Claim Form for non-underwritten group 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.

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Allianz Worldwide Care offers policy documents in English, German, French, Spanish, Italian and Portuguese. However, for convenience we also offer our Claim Form for non-underwritten group members in the following languages:

Arabic Claim Form - (PDF Version)

Chinese Claim Form - (PDF Version)

Latvian Claim Form - (PDF Version)

Russian Claim Form - (PDF Version)