Forms Hospicare


Our forms are different depending on your plan type. In order to better meet your needs, we request that you use the correct forms.

You can ask your human resources department for information about your plan.




  • Affiliation in the healthcare plan (additional form)
  NL  FR  EN  DE 
  • Hospitalisation
    • Claim notification
  NL  FR EN  DE   
    • Procedure for submitting medical costs and/or other documents
  NL  FR  EN  DE  
    • Medical certificate
  NL  FR EN  DE  
  • Healthcare insurance
    • Request for individual continuation
  NL  FR  EN  DE   
  • SEPA European domiciliation certificate
  • ​Insurance Product Information Document (IPID)
    • ​Corporate-sponsored hospitalisation insurance