The Allianz Claim Form is a medical expense reimbursement document for Allianz Worldwide Care policyholders. It collects all information needed to process your claim, from personal identification to detailed medical treatment records. Complete all fields in block capitals to ensure your claim is processed without delay.
The form covers four key sections: policyholder details (full name, date of birth, policy number, contact address), patient details if different from the policyholder, comprehensive medical information (diagnosis, treatment dates, provider name and address, itemized costs), and payment preferences. Gather your invoices, prescriptions, and medical reports before you start filling out the form.
Allianz offers two payment methods on the claim form. You can request direct payment to your medical provider or choose reimbursement to your own bank account. For international payments, include your IBAN and SWIFT/BIC codes. Specify your preferred currency in the payment section. See also the optical reimbursement claim form for vision-related expenses.
The form includes dedicated sections for specialized claims: physiotherapy and psychotherapy, dental procedures, and pregnancy-related expenses. Each section asks for the treating provider's registration number, treatment dates, and an itemized cost breakdown. Allianz Worldwide Care handles personal data in line with applicable data protection laws. Submit the completed form with all original documents. Keep photocopies of everything you send. Policyholders with multiple policies can also review the combined insurance claim form or the health insurance claim form for additional coverage options.
| Question | Answer |
|---|---|
| Form Name | Allianz Claim Form |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | orient reimbursement form, orient allianz reimbursement form, orient allianz claim form, orient insurance reimbursement form |