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	NL	FR

Insurance Product Information Document (IPID)
Corporate-sponsored hospitalisation insurance	NL	FR	EN