Making a claim.

We aim to make the claiming process as simple and stress free as possible.

The insured member is required to complete the following claim form and attach all the original medical bills and supporting documentation when filing the claim. A separate form must be completed for each medical condition, each currency and each member. All sections must be completed.

Personal Data provided in this claim form or submitted as part of this claim will be used and processed by us in line with our Privacy Policy which can be requested from us at any time.

Please click here to download the claim form as a pdf – you will need page 2 to give to your doctor.

If the form below does not appear immediately, please refresh this page.

Loading...

SECTION A: PATIENT DETAILS TO BE COMPLETED BY INSURED MEMBER


If the person named above is not the patient, please complete details

SECTION B: SETTLEMENT DETAILS

We settle all eligible claims by bank transfer (EFT), therefore it is important that you confirm your correct bank details every time you make a claim. Should the incorrect bank details be provided we reserve the right to charge an administrative fee to cover any charges incurred due to the error.

Bank Transfer – All fields in the box below are MANDATORY:

If the account holder is not the claimant then you must state their relationship with the claimant and provide evidence of their permission for the funds to be transferred to their account (except in the case of a minor):

PLEASE NOTE:

• It is important that you complete the bank details section in full. Any missing or unclear information may result in payments being delayed.

• Bank charges may apply when making bank transfers

• Payments are not made directly to any clinic, physician or medical provider

• If IBAN numbers are not used please ensure that the account number is entered and that the Swift Code/BIC is also completed. 


SECTION C: PATIENT DETAILS TO BE COMPLETED BY TREATING DOCTOR

Note: If there are multiple doctors, this section is to be completed by the last attending physician.


SECTION D: UPLOAD SECTION

Please upload your documents below, failure to do so will delay your claim

0% Complete

    0% Complete

      * Required

      “Giving you confidence in everything we do.”