Claim Form - GlobalPass Plans for Latin America

Please complete this form to obtain reimbursement of eligible medical expenses from Allianz Worldwide Care if you are covered by one of our GlobalPass Plans for Latin America. Please use one Claim Form per person and per condition.

For members of a group scheme... Claim Form for members who are part of a group that was not underwritten (Typically, these groups consist of 10 or more members) Claim Form for non-underwritten groups Claim Form for members who are part of a group that was underwritten (Typically, these groups consist of 3 to 9 members) Claim Form for underwritten groups

For individual members... If you applied for your policy (independent of an employer) and pay your own premium, you are an individual member. Please use the following claim form... Claim Form for individual members