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Leistungsauftrag - Barmenia Krankenversicherung AG - K4664 2026

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The document is a performance request form for Barmenia Krankenversicherung AG, detailing how to submit claims related to health insurance. It provides instructions for using the BarmeniaApp, online services for address changes, and guidelines for organizing receipts. The form includes sections for personal information, types of costs incurred, and additional notes regarding foreign insurance coverage.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your Versicherungsnummer at the top of the form. This is essential for processing your request.
Fill in your personal details, including Name, Straße, PLZ/Wohnort, and contact information such as Tel. privat and E-Mail-Adresse privat.
Indicate any notes regarding this Leistungsauftrag by checking the appropriate box.
List the costs associated with your claims under Kostenart, ensuring you enter amounts in EUR for each category.
If applicable, check the box for any foreign receipts and specify the exact duration of your stay abroad.
Complete any additional sections related to medical services received, including details about your Hausarzt and other healthcare providers.
Finally, review all entries for accuracy before signing and dating the form at the bottom.

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