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Philippines Itemized/Other Health Insurance Claim Checklist

Download the Philippines Itemized/Other Health Insurance Claim Checklist

  • Use pages 1 and 2 when your other health insurance plan (such as PhilHealth,etc.) doesn't, can't, or won't do a proper explanation of benefits (EOB) or other document showing what was paid and what was not paid.
  • Page 1 of this form serves as an itemized bill or receipt of services received/paid for, when a provider can't or won't produce an itemized bill, receipt or statement of services rendered. The form must be complete and signed by the provider.

If you have questions, contact the TAO-Pacific Regional Call Center: 

  • Monday-Friday
  • 7:30 a.m to 4:30 p.m.
  • Japan Standard Time
Address TRICARE Area Office-Pacific NH Okinawa
PSC 482, Box 2749
FPO AP 96362
Phone 1-888-777-8343 option 4
(if calling from the U.S.)
DSN 315-643-2036
Commercial +81-98-970-9155 (country code: 011)
Fax 315-643-2037

Last Updated 12/4/2013

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