Member Reimbursement Medical Claim Form 2026

1. Click ‘Get Form’ to open the Member Reimbursement Medical Claim Form in the editor.
2. Begin by entering the Patient’s name and Health Card No. or Emirates ID No. Ensure these details match those on the insurance card.
3. Fill in the Group member’s name if applicable, and specify the reason for not using listed Healthcare facilities by selecting from options like Emergency or Other.
4. Request your treating doctor to complete the medical information section, including condition requiring treatment, visit date, and treatment details.
5. Provide the Name & Address of the Hospital/Clinic along with Bill No., Treatment Date, Description of Services, and Amount for each service rendered.
6. Complete any additional information regarding work-related cases or other insurance coverage as required.
7. Finally, review and sign the Declaration section, ensuring all information is accurate before submitting your claim.

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