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Application for restitution of the health insurance expenses

IMPORTANT!

Please enter your phone number (and e-mail) carefully, as we will send you a link to the contact details you provide, by clicking which, you will need to confirm your request.

The decision on the expenses incurred and compensation thereof will be made within 15 calendar days of the receiving of the request.

For your convenience, the first digits of the health insurance file have been entered – you only need to enter the last 7 digits of the file number
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Drag files here
Physician’s referral, medical excerpt, prescription, receipt of expenss, etc.
Uploaded files must match following requirements:
Max size: 10 MB
Allowed formats: gif, jpg, jpeg, png, bmp, txt, odf, pdf, doc, docx, ppt, pptx, xls, xlsx
Max amount of files: 5