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Allianz Worldwide Care

Claim Form for underwritten group and individual members


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)