Get Retail & Individual Medical Claim Form

Navigating the process of completing the Retail & Individual Medical Claim Form online can be straightforward with the right guidance. This guide will provide you with step-by-step instructions to ensure your claim is filed correctly and efficiently.

Follow the steps to successfully complete your medical claim form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Start by completing the header section, where you must indicate whether the claim is under 'MyShield / MyHealthPlus Claim' or 'Other Medical Plan' and provide your policy number.
3. In Section A, provide the details of the assured (policyholder) and the life assured. This includes names, NRIC/FIN/Passport numbers, occupations, and dates of birth. Make sure to also specify the genders of both individuals.
4. For the details of illness or injury, fill in the date symptoms first started, describe the symptoms, and note when the first consultation occurred. Include the doctor’s name and address, final diagnosis, and any relevant admission or discharge dates.
5. If applicable, complete the section regarding accidents. Include the place and date of the accident, along with a detailed description of how it occurred and the nature of injuries.
6. Proceed to Section B to provide your bank account details for claim payments. Indicate if your account is a single or joint account and ensure to attach a copy of your bank statement or book for verification.
7. In Section C, complete the claimant’s declaration regarding beneficial ownership if the recipient is a legal entity. Confirm any changes in beneficial ownership by checking the appropriate box.
8. Next, in Section D, read and sign the declaration and authorization section. This section affirms that all statements made in the form are true and allows Aviva to access your medical data as needed.
9. Finally, complete Section E for the doctor’s report, which must be filled out by the attending physician. Ensure all necessary information is provided, including diagnosis, treatment, and any related conditions.
10. After completing all sections, review your form for accuracy. You can then save changes, download, print, or share the form as needed.

Begin your claims process by completing the necessary documents online today.