Get Kaeloxelus Gap Cover Claim Form 2016

Filling out the KaeloXelus Gap Cover Claim Form online can be a straightforward process if you follow the right steps. This guide will provide clear instructions to assist you in completing the form accurately and efficiently.

Follow the steps to fill out the KaeloXelus Gap Cover Claim Form online:

1. Press the ‘Get Form’ button to retrieve the KaeloXelus Gap Cover Claim Form 2016 and open it in your preferred online editor.
2. Begin by completing the personal details section for the principal member. Fill in your surname, first name, ID number, telephone number, cell phone number, email address, employer name, branch name, date of employment, medical scheme, membership number, benefit option, and gap cover policy number.
3. Provide the details of the patient and service providers. Enter the patient's surname, first name, ID number, the hospital they were admitted to, admission date, discharge date, admission time, discharge time, nature of illness or condition, procedure performed, name of the surgeon or medical practitioner, and their practice number.
4. Complete the reimbursement details section by entering the account name, bank name, account number, and account type. Ensure that the account mentioned belongs to the principal member.
5. Review the declaration section. By signing this section, you confirm that all information provided is accurate and that you understand the consequences of any misrepresentation or non-disclosure.
6. Once all fields are filled in, you can save your changes. Choose to download, print, or share the form as needed.

Start completing your KaeloXelus Gap Cover Claim Form online today for a seamless claims process.