Ms.

Lai Man Yee

Flat E 27/F
Tower 7 Le Point
8 King Ling Road
Tseung Kwan O New Territories

Confidential 密件

Claim Statement 賠償單 Issue Date 發出日期 : 20 SEP 22

Contract No. 合約編號 : 01383300

The claim(s) shown below has been processed. Please refer to the Summary for the total claim reimbursement.
以下索償已完成處理。請參閱「 賠償摘要」了解可獲賠償的總金額。

Employee name 僱員姓名 : Lai Man Yee

Department 部門 : SCMP
Staff number 職員編號 : HKG26581

Member name 會員姓名 : Ho Yue Cheong

Membership number 會員編號 : 01383300 03895212
Eligible
Incurred Deducted Maximum benefit
Voucher Days expenses
Incurred date Benefit item expenses amount limit Remarks
number paid 合資格
治療日期 保障項目 申請索償金額 自費金額 最高保險限額 備註
索償表編號 日數 賠償金額
(HK$) (HK$) (HK$)
(HK$)
53474488 10 AUG 2022 Specialist 001 1,500.00 1,500.00 9,999,999.00 - A
專科醫生
53474488 10 AUG 2022 Diag. Imaging & Lab Tests 001 2,300.00 2,300.00 9,999,999.00 - B
診斷影像及化驗

Subtotal of eligible expenses 合資格賠償金額小計 (HK$) 3,800.00

Claim reimbursement賠償金額 (HK$) 3,800.00

Summary 賠償摘要
Total claim reimbursement 賠償總金額 (HK$) 3,800.00

Remarks 備註:
A : Maximum amount per visit 每日每次之最高賠償金額
B : Maximum amount per year 每年之最高賠償金額

You will be reimbursed by autopay to your designated bank account 2 working days from the date of this claim statement.
賠償金額將於本賠償單發出日兩個工作天後自動轉賬至閣下之指定銀行戶口。

The terms and policy descriptions used on our website, myBupa, customer forms and letters may be different from the
VHIS plans. For details, please refer to the glossary on Bupa’s website or myBupa.
保柏網站、myBupa、客戶表格及信件上使用的部份詞彙及保單用詞，可能與自願醫保計劃有所不同。詳情請查閱保柏網
站或myBupa上的詞彙表。

Bupa (Asia) Limited 保柏（ 亞洲 ）有限公司

6/F, Tower 2, The Quayside, 77 Hoi Bun Road, Kwun Tong, Kowloon, Hong Kong
香港九龍觀塘海濱道77號海濱匯第2座6樓
Telephone 電話: (852) 2517 5388 Facsimile 傳真: (852) 2548 1848 Website 網址: www.bupa.com.hk

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This document is computer-generated. No signature or official stamp is required.
此文件由電腦列印，無須簽署或公司蓋印作實。

Bupa (Asia) Limited 保柏（ 亞洲 ）有限公司

6/F, Tower 2, The Quayside, 77 Hoi Bun Road, Kwun Tong, Kowloon, Hong Kong
香港九龍觀塘海濱道77號海濱匯第2座6樓
Telephone 電話: (852) 2517 5388 Facsimile 傳真: (852) 2548 1848 Website 網址: www.bupa.com.hk

2 of 2
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