Overseas claim form 2026

1. Click ‘Get Form’ to open the Overseas Medical Claim Form in the editor.
2. Begin by entering your Enrollment Code and Identification Number at the top of the form. Ensure that all information is typed clearly.
3. Fill in the Patient Information section, including the patient's name, date of birth, gender, and relationship to the subscriber. If applicable, attach a statement if the last name differs from the subscriber's.
4. Complete the Other Health Insurance section if applicable. Provide details about any other insurance coverage, including policy type and effective dates.
5. In the Diagnosis section, describe the reason for the visit and indicate if it was due to a work-related accident.
6. List all charges in the Charges and Payment Information section. Include start and end dates for services being claimed along with total charges.
7. Select your preferred payment method under Member Payment Information. Fill out Bank Wire Information if you choose that option.
8. Finally, sign and date the form to certify its accuracy before submitting it along with itemized bills to ensure prompt processing.

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