e-Medical Claims System

The e-Medical Claims System (the System) aims to streamline and automate the reimbursement of outpatient claims processing. The System, scheduled to be launched on 1 July 2021, provides an electronic portal for eligible members of the Integrated Medical Scheme to submit and track their outpatient medical claims through a web-based system or the HKBU mobile app. The System can not only result in more efficient reimbursement process and faster payment to the Claimants, but also reduce the circulation of hard copy claim forms, administrative work and overhead generally associated with manual claims processing and submission.

All out-patient medical claims, including:

(a) Out-patient medical claims (Western), which consist:

(i) General/Specialist Consultation (including a normal course of medication; for medication of 30 days or more, it will be classified as long-term medication) by a registered medical practitioner;
(ii) Referred Physiotherapy/Chiropractic treatments;
(iii) Referred Diagnostic X-Ray Examination (including Advanced Scanning) and Laboratory Tests; and
(iv) Long-term medications prescribed by a registered medical practitioner in western medicine for 30 days or more,

(b) Secondary dental care benefits;

(c) Maternity benefits; and

(d) Preventive care benefits (applicable to staff member only).

The following medical claims are not reimbursable under the e-Medical Claims System:

(a) Out-patient medical claims (Chinese medicine);
(b) Primary dental care;
(c) In-patient medical claims; and
(d) Clinical surgery or Advanced Diagnostic Scanning (including but not limited to all types of endoscopy, ear toileting, MRI, CT Scan, PET Scan, Angiogram) performed in a clinic which should be claimed under the in-patient/hospitalisation benefits.

The items (a) and (b) are provided free of charge to staff member by the University’s appointed service providers subject to an annual quota as specified in the Integrated Medical Scheme and hence, no separate reimbursement is required. For claim processing of items (c) and (d), Claimants should fill in the in-patient claim form "Hospitalisation & Surgical Claim Form" (click here) and submit the completed form together with the original receipts to the underwriter, directly via the Finance Office.

Submission of physical copy of the out-patient medical claim form will not be accepted after the transition grace period, which is ONE month after the launch of the System on 1 July 2021. This means that all hard copies of medical claim forms should reach the Finance Office on or before 31 July 2021. Thereafter, physical copies of medical claim forms will be returned unprocessed to the Claimants

All e-Claims should be submitted via the System within thirty (30) calendar days after the date of consultation/treatment. To facilitate a smooth transition, late submission is allowed until 31 July 2021. This means that up to 31 July 2021, Claimants may submit e-Claims which carry a consultation/treatment date of more than 30 calendar days. Thereafter, late submissions may be denied unless valid justifications are provided to the Finance Office for approval on a case-by-case basis. 

Claimants are NOT required to submit the ORIGINAL documents/receipts for their e-Claims unless their e-Claims are selected for sample checking. If an e-Claim is selected for sample checking, Claimant will be notified via email to submit the ORIGINAL documents/receipt(s), together with the printout of that email notification (or marked with the given e-Claim no.) within thirty (30) calendar days from the notification date. Claimants may submit the original receipt either via campus mail addressed to "Finance Office (Medical Team)" or by postal mail to "Hong Kong Baptist University Tsuen Wan Campus, Finance Office (Medical Team), TWC206, Riviera Gardens, No.2-12 Yi Lok Street, Tsuen Wan, NT".

Please note that the e-Claim will only be processed upon receipt of the original documents/receipt(s). If the original documents/receipts are not received by the Finance Office within thirty (30) calendar days, the e-Claim will be returned unprocessed to the Claimant automatically.

ORIGINAL receipts/invoices are required to be retained by Claimants for at least three (3) months from the claim completion date, or such period as may be advised in case the e-Claim has been randomly selected for sample checking.

Claimants can check processing status of his/her e-Claims using the “Claims Enquiry” function on the home page in the System. This function enables Claimants to view claims that were 3 submitted within the most recent two financial years (including the current financial year). Moreover, Claimants will receive an email notification when an e-Claim is submitted, processed and paid, returned or rejected. 

If you want to save an incomplete e-Claim and submit the claim later, you can click “Save as Draft” and your inputted data will be saved. You may return to the System to retrieve the draft record and complete the e-Claim. Please note that an incomplete e-Claim will be saved under “Action Alerts” for “Unsubmitted Claims” on the home page in the System. The draft e-Claims will be automatically deleted from the System if it remains unsubmitted after thirty (30) calendar days from its creation date.

To resume completing a saved draft e-Claim in the System, please select the draft e-Claim from the “Unsubmitted Claims” under “Action Alerts” on the home page of the System and finish completing the required information.

Please note that a draft e-Claim will ONLY be kept in the System for thirty (30) calendar days from its creation date. The system will automatically remove the unsubmitted draft e-Claims if they remain unsubmitted after thirty (30) calendar days from its creation date.

You can check the remaining medical benefit balances of all members (including your eligible family members) under your account by accessing “Benefit Balances” on the home page of the System.

You can check the status of each e-Claim under “Claims Enquiry” on the home page of the System. You can search your e-Claim by the e-Claim number, medical category, claimant or submission date, etc.

One e-Claim is designated for ONE medical consultation which is incurred by ONE Claimant. You cannot submit an e-Claim for multiple Claimants or medical consultations.

For enquiries or assistance, please provide the e-Claim number by contacting the Finance Office 4 (FO) 24-hour enquiry hotline (unmanned): 3411 2299 or email to fomedical@hkbu.edu.hk. Please note this hotline number is unmanned and it only provides pre-recorded information on various topics concerning staff’s payroll and benefits. To leave a message for FO after calling the enquiry hotline, please press 1 > 0 for Cantonese version OR press 2 > 0 for English version OR press 3 > 0 for Putonghua version. Please leave your name, question, e-Claim number and contact details when being prompted to leave a message. You may also write to FO’s email at fomedical@hkbu.edu.hk. Our FO colleagues will revert to you within the next two working days.

Step-by-step instructions:

Eligible staff can submit an e-Claim via web-based e-Medical Claims System (on BUniPort) (click here) or HKBU mobile app;

• Click “New e-Claims” on home page;
• Select “Claimant” and “Medical Category”;
• Input “Consultation/Treatment Date”;
• Input “Name of Doctor/Clinic (Optional)”;
• Input/select “Diagnosis”;
• Select “Nature of Claim” for either new claim or second claim;
• Input the “Receipt Amounts”;
• Upload the required supporting receipt/invoice and/or referral letter;
• Review the e-Claim; and
• Review and check the “Declaration and Authorisation” box before you click “Submit”

No. All e-Claims must have a medical diagnosis. The diagnosis should be clearly indicated by the registered medical practitioners on the official receipt.

The only exception will be consultations at the Government clinics or Hospital Authority hospitals, where a self-declaration of diagnosis may be acceptable for receipts issued by Government clinics or Hospital Authority hospitals’ out-patient department. 

Please note that not every diagnosis is included in the System as there are many professional medical terms. If you cannot find the required diagnosis on the drop down menu in the System, please select “Other Diagnosis” and input the diagnosis using the medical term as shown on the official receipt.

Claimant is required to attach the official receipt, referral letter or other required documents by uploading the scanned copy or image of the supporting documents (in PDF, JPG or PNG format) to the System. The System will specify a list of required document types (such as receipt, referral letter, etc.) according to the selected medical category/items.

For each document type (receipt or referral letter), a maximum of five images or files with a size limit of 5MB each can be uploaded in the System. Please note that the System only supports file format in PDF, JPG or PNG.

All e-Claims should be submitted within thirty (30) calendar days after the date of consultation/treatment. Late e-Claim submission may be denied for further processing and the Claimant is required to provide a valid justification in the message box when being prompted by the System. Please note that a late e-Claim submission will be reviewed and considered by the Finance Office on a case-by-case basis.

For certain e-Claims with receipt amount over a predefined threshold, the System will request the Claimant to input the number of “Days of Prescription”.

If such information is not provided or indicated on the official receipt, the Claimant should request the registered practitioner or clinic to provide a breakdown for the incurred medical costs, including (a) consultation fee; (b) medicine fee; and (c) days of prescription for the medication. The Claimant should then input the abovementioned information when submitting his/her eClaim. 

From time-to-time, an e-Claim will be returned to the Claimant due to insufficient or incorrect information provided. The Claimant will be notified via email when his/her e-Claim is returned and pending for further information from Claimant.

To provide the requested information, the Claimant can select the returned e-Claim from the “Claims Require Additional Information” on the home page of the System under “Action Alerts”. The Claimant may then provide the required information before re-submitting the e-Claim for processing. Please be reminded that if the required information is not received by the Finance Office within thirty (30) calendar days from the notification date, the said e-Claim will be automatically returned unprocessed to the Claimant and the e-Claim is deemed withdrawn by the 6 Claimant. 

If an e-Claim is rejected in whole or in part due to whatsoever reason, an email notification will be sent to the Claimant. The reason for rejecting the e-Claim would be provided under the “Reason” field of the e-Claim. The Claimant should review the reason and take appropriate action, i.e. (a) accept and take note of the rejection, OR, (b) file an appeal via email to fomedical@hkbu.edu.hk as soon as possible but, in any case, not later than thirty (30) calendar days from the receipt of rejection notification.

With the launch of the System, the frequency of out-patient reimbursements to the Claimant shall be shortened from a bi-weekly payout to a weekly payout. The Finance Office will pay your eClaims as quickly as possible and with compassion and care. The reimbursement will be paid directly to the staff’s salary bank account. Under normal circumstances, an e-Claim, which is filed correctly with necessary supporting documents, will be paid within 15 working days.

You can check the status of a submitted e-Claim by accessing “Claims Enquiry” on the home page. Whenever an e-Claim is processed and paid, you will receive an email notification on the issuance of “Out-patient Medical Credit Advice” via the BUniPort.

(a) Web based portal – click here

(b) HKBU mobile app – click here

(a) Web based portal – click here

(b) HKBU mobile app – click here

(a) Web based portal – click here

(b) HKBU mobile app – click here

http://hro.hkbu.edu.hk/images/page/69/IMS-regulations-Eng-20180701.pdf

Click here for more detail.

http://hro.hkbu.edu.hk/images/page/69/Pre-existing_conditions_list.pdf

http://hro.hkbu.edu.hk/images/page/69/Exclusions.pdf

http://hro.hkbu.edu.hk/images/page/127/bc-hospitalisation-surgical-claim-form.pdf

24-hour Hotline:       3411-2299 (unmanned)

Email:                         fomedical@hkbu.edu.hk