USE A SEPARATE FORM FOR EACH PERSON ON BEHALF OF WHOM A REIMBURSEMENT CLAIM IS BEING SUBMITTED
INSURED
PATIENT
 
Correspondence
Instructions
INSTRUCTION FOR SUBMITTING CLAIMS FOR REIMBURSEMENT

1. Attach original bills, prescriptions and receipts.
2. Proof of payment in respect of all bills should be enclosed.
3. Bills in languages other than English, French, German, Spanish or italian should be accompanied by translation.
4. Print 2 copies of this document and keep 1 copy.

USE A SEPARATE FORM FOR EACH PERSON ON BEHALF OF WHOM A REIMBURSEMENT CLAIM IS BEING SUBMITTED

CATEGORY OF EXPENSE:type of medical services are pre-printed in conformity with the provisions of the new Schedule of Benefits in force as from January 1, 2001.
PLEASE NOTE ESPECIALLY THE FOLLOWING:

    -   FUNCTIONAL REHABILITATION TREATMENTS: Include physiotherapy, kinesitherapy, ostheopathy,etc.., given to non-hospitalized patients.
    -   INSTITUTIONAL CARE:covers services provided to patient admitted to hospital or other residential institutions, as follows :
        Code 2.1   PUBLIC WARD: use only for hospitalization in common (public) ward, in a public hospital, charging a global price for accomodation + care
        Code 2.2   ACCOMODATION: Board and lodging; exclude extras or medical care.
        Code 2.7   MEDICAL CARE:all medical services provided to hospitalized patients, including X-rays, medication, surgical costs, etc., where these are shown as separate items on the hospital bill.
    -   TRANSPORT COSTS: include only costs of ambulance/other ermergency transportation or medical travel approved in advance.