Form B - Application For Reimbursement/direct Payment Of Medical Expenses (Except Drugs Provided By The Hospital Authority) In Accordance With Csb Circular No. 2/2013 Page 6
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Notes for Applicants
1. (a) Application for reimbursement / direct payment of medical expenses should be made by
the Government servant or pensioner.
(b) For reimbursement for medical expenses on drugs / equipment / services, the applicant
should submit the duly completed FORM B together with the ORIGINAL itemised
bill / receipt(s) to the Director of Health for processing. For serving officers, their
applications should be submitted through their bureau / department after completion of
Part D of FORM B.
(c) For applications in respect of expenses on drugs purchased outside HA, the applicant
must also attach a photocopy of the prescription issued by the attending HA doctor to
FORM B.
(d) For medical equipment, unless prescribed by the attending HA doctor as per Note 5 below
that a specific or a more sophisticated model of the equipment is required, only the costs
of the basic model will be reimbursable. The applicant may request the Government to
pay for the expenses to an outside supplier direct or pay for them first and seek
reimbursement subsequently.
The applicant should secure the acceptance of such
arrangement from the supplier before submitting the application to the Department of
Health for direct payment of expenses. If the application is rejected by the Department
of Health or the amount approved is less than the actual amount incurred, it is the
responsibility of the applicant to settle the remaining sum with the outside supplier.
(e) The steps for applying for direct payment or reimbursement using this form (i.e. FORM B)
are show at Annex.
2. This form (i.e. FORM B) is applicable for the following direct payment items under the
arrangement with HA:
(a) percutaneous transluminal coronary angioplasty (PTCA) procedures;
(b) intraocular lens operation;
(c) non-PTCA consumables for interventional cardiology; and
(d) positron emission tomography (PET) service
This form is not applicable for direct payment of medical expenses on drugs provided by
the attending HA facility. Applicants should use FORM A instead.
3. For items (a) to (d) in Note 2 above, the applicant should complete Parts B-C, and present the
partially completed FORM B via the Medical Records Office of the relevant HA hospital to
the attending HA doctor who will complete Part A. For direct payment for procuring HA
items, the applicant should forward the form to the Shroff Office of the hospital / clinic
concerned for processing. Completion of Part D is not required for application for direct
payment.
4. Applicants who are pensioners but not covered by the Medical and Dental Benefits Eligibility
Checking System (e.g. pensioners without Hong Kong Identity cards) should also attach a
valid Try. 447 to the application FORM B as a proof of the patient’s eligibility for civil service
medical benefits.
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