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Click ‘Get Form’ to open it in the editor.
Begin by entering your Policy Number and family name in the designated fields. Next, provide your first name and current postal address, ensuring accuracy for correspondence related to your claim.
Fill in your daytime phone number. Then, complete the details of your claim by selecting whether you are claiming medical services or everyday extras. For medical claims, include dates of admission and discharge, and indicate if the account is paid in full.
If claiming everyday extras, specify the date of service and type of service. Indicate if you have a Medicare card and provide the card number if applicable.
Select how you want IMAN to pay your claim. Review all information provided before signing at the end of the form to confirm its accuracy.
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