Medical Claim Reimbursement Form Instructions and Details

To submit your Medical Claim Reimbursement Form, you can use the myMetLife website or mobile app. Alternatively, send the completed form and required documents to CustomerServices.Gulf@metlife.ae. Physical submissions can be sent to Office# 31, Building # A0452, Road # 1010 Sanabis 410, PO Box 20281, Manama 319, Kingdom of Bahrain. Fax submissions can be sent to +973-17311229. Ensure all required information is accurate and all necessary documents are included to avoid delays. Always keep copies of your submission for your records.

Claims should be submitted within 30 days of the incurred date. Claims submitted more than 90 days after the incurred date may be denied.

The purpose of the Medical Claim Reimbursement Form is to facilitate the reimbursement process for medical expenses incurred by MetLife policyholders. This form requires detailed information about the employee, patient, and treatment received, alongside necessary documentation like medical reports and bills. Submitting a thorough and complete form ensures timely processing and approval of claims. This form is vital for employees seeking to recover costs associated with medical treatments that are covered under their health insurance policy. The attending physician must also provide essential information about the diagnosis and treatment administered. Accurate completion and submission of this form, along with the required documentation, help streamline the reimbursement process and avoid any delays. The Medical Claim Reimbursement Form also includes an authorization statement, which allows MetLife to access relevant medical records for verifying the claim. Understanding and adhering to the guidelines provided in the form are crucial for successful claim approval.

• 1. Employee's full name: The full name of the employee seeking reimbursement.
• 2. Date of birth: The employee's date of birth in DD MM YYYY format.
• 3. Patient's full name: The full name of the patient receiving medical treatment.
• 4. Date of birth: The patient's date of birth in DD MM YYYY format.
• 5. Employee's nationality: The nationality of the employee.
• 6. Patient's nationality: The nationality of the patient.
• 7. Policy number: The policy number mentioned on the Medical Card.
• 8. Certificate number: The certificate number mentioned on the Medical Card.
• 9. Reimbursement Method: Choose between wire transfer or cheque for reimbursement.
• 10. Total amount claimed: The total amount claimed for reimbursement.
• 11. Currency: The currency in which the claim amount is specified.
• 12. Authorization Statement: A certification and authorization statement for accessing relevant medical records.
• 13. Employee's signature: Signature of the employee confirming the details provided are accurate.
• 14. Date: The date of signature in DD MM YYYY format.
• 15. Attending Physician Section: Section for the attending physician to fill out details about the patient's treatment.
• 16. Checklist for Insured member: A checklist of required documents to be submitted along with the form.

Failing to submit the Medical Claim Reimbursement Form accurately and on time may result in delays or denial of the claim. It's crucial to adhere to the guidelines provided and ensure all required information and documents are submitted.

• Delayed Processing: Incomplete forms or missing documents can cause delays in processing the claim.
• Claim Denial: Claims not submitted within the specified timeframe may be denied.

• 1. Medical Expense Reimbursement: Use this form to claim reimbursement for medical treatments received.
• 2. Accident Claims: Submit this form when filing a claim for medical expenses resulting from an accident.