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Required Documents

Individual Natural Death Claim

Loss of life of the insured/ payor due to sickness, suicide or homicide

Required papers for Natural Loss of Life

  • Completed Claimant Statement Form by the claimant (beneficiary) which must be witnessed by a First Class Gazetted Officer or notary public; In case the beneficiary is a minor, the guardian must sign the Claimant Statement Form on their behalf
  • Completed Physician’s Statement Form by a registered physician (minimum MBBS) mentioning the actual cause of death along with his/her official seal
  • Completed Identification Statement Form by a non-relative person who has no interest on this claim which must be witnessed by a First Class Gazetted Officer or notary public
  • Original policy document
  • Original or attested photocopy of death certificate issued by the municipal body on a prescribed form, either from Health Department of City Corporation or by Local Union Parishad Chairman (on official printed letterhead) where the deceased was buried or cremated
  • Attested copy of age proof (either national ID, passport, secondary school certificate or birth registration certificate from the concerned authority) of the policy insured
  • Attested copy of identity of the beneficiary (either national ID, passport, Secondary School Certificate or nationality certificate)

 

Additional required papers for Unnatural Loss of Life (Death due to Suicide / Homicide):

  • Certified police report (FIR / Surathal) from the concerned police station
  • Certified autopsy (post-mortem) report from the concerned forensic medicine department or police station

or

  • Certified copy of Magistrate’s or police station officer-in-charge’s permission for burial without conducting post-mortem (where applicable)

or

  • Medical treatment papers and follow-ups from concerned medical hospitals or clinics (where applicable)
  • Newspaper cutting (if any)

 

MetLife reserves the right to ask for further documents, when deemed necessary.

Individual Accidental Death Claim

Loss of life of the insured due to accidental injury

Required papers for Accidental Loss of Life

  • Completed Claimant Statement Form by the claimant (beneficiary) which must be witnessed by a First Class Gazetted Officer or notary public; In case the beneficiary is a minor, the guardian must sign the Claimant Statement Form on their behalf
  • Completed Physician’s Statement Form by a registered physician mentioning the actual cause of death along with official seal
  • Completed Identification Statement Form by a non-relative person who has no interest on this claim which must be witnessed by a First Class Gazette Officer or notary public
  • Original policy document
  • Original or attested photo copy of death certificate issued by the municipal body on a prescribed form, either from Health Department of City Corporation or by Local Union Parishad Chairman (on official printed letterhead) where the deceased was buried or cremated
  • Attested copy of age proof (either national ID, passport or secondary school certificate or birth registration certificate from the concerned authority) of the policy insured
  • Attested copy of identity of the beneficiary (either national ID, passport, secondary school certificate or nationality certificate)
  • Certified police report (FIR / Surathal) from the concerned police station
  • Certified autopsy (post-mortem) report from the concerned forensic medicine department or police station

or

  • Certified copy of Magistrate’s or police station officer-in-charge’s permission for burial without conducting post-mortem (where applicable)

or

  • Medical treatment papers and follow-ups from concerned medical hospitals or clinics (where applicable)
  • Newspaper cutting (if any)

 

MetLife reserves the right to ask for further documents, when deemed necessary.

 

Accident Indemnity for Total or Partial Disability (Accidental Indemnity, Circles of Protection-2)

  • Proof of Loss (Claimant Statement Form) to be completed in detail by the claimant (insured) along with signature, which must be witnessed by an adult person
  • Proof of Loss (Claimant Statement Form) should also be completed in detail by the attending physician along with signature and official seal
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • Treatment papers, prescriptions, detailed case summary, hospital discharge certificate, diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plate or report and other investigation related reports
  • Copy of passport showing dates of exit from and entry to Bangladesh (where applicable)

 

Accident Medical Reimbursement (3PP Plus, EPP Plus, IGP Plus, Life Line, My Child, Circles of Protection-3

  • Proof of Loss (Claimant Statement Form) to be completed in detail by the claimant (insured) along with signature, which must be witnessed by an adult person
  • The Proof of Loss (Claimant Statement Form) should also be completed in detail by the attending physician along with signature and official seal
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • Treatment papers, prescriptions, detailed case summary, hospital discharge certificate, diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plate or report and other investigation related reports
  • All original bills and vouchers along with supporting document 
  • Copy of passport showing dates of exit from and entry back to Bangladesh (where applicable)

 

Surgical & Medical Expenses (Good Health, Circles of Protection-4B)

Health Insurance Claim Form

  • To be completed in full by the claimant (insured) along with signature, which must be witnessed by an adult person (Part A)
  • To be completed by the attending physician under official seal (Part C)
  • To be completed by the hospital representative (Part D)
  • Proof of Loss (Claimant Statement Form) to be completed in detail by the claimant (insured) along with signature, which must be witnessed by an adult person; This Proof of Loss (Claimant Statement Form) should also be completed in detail by the attending physician, including signature and official seal (this form is necessary only if the sickness is due to accidental injury)
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • Treatment papers, prescriptions, detailed case summary, hospital discharge certificate, diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plate or report and other investigation related reports
  • All original hospital and surgical itemized bills (like surgeon fees, anesthesia, OT charges); emergency ambulance bills (if any) along with supporting document 
  • Copy of passport showing dates of exit from and entry back to Bangladesh (where applicable)

 

Critical Illness Benefit (Critical Care, Super Care, Heart Care)

Health Insurance Claim Form

  • To be completed in full by the claimant (insured) along with signature, which must be witnessed by an adult person (Part A)
  • To be completed by the attending physician under official seal (Part C)
  • To be completed by the hospital representative (Part D) (where applicable)
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • Treatment papers, prescriptions, detailed case summary, hospital discharge certificate, diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plate or report and other investigation related reports (like CAG report, initial cardiac enzyme report)
  • Original policy document
  • Attested copy of age proof (either national ID, passport, secondary school certificate or birth registration certificate from the concerned authority) of the insured
  • Copy of passport showing dates of exit from and entry back to Bangladesh (where applicable)

 

Disability Claim Benefit (Permanent Total Disability, Disability Protection Rider/Waiver of Premium, Income Benefit Rider / Family Protection Rider, Annuity, Super Proctor)

  • Claimant Statement Form (Continuing Proof of Loss) to be completed in detail by the claimant (insured) along with signature, which must be witnessed by an adult person
  • The Claimant Statement Form (Continuing Proof of Loss) should also be completed in detail by the attending physician along with signature and official seal
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • All present and past treatment papers, prescriptions, detailed case summary, hospital discharge certificate, diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plates or reports and other related investigation reports must accompany the above forms
  • Recent neurological evaluation report by a neurologist
  • Opinion of two renowned eye specialists along with detailed case summary (for loss of sight, if required)
  • Opinion of two renowned ENT specialists along with detailed case summary (for loss of hearing, if required)

 

Accidental Dismemberment Benefit (Permanent Partial Disability, AD&D in 3PP Plus, EPP Plus, IGP Plus, Life Line)

  • Claimant Statement Form (Continuing Proof of Loss) to be completed in detail by the claimant (insured) along with signature, which must be witnessed by an adult person
  • The Claimant Statement Form (Continuing Proof of Loss) should also be completed in detail by the attending physician along with signature and official seal
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • All present and past treatment papers, prescriptions, detailed case summary, hospital discharge certificate, diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plate or report and other related investigation reports must accompany the above forms
  • Orthopedic evaluation report by a qualified orthopedic surgeon
Individual Living (Sickness/Accident/Disability) Claim

In – Hospital Income (Hospital Care, Hospital Cash, Executive Plus, Good Health, My Child, Circles of Protection-4A) “Health Insurance Claim Form”

Health Insurance Claim Form

  • Please contact us at claimsbangladesh@metlife.com.bd for details about filling up Health Insurance Claim Form
  • Competed “Employer Statement Form” by the Company’s representative along with Official Title & Seal (where applicable); 
  • Original (or duly attested photocopies of) Hospital Discharge Certificate, diagnosis report, prescriptions, detailed case summary (if any), daily follow-up notes (if any), X-Ray plate/report (recent- one) and other related investigation reports
  • Copy of Passport showing dates of exit from and entry back to Bangladesh (where applicable)

Accident Indemnity for Total or Partial Disability (Accidental Indemnity, Circles of Protection-2)

  • Proof of Loss (Claimant Statement Form) to be completed in detail by the claimant (insured) along with signature, which must be witnessed by an adult person
  • Proof of Loss (Claimant Statement Form) should also be completed in detail by the attending physician along with signature and official seal
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • Treatment papers, prescriptions, detailed case summary, hospital discharge certificate, diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plate or report and other investigation related reports
  • Copy of passport showing dates of exit from and entry to Bangladesh (where applicable)

Accident Medical Reimbursement (3PP Plus, EPP Plus, IGP Plus, LifeLine, My Child, Circles of Protection-3)

  • Proof of Loss (Claimant Statement Form) to be completed in detail by the claimant (insured) along with signature, which must be witnessed by an adult person
  • The Proof of Loss (Claimant Statement Form) should also be completed in detail by the attending physician along with signature and official seal
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • Treatment papers, prescriptions, detailed case summary, hospital discharge certificate, diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plate or report and other investigation related reports
  • All original bills and vouchers along with supporting document 
  • Copy of passport showing dates of exit from and entry back to Bangladesh (where applicable)

Surgical & Medical Expenses (Good Health, Circles of Protection-4B)

Surgical & Medical Expenses (Good Health, Circles of Protection-4B)

Health Insurance Claim Form

  • Please contact us at claimsbangladesh@metlife.com.bd for details about filling up Health Insurance Claim Form
  • Proof of Loss (Claimant Statement Form) to be completed in detail by the claimant (insured) along with signature, which must be witnessed by an adult person; This Proof of Loss (Claimant Statement Form) should also be completed in detail by the attending physician, including signature and official seal (this form is necessary only if the sickness is due to accidental injury)
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • Treatment papers, prescriptions, detailed case summary, hospital discharge certificate, diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plate or report and other investigation related reports
  • All original hospital and surgical itemized bills (like surgeon fees, anesthesia, OT charges); emergency ambulance bills (if any) along with supporting document 
  • Copy of passport showing dates of exit from and entry back to Bangladesh (where applicable)

Critical Illness Benefit (Critical Care, Super Care, Heart Care)

Health Insurance Claim Form

  • Please contact us at claimsbangladesh@metlife.com.bd for details about filling up Health Insurance Claim Form
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • Treatment papers, prescriptions, detailed case summary, hospital discharge certificate, diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plate or report and other investigation related reports (like CAG report, initial cardiac enzyme report)
  • Original policy document
  • Attested copy of age proof (either national ID, passport, secondary school certificate or birth registration certificate from the concerned authority) of the insured
  • Copy of passport showing dates of exit from and entry back to Bangladesh (where applicable)

Disability Claim Benefit (Permanent Total Disability, Disability Protection Rider/Waiver of Premium, Income Benefit Rider / Family Protection Rider, Annuity, Super Proctor)

  • Claimant Statement Form (Continuing Proof of Loss) to be completed in detail by the claimant (insured) along with signature, which must be witnessed by an adult person
  • The Claimant Statement Form (Continuing Proof of Loss) should also be completed in detail by the attending physician along with signature and official seal
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • All present and past treatment papers, prescriptions, detailed case summary, hospital discharge certificate, diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plates or reports and other related investigation reports must accompany the above forms
  • Recent neurological evaluation report by a neurologist
  • Opinion of two renowned eye specialists along with detailed case summary (for loss of sight, if required)
  • Opinion of two renowned ENT specialists along with detailed case summary (for loss of hearing, if required)

Accidental Dismemberment Benefit (Permanent Partial Disability, AD&D in 3PP Plus, EPP Plus, IGP Plus, Life Line)

  • Claimant Statement Form (Continuing Proof of Loss) to be completed in detail by the claimant (insured) along with signature, which must be witnessed by an adult person
  • The Claimant Statement Form (Continuing Proof of Loss) should also be completed in detail by the attending physician along with signature and official seal
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • All present and past treatment papers, prescriptions, detailed case summary, hospital discharge certificate, diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plate or report and other related investigation reports must accompany the above forms
  • Orthopedic evaluation report by a qualified orthopedic surgeon

MetLife reserves the right to ask for further documents, when deemed necessary.

Group Natural Death Claim

Loss of life of the insured due to sickness, suicide or homicide

Required papers for Natural Loss of Life

  • Completed Notification of Claim Form for Group Insurance Death Claim by the employer’s representative along with signature and official seal
  • Completed Group Death Claim Form (Beneficiary’s / Employer’s Statement) by the beneficiary in the beneficiary’s statement and authorization part, which must be witnessed by an adult person,  employer’s statement part to be completed by the employer’s representative along with signature and official seal
  • Completed Physician’s Statement Form by a registered physician mentioning the actual cause of death along with official seal
  • Original or attested photo copy of death certificate issued by the municipal body on a prescribed form, either from Health Department of City Corporation or by Local Union Parishad Chairman (on official printed letterhead) where the deceased was buried or cremated
  • Attested copy of age proof (either national ID, passport, secondary school certificate or birth registration certificate from the concerned authority) of the insured
  • Attested copy of Identity of the beneficiary (either national ID, passport, secondary school certificate or nationality certificate) - applicable only for individual beneficiary

 

Additional required papers for unnatural loss of life (Death due to accident, suicide or homicide)

  • Certified police report (FIR / Surathal) from the concerned police station
  • Certified autopsy (post-mortem) report from the concerned forensic medicine department or police station

or

  • Certified copy of Magistrate’s or police station officer-in-charge’s permission for burial without conducting post-mortem (where applicable)

or

  • Medical treatment papers and follow-ups from the concerned medical hospitals or clinics (where applicable)
  • Newspaper cutting (if any)
Group Accidental Death Claim

Loss of life of the Insured due to accidental injury

Required papers for Accidental Loss of Life

  • Completed Notification of Claim Form for Group Insurance Death Claim by the employer’s representative along with signature and official seal
  • Completed Group Death Claim Form (beneficiary’s / employer’s statement) by the beneficiary in the beneficiary’s statement and authorization part, which must be witnessed by an adult person; employer’s statement part to be completed by the employer’s representative along with signature and official seal
  • Completed Physician’s Statement Form by a registered physician (minimum MBBS) mentioning the actual cause of death along with official seal
  • Original or attested photo copy of death certificate issued by the municipal body on a prescribed form, either from Health Department of City Corporation or by Local Union Parishad Chairman (on official printed letterhead) where the deceased was buried or cremated
  • Attested copy of age proof (either national ID, passport, secondary school certificate or birth registration certificate from the concerned authority) of the insured
  • Attested copy of identity of the beneficiary (either national ID, passport, secondary school certificate or nationality certificate) - applicable only for individual beneficiary

 

Additional required papers for unnatural loss of life (Death due to accident, suicide or homicide)

  • Certified police report (FIR / Surathal) from the concerned police station
  • Certified autopsy (post-mortem) report from the concerned forensic medicine department or police station

or

  • Certified copy of Magistrate’s or police station officer-in-charge’s permission for burial without conducting post-mortem (where applicable)

or

  • Medical treatment papers and follow-ups from the concerned medical hospitals or clinics (where applicable)
  • Newspaper cutting (if any)
Group Disability Claims

Permanent Total / Partial Disability of the Insured due to sickness or accidental injury

  • Claimant Statement Form (Continuing Proof of Loss) to be completed in detail by the claimant (insured) along with signature, which must be witnessed by an adult person
  • This Claimant Statement Form (Continuing Proof of Loss) should also be completed in detail by the attending physician along with signature and official seal
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • All present and past treatment papers, prescriptions, detailed case summary, hospital discharge certificate, diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plates or reports and other related investigation reports must accompany the above forms
  • Recent neurological evaluation report by a neurologist
  • Opinion of two renowned eye specialists along with detailed case summary (for loss of sight, if required)
  • Opinion of two renowned ENT specialists along with detailed case summary (for loss of hearing, if required)
Group Medical Claims – I (In/Out Patient & Accidental Medical Reimbursement)

Reimbursement Claim

Our basic Group Medical contract provides reimbursement of necessary medical expenses per policy terms and limits. As such, the usual process is to obtain a MetLife Group Medical Claim Form, fill it out, and send it through your company’s HR or admin department to the MetLife Head Office along with required supporting treatment papers and bills for reimbursement. These are usually known as cash claims.

For reimbursement (cash claims), you must submit the following to the MetLife Head Office:

  • Completed Group Medical Claim Form by the claimant (employee) in the employee’s section; employer’s section to be completed by the employer’s representative along with signature and official seal

 

For out-patient treatment, the necessary documents are: 

  • Original money receipt showing the attending physician detailed charges along with stamp and signature
  • Original itemized pharmacy bill showing the date of purchase, name of patient, quantity and name of drugs along with photocopy of physician’s prescriptions
  • Original receipt showing charges for each of the lab test, x-ray films and other examination done and supported by the respective physician’s request to undergo examinations and copies of the results of examination undertake

 

For in-patient treatment, the necessary documents are:

  • Itemized original hospital bill supported by the official hospital receipt for the total amount paid
  • Original receipt showing attending physician’s or surgeon’s charges along with stamp and signature
  • Photocopy of detailed hospital discharge report
  • Photocopy of MetLife Hospitalization Insurance Card
  • Photocopy of MetLife pre-approval for non-emergency hospitalization

 

Direct Settlement

As an added value service, MetLife Bangladesh has entered into credit agreement with leading hospitals and medical providers all across the country to provide what we call Direct Settlement facility. Patients with an in-force Group Medical Coverage from MetLife may take admission and avail treatments at credit. 

These hospitals and medical providers with whom we have the credit agreement are collectively known as MetLife Preferred Provider Organization or PPO Network.

For elective hospitalizations within the MetLife PPO Network (against advice of general hospitalization or maternity), the procedures are as follows:

  • Obtain a copy of the Pre-approval Form from your employer’s representative (for Group Medical Insurance)
  •  Have it filled out by the physician or hospital authority
  • Submit scanned copy of the Pre-approval Request to us as an attachment to the e-mail Preapproval.Admission@metlife.com.bd with a copy to Corporate.Solutions@metlife.com.bd

or

  • Fax it to (+ 880-2) 9558682

or

  • When you arrive at one of our PPO Hospitals, show the MetLife Hospitalization Insurance Card and let the hospital obtain pre-approval from MetLife

You may also seek pre-approval in the same manner as above when your physician advises you to have an MRI or CT scan while your employer has purchased out-patient general coverage for you from us. 

Group Medical Claims – II (Group Critical Illness)

Critical Illness

Health Insurance Claim Form

  • To be completed in full by the claimant (insured) along with signature and must be witnessed by an adult person (Part A)
  • To be completed by the attending physician under his official seal (Part C)
  • To be completed by the hospital representative (Part D)
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • Treatment papers, prescriptions, detailed case summary, hospital discharge certificate, diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plate or report and other investigation related reports (like CAG report, initial cardiac enzyme report)
  • Attested copy of age proof (either national ID, passport, secondary school certificate or birth registration certificate from the concerned authority) of the insured
  • Copy of passport showing dates of exit from and entry back to Bangladesh (where applicable)
Credit Life Claims (Credit Card Holder/Loan Borrower)

Loss of life of the Insured (Card Holder)

  • Required papers for Natural Loss of Life
  • Credit Life Death Claim Form for Credit Cards or Credit Life Death Claim Form for Loans in which the beneficiary's statement and authorization part needs to be filled out and signed by the beneficiary and witnessed by an adult person, and the policyholder’s statement part needs to be completed and signed by the policyholder's representative along with official seal
  • Physician's statement part of the appropriate claim form needs to be completed by a registered physician (minimum MBBS) mentioning the actual cause of death along with official seal
  • Original or attested photocopy of death certificate issued by the municipal body on a prescribed form, either from Health Department of City Corporation or by Local Union Parishad Chairman (on official printed letterhead) where the deceased was buried or cremated
  • Attested copy of age proof (either national ID, passport, secondary school certificate or birth registration certificate from the concerned authority) of the insured
  • Photocopy of the initial application submitted by the cardholder for credit card or loan
  • Transaction details or statement showing cardholder’s outstanding balance as on the date of death

Additional required papers for unnatural loss of life (death due to accident, suicide or homicide)

  • Certified police report (FIR / Surathal) from the concerned police station
  • Certified autopsy (post-mortem) report from the concerned forensic medicine department or police station

or

  • Certified copy of Magistrate’s or police station officer-in-charge’s permission for burial without conducting post-mortem (where applicable)

or

  • Medical treatment papers and follow-ups from the concerned medical hospitals or clinics (where applicable)
  • Newspaper cutting (if any)
Credit Permanent Total Disability (PTD) Claims

PTD of the Insured due to Sickness / Accidental Injury

  • Completed Notification of Claim Form for Credit Life Insurance Death Claim by the policyholder’s representative along with signature and official seal
  • Completed Disability Claim Form to be completed in detail by the claimant (insured) along with signature in the authorization part, which must be witnessed by an adult person
  • Policyholder’s statement part to be completed by the policyholder’s representative along with signature and official seal
  • Completed Physician’s Statement Form by a registered physician mentioning the actual cause of PTD along with his/her official seal
  • Completed Employer Statement Form by the company’s representative along with official title and seal (where applicable)
  • All present and past treatment papers, prescriptions, detailed case summary, hospital discharge certificate (if any), diagnosis report (if any), daily follow-up notes (if any), most recent x-ray plates or reports (if any) and other related investigation reports must accompany the above forms
  • Recent neurological evaluation report by a neurologist
  • Opinion of two renowned eye specialists along with detailed case summary (for loss of sight, if required)

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Terms & conditions

By clicking the Submit button, you agree that we* may contact you at the number/email you’ve provided, possibly using automated technology or prerecorded voice or direct marketing emails, to discuss about our products, special offers and services. If you don’t want to give this permission, you can still get a quote or make a purchase decision by calling us directly at 16344.

*MetLife or third party acting on MetLife’s behalf.

Thank you for contacting us.
Someone from MetLife will be reaching shortly to provide you help.
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An error occured while submitting your information.