Get Globality Claim

Submitting a health insurance claim can be straightforward when you know how to fill out the Globality Claim form correctly. This guide provides clear instructions to help you complete your claim efficiently and accurately.

Follow the steps to successfully complete your Globality Claim form.

1. Press the ‘Get Form’ button to access the Globality Claim form and open it in your preferred editor.
2. Begin with section A, where you will need to provide the policyholder's insured details. Fill out your insurance number, full name, date of birth, correspondence address, country and region, postcode and town, phone and fax numbers, and email.
3. Move on to section B to enter the patient details. Include the insured's or co-insured's number, full name, date of birth, and indicate if the claim relates to an accident. If applicable, briefly describe the accident's occurrence.
4. In section C, provide the reimbursement details. List the bank name, country, postcode, account holder’s name and address, account number, beneficiary bank BIK, BIC/SWIFT, IBAN, taxes, and the currency for payment.
5. Section D requires the patient’s signature and date to confirm the accuracy of the information provided and to authorize the release of medical records if needed.
6. Proceed to section E, where your treating doctor or therapist will complete their information, including their name, qualifications, hospital or clinic name, address, and contact details.
7. In section F, the treating doctor or therapist will provide medical information, including treatment type, confirmation of coverage, details of similar past treatments, and the corresponding ICD code.
8. Review all sections for completeness and accuracy. It is crucial to complete the form in block capitals, and to keep copies of all documents submitted.
9. Once every section is diligently filled out, you can save your changes, download, print, or share the completed Globality Claim form as needed.

Start your claim process by filling out the Globality Claim form online today.