coronary Angiogram
  - Electrocardiography (ECG)
• For Outpatient Accident Treatment only:
  - Medical Report (Accident Claim)
  Only necessary when total claim amount exceeds RM500. If total claim amount is RM500 or below, diagnosis, date and cause of accident have to be endorsed by the treating doctor on the bills (with signature and clinic’s official stamp)
  Download form
• For Overseas Treatment (not required for Singapore and Brunei) please include
  Proof of Life Assured leaving Malaysia:
  - Life Assured’s Passport Copy indicating date of departure from Malaysia
  - Boarding Pass
  - Travel Ticket Details
  
  Following supporting documents in English:
  - Medical Report
  - Original Receipts
  - Original Final Tax Invoices/Final Bills
  - Itemised Bills/Detailed Bills
  - Diagnostic Reports

*Note: Outpatient Dengue or Enteric Fever Treatment is only coverable for MediSafe Infinite, MediSafe Infinite Xtra and MediEssential Plans.

• Claimant’s Statement (Accident Claim)
  Download form
• Claimant’s NRIC (Both Sides) / Passport Copy, duly certified (if not submitted previously)
• E-Payment Authorisation Form (if not submitted previously)
  Download form
• Updating of e-Invoice Details (if not submitted previously)
  Download form
  
• Police Report (if any)
  

• Medical Report (Accident Claim)
  Download form
• Medical Certificate or Sick Leave (minimum 7 days)
• Radiology Reports for example:
  - Magnetic Resonance Imaging (MRI)
  - X-ray
  - Computed Tomography (CT) Scan

• Claimant’s Statement (Accident Claim)
  Download form
• Claimant’s NRIC (Both Sides) / Passport Copy, duly certified (if not submitted previously)
• E-Payment Authorisation Form (if not submitted previously)
  Download form
• Updating of e-Invoice Details (if not submitted previously)
  Download form
  
• Photograph of Dismemberment
  
• Police Report (if any)

• Medical Report (Accident Claim)
  Download form
• X-ray Film and Radiologist Report
• All relevant investigation reports to support the dismemberment

Please request your treating doctor to fill in the medical report, and include other relevant investigation reports.

Angioplasty

• Medical Report (Heart Related Condition)
  Download form
• Coronary Angiogram Report
• Angioplasty/Percutaneous Coronary Intervention (PCI) Report
• Electrocardiography (ECG) Report

Cancer

• Medical Report (Cancer)
  Download form
• Histopathology Examination (HPE)/Biopsy Report
• Bone Marrow Trephine/Aspiration Report (for Blood Cancers only)
• All relevant investigation reports, for example, Blood Test, Laboratory Test, Computed Tomography (CT) Scan, Magnetic Resonance Imaging (MRI), Pap Smear and Mammogram (if any)

Coronary Artery By-Pass

• Medical Report (Heart Related Condition)
  Download form
  
• Surgical Report

Heart Attack

• Medical Report (Heart Related Condition)
  Download form
  
• Cardiac Enzyme (Creatine Kinase-MB (CK-MB), Troponin T, Troponin I) Test Results
• Electrocardiography (ECG) Report
• Echocardiogram Report (if any)
• Coronary Angiogram Report (if any)

Kidney Failure

• Medical Report (Kidney Failure)
  Download form
• Kidney Dialysis Appointment Card
• Copy of Kidney Dialysis Receipts (if any)
• Kidney Function Test Results
• If kidney transplantation has been performed, please include a copy of:
  - Surgical Report
  - Admission Bills
  - Discharge Summary

Other Coronary Artery Disease

• Medical Report (Heart Related Condition)
  Download form
• Coronary Angiogram Report

Stroke

• Medical Report (Brain & Spine Related Condition)
  Download form
  
• Brain Magnetic Resonance Imaging (MRI)/Computed Tomography (CT) Scan Report

Please request your treating doctor to fill in the medical report, and include other relevant investigation reports.

AIDS

• Medical Report (AIDS)
  Download form
• Human Immunodeficiency Virus (HIV) Antibody Test Results
• Western Blot Test Results
• CD4 Cell Count Results
• All relevant investigation reports, for example, Computed Tomography (CT) Scan, Magnetic Resonance Imaging (MRI), Biopsy (if any)

Bacterial Meningitis

• Medical Report (Bacterial Meningitis)
  Download form
• Brain and Spine Computed Tomography (CT) Scan/Magnetic Resonance Imaging (MRI) Report
• All relevant investigation reports (if any)

Benign Brain Tumour

• Medical Report (Benign Brain Tumour)
  Download form
• Brain Computed Tomography (CT) Scan/Magnetic Resonance Imaging (MRI)/Biopsy Report

Blindness

• Medical Report (Blindness)
  Download form
• Visual Acuity Report on both eyes to be completed by ophthalmologist
• All relevant investigation reports, for example, Brain Computed Tomography (CT) Scan/Magnetic Resonance Imaging (MRI) (if any)

Cardiomyopathy

• Medical Report (Cardiomyopathy)
  Download form
• Echocardiogram Report
• Electrocardiography (ECG) Report
• All relevant investigation reports (if any)

Coma

• Medical Report (Coma)
  Download form
• Glasgow Coma Scale throughout the whole period of coma
• All relevant investigation reports, for example, Brain Computed Tomography (CT) Scan/Magnetic Resonance Imaging (MRI) (if any)

Deafness

• Medical Report (Deafness)
  Download form
• Audiometry and Sound Threshold Test Results for both ears, to be certified by ear, nose and throat (ENT) specialist
• All relevant investigation reports, for example, Brain Computed Tomography (CT) Scan/Magnetic Resonance Imaging (MRI) (if any)

Encephalitis

• Medical Report (Encephalitis)
  Download form
• Brain Computed Tomography (CT) Scan/Magnetic Resonance Imaging (MRI) Report
• All relevant investigation reports (if any)

End Stage Liver Failure

• Medical Report (End Stage Liver Failure)
  Download form
• Computed Tomography (CT) Scan/Magnetic Resonance Imaging (MRI)/Biopsy/Ultrasound Liver Reports that showed Ascites, Portal Hypertension and Encephalopathy
• Liver Function Test Results
• All relevant investigation reports (if any)

End Stage Lung Disease

• Medical Report (End Stage Lung Disease)
  Download form
• All FEV 1 Test Results
• Arterial Blood Gas Analysis on Partial Oxygen Pressure
• All relevant investigation reports (if any)

Heart Valve Surgery

• Medical Report (Heart Valve Surgery)
  Download form
• Surgical Report

Loss of Independent Existence

• Medical Report (Loss of Independent Existence)
  Download form
• All relevant investigation reports, for example, Computed Tomography (CT) Scan, Magnetic Resonance Imaging (MRI), X-ray and Ultrasound

Major Burns

• Medical Report (Major Burns)
  Download form
• Total Body Surface Area Burn Assessment Report, as measured by “The Rule of 9” of The Lund and Browder Body Surface Chart
• Photograph (if deemed necessary)

Major Head Trauma

• Medical Report (Major Head Trauma)
  Download form
• Brain Computed Tomography (CT) Scan/Magnetic Resonance Imaging (MRI) Report
• All relevant investigation reports (if any)

Motor Neurone Disease

• Medical Report (Motor Neurone Disease)
  Download form
• Brain and Spine Computed Tomography (CT) Scan/Magnetic Resonance Imaging (MRI) Report
• Electromyography (EMG) Report
• Nerve Conduction Study Report (if any)

Multiple Sclerosis

• Medical Report (Multiple Sclerosis)
  Download form
• Brain Magnetic Resonance Imaging (MRI)/Computed Tomography (CT) Scan Report
• Spine Lumbar Puncture Test Report (if any)
• Evoked Potential Test Report (if any)
• All relevant investigation reports (if any)

Parkinson’s Disease

• Medical Report (Parkinson’s Disease)
  Download form
• All relevant investigation reports, for example, Brain Computed Tomography (CT) Scan/Magnetic Resonance Imaging (MRI) (if any)

Primary Pulmonary Arterial Hypertension

• Medical Report (Primary Pulmonary Arterial Hypertension)
  Download form
• Cardiac Catheterisation Test Results
• Echocardiogram Report
• All relevant investigation reports (if any)

Surgery to Aorta

• Medical Report (Surgery to Aorta)
  Download form
• Surgical Report

Systemic Lupus Erythematosus (SLE) with Lupus Nephritis

• Medical Report (SLE)
  Download form
• Renal Biopsy Report
• All relevant investigation reports, for example, Urinalysis, Anti-Nuclear Antibodies, Blood Count and Renal Function Test
• Computed Tomography (CT) Scan/Magnetic Resonance Imaging (MRI) Report (if any)

Note: If the Critical Illness that you wish to claim for is not listed above, kindly contact your agent or Allianz’s Customer Service for more information.