Get Expacare Claim Form

Filling out the Expacare Claim Form online can be a straightforward process when you understand each section's requirements. This guide will walk you through the necessary steps to complete your claim accurately and efficiently.

Follow the steps to complete your Expacare Claim Form online.

1. Click the ‘Get Form’ button to access the claim form and open it in your editor.
2. Begin filling out Section A, which should be completed by the patient or the patient's legal guardian. This section includes fields for the insured person's family name, first name(s), nationality, date of birth, membership number, group name (if applicable), correspondence address, and contact details, including telephone number and email address.
3. Answer the claim details questions, such as whether this is your first claim for the medical condition, if you are claiming for cash benefit, and details regarding the medical event. Provide a clear description of the symptoms and diagnosis where applicable.
4. List invoices related to your claim, ensuring original invoices are enclosed. Indicate the dates of treatment, the list of expenses for which you are claiming, the currency and amount paid, and the preferred payee and currency.
5. Move to the Payment Details section. Fill in the account number, bank name, account holder(s) name(s), branch name, bank code, bank address, SWIFT/BIC code, and IBAN number as required.
6. Section B requires information from the treating doctor or dentist. Ensure details about symptoms, diagnosis, treatment plans, hospital admission information, and any previous treatments in the past two years are accurately filled out.
7. Review and confirm all sections are completed. Ensure that you or your representative signs the declaration to certify the information provided is accurate.
8. Finally, save your changes. You may then download, print, or share the completed form as needed.

Complete your Expacare Claim Form online today and secure your claim efficiently.