Forms Download

• Claim Reimbursement Form for members 209 KB
• Consent Form 215 KB
• Physical Attending Report 402 KB
• OPD Form 157 KB
• Pre-Arrangement Form 141 KB
• Admission Form 155 KB
• HB Incentive Claim Reimbursement Form 140 KB

• ATH Medical Claim Form 1009 KB
• ATH Dental Claim Form 983 KB
• ATH Personal Accident Claim Form 870 KB
• ATH Compassionate Emergency Visit Form 764 KB
• ATH Mortal Remains Claim Form 793 KB
• ATH Maternity Claim Form 744 KB

• Personal Accident Insurance Designation (Group) 542 KB
• Application for Debiting a Deposit Bank Account 150 KB
• Beneficiary changing request form 521 KB
• Power of attorney form 165 KB
• Letter of Consent of Automatic Recurring Payment 506 KB
• Request form for the payment of insurance premiums certificate of Health and Personal Accident Insurance 140 KB
• Hospital and Clinic List 1 MB
• Request to amend information 190 KB
• Upgrade form 222 KB

• Membership Handbook-Individual Health Insurance 1 MB
• UltraCare Plan guide – Individual 5 MB
• UltraCare Plan guide – Group 5 MB
• Superior Health 1 MB
• Savvy Health 1 MB
• Beyond Care Plan 754 KB
• Max Care Plan 982 KB
• Basic Care Plan 754 KB
• Care Plus Plan 264 KB
• Care Anywhere Plan 1 MB
• Employee Care Plus Plan 336 KB
• Extra Value Plan 841 KB
• Travel Insurance 1016 KB
• my health Allianz Ayudhya Leaflet 986 KB
• Group Health Insurance 996 KB
• FlexCare Plan 4 MB

• Extra Value Plan Form 204 KB
• Travel Insurance Form 468 KB

• Superior Health 1 MB
• Savvy Health 1010 KB
• Beyond Care 1 MB
• Max Care 1 MB
• Basic Care 1 MB
• Care Plus 999 KB
• Care Anywhere 1006 KB
• Extra value (telesales) 1 MB
• Extra Value 1 MB
• Extra Value Plus 1 MB
• Personal Care and Beyond Personal Care 1 MB
• Platinum and Platinum+ 1 MB
• vHealth vCare 959 KB
• Extra Care 966 KB
• Employee Plus 1 MB
• Maximum Limit Per Year 980 KB
• Maximum Limit Per Year (Telesales) 800 KB
• Accident Plus 1 MB
• Worldwide Travel Health Insurance Policy 7 MB
• Smarter Health 1 MB
• Exclusive Care @BDMS 1 MB
• FlexCare 1 MB