The Health Shield Claim Form is designed for use when policy holders need to claim reimbursement for medical expenses under their health insurance coverage. This document, governed by English and Welsh law, collects essential information including personal details, treatment information, and payment preferences. The form ensures compliance with UK GDPR, insurance regulations, and healthcare laws while facilitating efficient claims processing. It's particularly relevant for both individual policy holders and corporate scheme members seeking to access their health benefits.
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1. Personal Information: Claimant's details including name, address, date of birth, policy number
2. Claim Details: Nature of claim, dates, treatment received
3. Medical Information: Relevant medical history and current condition details
4. Payment Details: Bank account information for claim settlement
5. Declaration: Truth statement and consent for data processing
1. GP Details: Required only for claims requiring medical verification - used for claims over certain value or involving specific conditions
2. Additional Treatment Information: Details of ongoing or planned treatments - used for complex or continuing treatment claims
1. Receipt Attachments: Space for attaching treatment receipts and invoices
2. Medical Reports: Section for attaching relevant medical documentation
3. Privacy Notice: Detailed information about data processing and rights
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