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1. Click ‘Get Form’ to open the Claims Reimbursement form in the editor.
2. Begin by filling out the 'Member General Information' section. Enter your Patient ID No, Patient Name, Company, and Principal Member Name. Ensure that you provide a valid email address for communication regarding your reimbursement.
3. Select the appropriate claim type by checking the relevant box (Out-patient, In-patient, Optical, etc.). Include contact numbers for both the patient and principal member.
4. In the 'Report of the Attending Physician' section, have your physician complete their details including Hospital/Clinic name, their name, contact number, and type of availment. This serves as a medical certificate.
5. Attach all required documents as specified in the Basic Requirements section based on your claim type. Ensure all original documents are included before submission.
6. Review all entries for accuracy and completeness before signing. Once finalized, submit your form to Maxicare Healthcare Corporation within 30 days from date of availment.

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