Your forms



TIP: You can easily report your hospital admission online via It's also your go-to source for information on how to claim back your medical expenses online.

Below you will also find all the necessary forms to report your admission in writing or claim your refund.

Reporting a hospital admission

• Claim form
Report your hospital admission online.
Form for expenses linked to a hospitalisation or an accident​.

NL - FR - EN - DE 

• Medical certificate          
You only need to fill out this form if explicitly directed to do so by our medical department.

NL - FR - EN - DE       

Request for reimbursement of medical expenses (hospitalisation, outpatient care and critical illnesses)

    Claim back your medical expenses safely and easily online 

    or, by post, using the form below.

NL - FR - EN - DE

Additional information when enrolling in a group hospital plan


Individual continuation of group hospital plan


SEPA attestation (European direct debit)


Requesting a certificate of insurance

​​​Request a certificate of insurance through the MyAG Employee Benefits platform or mobile app.​

Fact sheets (IPID)

IPID stands for Insurance Product Information Document. This document gives you useful, simple and concise information about your insurance. It is drawn up in accordance with the legal provisions of Assuralia, the professional association of insurance companies in Belgium.

• Group hospitalisation plan

NL - FR - EN

• Group outpatient care plan

NL - FR - EN

• Group dental care plan