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Insurance Authorization Letter Template for Philippines

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Key Requirements PROMPT example:

Insurance Authorization Letter

"I need an Insurance Authorization Letter for my medical insurance claim with ABC Insurance Company, authorizing release of my hospital records from Manila General Hospital for a cardiac procedure scheduled for March 2025, with the authorization valid for 6 months only."

Document background
The Insurance Authorization Letter is a critical document in the Philippine insurance landscape, required whenever an insurance company needs access to a policyholder's medical information. This document, governed by the Insurance Code of the Philippines and the Data Privacy Act, enables insurance companies to process claims, assess risks, or make coverage decisions while protecting the policyholder's privacy rights. The letter typically includes specific details about what medical information can be shared, who can access it, and how long the authorization remains valid. It's particularly important in health insurance claims, life insurance applications, and medical benefit processing, where detailed medical information is necessary for decision-making.
Suggested Sections

1. Letter Date and Address Block: Current date and complete contact information for the recipient insurance company

2. Subject Line: Clear identification of the letter's purpose and any relevant policy or claim numbers

3. Patient/Policyholder Information: Full name, policy number, date of birth, and other identifying information of the person whose information is being authorized for release

4. Authorization Statement: Clear and specific statement of authorization for the release of medical information

5. Scope of Authorization: Detailed description of what medical information can be released and for what purpose

6. Duration of Authorization: Specific timeframe for which the authorization remains valid

7. Privacy Rights Statement: Acknowledgment of rights under the Data Privacy Act and consent to share information

8. Signature Block: Space for signature, printed name, and date with any required witness signatures

Optional Sections

1. Specific Restrictions: Used when the policyholder wants to exclude certain types of medical information from the authorization

2. Third Party Authorization: Include when authorizing release of information to parties other than the insurance company

3. Emergency Contact Information: Added when alternate contact persons need to be designated for communication

4. Revocation Instructions: Detailed instructions on how to revoke the authorization, included when required by specific insurance companies

5. Language Translation Statement: Required when the letter is being prepared in multiple languages or for non-English speaking parties

Suggested Schedules

1. Schedule A - Authorized Healthcare Providers: List of specific healthcare providers authorized to release information

2. Schedule B - Types of Medical Information: Detailed list of specific medical records and information types covered by the authorization

3. Schedule C - Authorized Recipients: List of specific departments or individuals within the insurance company authorized to receive the information

Authors

Alex Denne

Head of Growth (Open Source Law) @ 抖阴短视频 | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions




















Clauses


















Relevant Industries

Insurance

Healthcare

Medical Services

Employee Benefits

Legal Services

Healthcare Administration

Financial Services

Relevant Teams

Legal

Compliance

Claims Processing

Underwriting

Risk Assessment

Medical Records

Customer Service

Privacy and Data Protection

Policy Administration

Benefits Administration

Relevant Roles

Insurance Claims Officer

Medical Records Administrator

Compliance Officer

Insurance Underwriter

Healthcare Administrator

Risk Assessment Manager

Privacy Officer

Legal Counsel

Benefits Administrator

Insurance Agent

Medical Records Clerk

Claims Processing Specialist

Industries





Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks, 聽Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination, 聽Severance Pay, Governing Law, Entire Agreemen

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