Alliance Insurance Reimbursement Form - Download Claim Form PDF

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Founded in the year 1975, Alliance Insurance has been a part of the UAE insurance market for the past four decades. Alliance Insurance deals in both life and general insurance products. It caters to the general public, large- and small-scale businesses and government bodies as well. Alliance health insurance headquarters are located in Dubai with several branches located across the UAE. Alliance is known for its spectacular health insurance plans, trouble-free application, and easy claim procedures. Alliance health insurance claims can be submitted as both direct and reimbursement claims. An Alliance Insurance reimbursement form is required to be submitted to file a reimbursement claim for health insurance plans. Let’s go through the complete claim process for Alliance health insurance.

Download Alliance Insurance Reimbursement Form PDF

How to Fill Alliance Insurance Reimbursement Form?

The Alliance Insurance claim form is a NextCare network form. You can easily recognize the correct Alliance Insurance Reimbursement Form by the NextCare logo. Download the form using the official link given on the Alliance Insurance website.
The first section of the form requires the details of the patient or the claimant. Enter the name of the healthcare provider i.e., Alliance Insurance, patient’s name, insurance card number, and contact details such as phone number.
Moving on to section 2, you will find a subject summary of the diagnosis. This section is to be filled by the treating physician of the claimant/patient. Ask the doctor to add these details in the allotted sections – early symptoms of the patient, date when the current symptoms occurred, date of the initial symptoms, and the treatment the patient is undergoing as of now if any.
Move on to the next section which will contain a detailed analysis of the condition or ailment. The treating doctor is supposed to fill this section as well. Add clinical findings of the patient, cause of the ailment, assessment or diagnosis of the doctor, and diagnosis codes.
The third section named “Medical Plan” will contain all the bills, invoices, and receipts of the expenses that you are looking to get reimbursed. There is a well-formed table given in this section. It is divided into four parts – consultation, physiotherapy, pharmacy, and laboratory tests. Classify and add expenses according to this categorization. You must be thorough and include every single expense in detail here.
There is a small column below section 3 that can be used to add in-patient expenses i.e., hospitalization and such. Check the box if in-patient services were taken, write the length of the stay and the provider. Check the next column to specify whether you will be attaching the discharge summary for in-patient services taken.
The final section will include your own (claimant’s) declaration and signature as well as the doctor’s signature and declaration. Get the form signed and attested and you are done.

Document Required for Alliance Health Insurance Reimbursement Claim

Properly filled, signed, and stamped Alliance Insurance reimbursement form.
Invoices and bills for all the expenses you have listed in the Alliance Insurance reimbursement form.
Payment receipts for all the expenses. Include credit and debit card receipts as they are and obtain a cash memo for payments made in cash.
Prescription for all medicines claimed for reimbursement in the form.
Laboratory, diagnostic and radiology reports for the tests listed in the reimbursement form.
Doctor’s account or report for the treatment that was taken.
Hospitalization records and discharge documents.

How to Submit Alliance Insurance Reimbursement Form?

You can submit an Alliance Insurance claim form using both online and offline methods. If you prefer to get done with the submission online, use the official grievance website of Alliance Insurance. Scan all the documents and the claim form, attach them in an email and forward. Don’t forget to notify the company in advance about the upcoming claim. You also have the option of using the Alliance Insurance Fax number to send the documents.

Alliance Insurance reimbursement form can be submitted using offline channels as well. You can send the form and related documents via courier facilities to the head office in Dubai. If you would rather submit in person, it is also an option to submit the claim documents at one of the branches of Alliance Insurance.

Things to Keep in Mind

Alliance Insurance reimbursement form must not have any clerical errors. Any such error may lead to claim rejection on the administration level itself.
The reimbursement form must be filled either in English or Arabic.
Make sure that all the supporting documents attached with the form must also be either in English or Arabic. If any of the documents are in other languages, get them translated from a certified public translator. Attach both the original and translated copies with your Alliance Insurance claim form.
When you are submitting the reimbursement offline, you will need to submit the original supporting documents. If that is the case, make sure that you get all the original documents photocopied for yourself.
If there are two or more claimants, a separate form is required to be submitted for each.
Double-check that every expense listed in the form has a supporting document.

Conclusion

The alliance insurance claim form submission process is quite straightforward if you follow all the important steps diligently. Just ensure that you only use the official website links to download the Alliance insurance claim form. Double or triple check the form and the documents before submission. Once rejected, the claim will have to be submitted from scratch once again. If you are careful enough, you can easily submit and get the claim settled successfully.