MEDICAL ASSISTANCE

REQUIREMENTS

  • Medical Record (Xerox)
  • Hospital Billing and/or Proof of Billing Statement (Xerox)
  • Letter Request Seeking financial assistance
  • 2 Xerox Valid Id (Govt/Company ID)
  • Note: Subject for Board Approval

Exclusions:

  • Those that covered by the Bank’s Health Care Provider (HMO)
  • Assistance on maintenance drugs
  • Those cases that upon evaluation by the NEB, failed to convince its approval and therefore, declare, declined and/or denied.

CLAIM INFORMATION FORM