Get Medical Expenses Claim Form - At-mtm Group Web Pages - Cern - At-dep-mtm Web Cern

Filling out the Medical Expenses Claim Form is an essential step in obtaining reimbursement for healthcare expenses. This guide provides clear instructions on how to accurately complete the form online, ensuring that you gather all necessary information and supporting documents.

Follow the steps to effectively complete your claim form.

1. Press the ‘Get Form’ button to access the Medical Expenses Claim Form and open it in your preferred document editor.
2. Begin by entering the patient's name and first name, as well as their insurance number and CERN ID. Next, provide the main member's name and division.
3. Indicate whether emergency hospitalization was required by selecting 'yes' or 'no.'
4. Specify the number corresponding to your case from the provided options. Include any required supporting documents, such as CERN justification or accident reports, if applicable.
5. If your case involves an accident, provide the date of the accident and any relevant reports. Include information about any third parties involved, such as their name and address.
6. Enter the total number of documents enclosed with your claim.
7. Indicate whether other insurance covers the treatments by selecting 'yes' or 'no.' If yes, provide the name of the insurance company, their address, and the policy number.
8. List down all applicable treatments and benefits in the provided sections, detailing the currency code and the amounts for various medical expenses, including doctor's fees, pharmaceutical expenses, hospital stays, and dental expenses.
9. Ensure all information is complete and accurate. When finished, save your changes, and choose to download, print, or share the form as needed.

Complete your Medical Expenses Claim Form online today for a swift reimbursement process.