Details of Services For Claim Compensation through Electronic Means (Electronic Claim Submission "E-claim")
This E-claim system has been established for AXA Insurance PCL. ("Company") to facilitate Insureds under health insurance policies, without incurring additional charges. It serves as an alternative channel for completing claim form and submitting required documents and supporting evidence by electronic mean for claim consideration under the insurance contract to the Company.
In furtherance of the utilization of the E-claim system, in a manner convenient and in accordance with the term of use set forth by the Company and relevant laws, the Company respectfully requests that you read and comprehend the terms and conditions specified herein prior to commencing any usage.
Should you have any inquiries or require additional information regarding a list of documentations and evidences, claim procedure, duration of claim consideration, further details can be reviewed through https://www.axa.co.th/th/health-insurance-claim or contact our Customer Service at telephone number 02-118-8111, available 24 hours every day.
Terms and Conditions for E-claim Usage
1. Definition
Unless explicitly specified otherwise, the definitions in this document are binding solely within the contents of this document and do not affect the interpretation of the insurance policy of the Company or any Insured.
1.1 Information means information generated, sent, received, stored or processed by electronic means, such, as electronic data interchange (EDI), electronic mail, telegram, telex or facsimile; and for this document including Image of Documents and Electronic document submitted into the E-Claim system.
1.2 Insured means a person named as the Insured in a schedule of an insurance policy, who applies for the insurance policy, and is covered under such insurance policy; and for this document including a person who is entitled to receive a compensation under such insurance policy.
1.3 User means individual who registers the E-claim system for submitting Information into the E-claim system, who holds the status of the Insured or the authorized representative/legal guardian/agent/ curator of the Insured (hereinafter referred to as “You”).
1.4 Image of Documents means Scan, photograph of document which the User applies an Electronic method to create.
1.5 Electronic document means document created by Electronic data and Electronic signatures
(For avoidance of doubt, " Image of Documents " and “Electronic document” may collectively be referred to as "documents and supporting evidence")
1.6 Electronic means an application of an electron means, an electrical means, an electromagnetic means or any other means of a similar nature including an application of an optical means, a magnetic means or a device in connection with an application of any of the aforesaid means as definition mentioned in Electronic Transactions Act B.E. 2544.
2. The Company will make a consideration on your claim when you have completely fulfilled the following terms and conditions for using the E-claim system:
2.1 Conditions and completeness of documents and supporting evidence submitted through the E-claim system for claim consideration.
a. All Images of Documents must be clear color photograph, accompanied by a duly signed certification of the true copy.
b. All Electronic documents must be original and free from any modifications.
c. In the case of Images of payment receipt, the document must specify "For claim reimbursement purposes with AXA Insurance PCL. only”
d. In the case of Images of Documents such as ID cards/passports as well as other documents and supporting evidences, they must not be expired at the time of submitting into the E-claim system.
2.2 Conditions and completeness of E-claim system usage
a. User is required to register a username and set your own password, along with entering the OTP number received from the Company via your registered email for accessing services in the E-claim system. This process shall be done for identification verification process prior to accessing the services of the E-claim system. It is the User's responsibility to securely maintain the confidentiality of your username and password.
b. You are required to submit documents and supporting evidence for claim consideration to the Company within 30 days from the date of discharge from the hospital/healthcare facility (for inpatients) or from the completion date of medical treatment (for outpatient).
Failure to submit within the specified timeframe does not forfeit your right to claim. If you can demonstrate reasonable cause for the inability to submit documents and supporting evidence within the designated period and have submitted it as promptly as possible under the circumstances.
c. The E-claim system does not limit the number of services throughout your insurance policy's period. However, the maximum amount of compensation for each claim that can be submitted through the E-claim system is as follows:
- 10,000 Thai Baht per each medical treatment (per a receipt) for individual insurance policy and;
- 30,000 Thai Baht per each medical treatment (per a receipt) for Group insurance policy
d. The E-claim system can only provide claim submission services for incident occurring in Thailand. In the case of the incident occurring outside Thailand, please contact the Customer Service for further information.
e. The submission of Information into the E-claim system will be considered successful when you receive a confirmation email from the Company only.
In the event that there is an issue with your or the Company's internet network preventing the submission of Information into the E-claim system, it will not be considered that the Company has received such Information from you for claim consideration.
f. After successfully submitting your Information into the E-claim system, you can check the progress of claim consideration through https://myclaims.axa.co.th/
g. Conditions of compensation and the process of claim adhere to the terms and conditions specified in the insurance policy. If the Insured conceals the truth or provides false statements, the insurance contract shall be voidable. The Company preserves rights to terminate the insurance contract in accordance with Civil and Commercial Code of Thailand, Section 865, and may refuse to pay compensation to you.
3. This E-claim system supports exclusively for claim submission for claim consideration for compensation reimbursement purposes. It does not encompass a pre-authorization verification service for medical treatment.
4. Incomplete filling of mandatory fields marked with (*) will prevent you from submitting the entire set of documents and supporting evidence into this E-claim system.
5. The Company will finalize considering your submitted claim within 15 days from the date of receiving complete and accurate documents and supporting evidence into the E-claim system and/or from you in the case where an original document review or additional Information is required. This period may be extended as stipulated by applicable laws.
6. The Company preserves rights to request original documents, additional documents/evidence/information for claim consideration. The Company respectfully requests you to submit these requirements to the Company within the designated timeframe, to the following Company’s address;
“Headquarters address at 414 Siam Patumwan House, Floor 25th, unit2511-1-2, Phayathai Rd., Wangmai Sub-district, Pathumwan, Bangkok 10330 Thailand”
Nevertheless, in the event the Company does not specifically request the original documents from you, you are obligated to retain all these original documents for a minimum period of 2 years from the expiration date of your insurance policy. This is for retrospective auditing purposes by the Company and for your benefit in compliance with legal obligations or proceedings.
7. The Company preserves rights to request the Insured to return paid compensation, entirety or partially, if the Company discovers inaccuracies, concealment, false information/statement, errors, or any discrepancies in your submitted Information. Moreover, the Company may also consider suspending your access to the E-claim system without prior notice.
8. If you have specified a channel for receiving notification of the results of the claim consideration by the Company, and in the event the Company is unable to deliver the results through your designated channel, the Company preserves rights to promptly deliver the results through an alternative channel.
9. Upon accessing the E-claim system, it is deemed that you have acknowledged and accepted that the Company is required to process your personal information for the purpose of claim consideration, payment processing, and related activities, as specified in the https://www.axa.co.th/th/privacy-bp-statement
10. To submit the Information into the E-claim system, the Company requests that you, as the Insured according to the insurance policy, undertakes the process by yourself.
In the case that you submit the Information into the E-claim system on behalf of the Insured under your legal guardianship, whether as a guardian, curator, legal representative, or agent, the Company considers that you have certified the accuracy and truthfulness of the Information submitted into the E-claim system. Furthermore, you have consented to the Company processing the personal data of the individual under your legal guardianship or the person who appointed you as legal representative for the purpose of claim consideration and relevant activities.
11. To click in the bottommost response box on the Page shall be considered an electronic signature in accordance with the Electronic Transactions Act B.E. 2544. By doing so, it shall be deemed that you wish to declare your intention for the Company to receive the Information submitted into the E-claim system for the purpose of claim consideration in accordance with the Company's procedures and other relevant legal requirements, such as Know Your Customer processes. You also affirm that the Information submitted through the E-claim system are accurate, complete, and true. You acknowledge that false statements, concealment of true information, or fraudulent acts are illicit.
12. Failure to provide a complete Information or non-compliance with any of the conditions outlined in this document, the Company preserve rights to reject to consider upon your claim submitted through the E-claim system until such failure is completely remedied by you. Nevertheless, you are still be entitled to submit the required documents and supporting evidence to the Company for claim through normal claim channel according to the Company's address as per Section 6 herein, under general terms and condition of such claim channel.
13. You are required to securely maintain your E-claim system username and password as strictly confidential. In the event of any violation resulting in loss and/or damages towards the Company, the Company preserves rights to pursue a compensation for such incurred loss and/or damages from you (if any).
14. The Company preserve rights to modify this Details of Services for Claim Compensation through Electronic Means (Electronic Claim Submission "E-claim") without prior notice to you. For avoidance of any ambiguity, the Company will post the official enforcement date of updated terms and conditions for your examination. Therefore, the Company strongly recommends that you review terms and conditions in this document in each time of requiring a service.
Should any terms and conditions within this Details of Services for Claim Compensation through Electronic Means (Electronic Claim Submission "E-claim") be deemed unlawful, void, or unenforceable for any reason, it is considered non-existent and does not affect the validity or enforceability of the remaining terms and conditions outlined in this document.
15. This Details of Services for Claim Compensation through Electronic Means (Electronic Claim Submission "E-claim") are subject to the laws of the Kingdom of Thailand.
Officially issue on 1st December 2023
AXA Insurance PCL.
