Get International Claim Form - Wea Trust

This guide provides comprehensive instructions for completing the International Claim Form - WEA Trust online. By following these steps, users can efficiently submit their claims for benefits associated with covered services received outside the United States.

Follow the steps to successfully complete the International Claim Form - WEA Trust.

1. Press the ‘Get Form’ button to access the form and open it in the editor.
2. Begin by entering the patient information. This includes the member number, group number, patient’s name, date of birth, and their relationship to the subscriber. Make sure to provide the subscriber's name and current mailing address.
3. Indicate whether the patient is covered under other health insurance including Medicare. If yes, complete the additional fields about the other insurance company, policy number, and subscriber information.
4. In the diagnosis section, enter details about the illness, injury, or symptoms that require treatment. Also, indicate if the treatment resulted from a work-related accident.
5. For charges, list each type of service or provider on a separate line. Ensure that you attach all relevant itemized bills received from the service providers.
6. Finally, sign the form to certify that all information is complete and accurate. This section should be signed by the subscriber, spouse, or the patient, along with the date.
7. After completing the form, ensure all documents are reviewed. Users can save changes, download, print, or share the completed form as necessary.

Begin filling out your International Claim Form - WEA Trust online today to ensure your claims are processed efficiently.