Get International Claim Form

Completing the International Claim Form online can help ensure that your medical claims are processed efficiently. This guide provides you with clear, step-by-step instructions on how to fill out the form to submit your claim successfully.

Follow the steps to fill out the International Claim Form online.

1. Click ‘Get Form’ button to download the International Claim Form. Open the form in your preferred editor for filling out the information.
2. Begin with Section 1, which collects member and patient information. Indicate your status by checking one of the three options: expatriate/retiree living abroad, traveling for pleasure, or traveling for business. Complete all requested fields including group name, policy number, member details, patient name, relationship, and contact information.
3. Provide details about the treatment in the designated fields. Specify the country where the treatment occurred, the currency of the bill, and include the total claim amount in U.S. dollars if applicable. Check the service types rendered, marking all relevant options.
4. Proceed to Section 2, which requires healthcare provider contact information. Fill in the name of the healthcare provider, facility or hospital, address, telephone number including the country code, and fax number if known.
5. Document the date of service along with a brief explanation of your provider visit, which should detail the services rendered and any procedures performed on the form.
6. In Section 3, review the important information for submitting your medical claim. Ensure you follow guidelines for faxing and submitting original documents to expedite the processing time.
7. Double-check all sections to ensure all required information is provided. Once completed, save your changes, and you may choose to download, print, or share the form for submission.

Start completing your International Claim Form online today to ensure a smooth claims process.