Get Health Net Foreign Claim Questionnaire 2016-2025

Completing the Health Net Foreign Claim Questionnaire is crucial if you received health care services while traveling abroad. This guide provides clear, step-by-step instructions to help you efficiently complete the form online.

Follow the steps to complete the claim questionnaire online effectively.

1. Press the ‘Get Form’ button to obtain the Health Net Foreign Claim Questionnaire and access it in your preferred online format.
2. Begin with the primary subscriber details. Enter the primary subscriber name and subscriber number in the designated fields. If the individual receiving services differs, specify their name in the provided space.
3. Indicate the name of the school and confirm your enrollment status by checking 'Yes' or 'No'.
4. Input the travel dates when you were outside the country to provide context for your claim.
5. Describe the nature of the emergency that necessitated the medical treatment. Be specific to aid in processing your claim.
6. Note how long you were ill before seeking medical attention. This helps to establish the timeline of your condition.
7. Specify whether you were admitted to a hospital by selecting 'Yes' or 'No'. If you were treated as an outpatient, indicate the number of times you saw a doctor.
8. Provide the name, address, and phone number of the hospital, clinic, or doctor’s office where you received treatment. Include the name of the treating physician and their contact information as well.
9. Answer questions regarding any diagnostic tests you received, surgical procedures performed, or if a special diet was recommended by selecting 'Yes' or 'No'.
10. Confirm whether your primary doctor in the U.S. was notified about your medical treatment. If applicable, note the type of notification and when it occurred.
11. After completing all sections, ensure that all information entered is accurate. You can save your changes, download, print, or share the questionnaire as needed.

Complete your Health Net Foreign Claim Questionnaire online today to ensure your claim is processed efficiently.