Please complete this form to obtain reimbursement of
eligible medical expenses from Allianz Worldwide Care if you are covered
by one of our International Healthcare Plans. Please use one Claim Form
per person and per condition.
Claim Form - Editable (WORD Version)
Claim Form - (PDF Version)
For further details on our claims process, please see our ‘
How to Claim’ guidelines.
Allianz Worldwide Care offers policy documents in English, German,
French, Spanish, Italian and Portuguese. However, for convenience we also offer our Claim Form for underwritten groups and individual members in the
following language:
Bulgarian Claim Form - (PDF Version)