Claims reimbursement (IPMI)
Claims reimbursement (IPMI)
1. Prepare the documents required for reimbursement claim as below
- A fully completed Claim form with signed and dated declarations. Download the form here
- Section A-C and F would be completed by the insured.
- Section D would be signed by the insured.
- Section E would complete and sign by the attending doctor. - Medical report of the hospital/the clinic could be accepted in case the attending doctor does not provide the complete information in Section E.
- The Original receipts
- Original itemized invoice
- A copy of the prescription
- A copy of the investigative test results where relevant (blood tests, X-rays, Ultrasounds, etc.)
- A copy of insurance card and a copy of your ID/Passport with wet ink signature to certify true copies.
- Proof of payment.
2. Submit the documents via registered postal mail or EMS to prevent loss of items to the address below.
Claim Department : IPMI (Health Insurance)
Allianz Ayudhya General Insurance Public Company Limited
898 Ploenchit Tower, Ploenchit Road, Khwang Lumpini, Khet Pathumwan, Bangkok 10330
Please remember these important points when completing your Claim form:
- Assessment of your claim may be delayed if you and your medical practitioner do not complete all the necessary sections of this form.
- Send your claim to us as soon as possible. We recommend that you do so within a maximum period of six (6) months of the first treatment date.
- Always send us the original receipts with this form. Photocopies and credit card statements will not be accepted.
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Remarks:
OPD – claim amount up to 5,000 baht per time (maximum 20 claims per year) IPD – claim amount up to 20,000 baht per time (maximum 2 claims per year). Your claim will be considered as per the terms and conditions of insurance policy.