Health claim

Claim application
for health insurance

Report a claim | Health insurance | If Insurance

Before the claim application submission:
1) check which medical costs are payable and which not
2) ask the policy number from your employer
3) take a picture or scan medical receipts (every receipt separately)
4) find your bank account number

Policy number

Required

Required

Policy number {{ model.policyNumber }}

Your employer (Policyholder) {{ model.policyHolderName }}

Recipient of treatment

Required

Person who received medical service

Required

Required

Required

Required

Check the phone number

Check the phone number

Required

Check the e-mail address

I do not have e-mail address

Did you received medical service? Yes No

Person who received medical service

Name {{ sufferer.name }}

Surname {{ sufferer.surname }}

ID code {{ sufferer.code }}

Phone number {{ sufferer.phoneNumber }}

E-mail {{ sufferer.email }}

Medical services

Please enter every receipt separately

Required

Required

Date not valid

Date can not be in the future

Date cannot be in a past

Required

Required

Check the number. Correct is: 100 or 100.20

Medical receipt or document {{ fileUploadProperties.pendingFilesCount + fileUploadProperties.uploadedFilesCount }} / {{ fileUploadProperties.maxFilesCount }}
File count limit reached. Some files has not been uploaded.
×
{{ file.size | hkFileSize }}
{{ file.name }}
{{ file.error }}
Upload one photograph or document at a time. To add the next one, click on the ‘Add the next medical treatment document’ button.

Required

Comments {{ model.receivedServices.comments != undefined ? model.receivedServices.comments.length : 0 }} / 1000

Service description {{ service.descriptionName }}

Date of receipt of the medical service {{service.dateOfService | hkDate }}

Service provider {{ service.providerName }}

Service provider {{ service.providerOther }}

Sum of the service fee € {{ service.sumOfFee | number:2 }}

Medical receipt or document
{{ file.name }}
Comments

{{ model.receivedServices.comments }}

Compensation

I request the compensation

Compensation will go to me

Required

Required

Required

Required

Required

Required

I do not know account number

Required

Required

Name {{ model.compensation.recipient.name }}

Surname {{ model.compensation.recipient.surname }}

ID code {{ model.compensation.recipient.code }}

Name {{ model.compensation.recipient.name }}

Company reg. code {{ model.compensation.recipient.code }}

Bank {{ model.compensation.bankName }}

Account number (IBAN) {{ model.compensation.bankAccountNumber }}

My Data

Required

Required

Required

Required

I do not have e-mail address

First name {{ model.submitter.name }}

Last name {{ model.submitter.surname }}

Phone number {{ model.submitter.phoneNumber }}

E-mail {{ model.submitter.email }}

Privacy notice

If Insurance collects and processes personal data submitted with the claim and through the claims handling process according to the Privacy policy among other things: 1. to handle the claim and decide on the insurance indemnity; 2. to request information about the claim event (incl information concerning the state of health) from state and local government and other persons; 3. to contact you.

ADVANTAGES

  • Ninety percent of our clients evaluate our claims handling process as ‘good’ or ‘very good’.

  • In case of questions call us 24/7 by phone777 1211.