Date Format: DD slash MM slash YYYY
Which costs would you like to submit?
In order to guarantee a swift treatment of your costs, we can give you the following tips:
- For outpatient medical treatments and consultations (specialist, physiotherapist, examination, etc.) you provide us preferably with the separate receipts of the health insurance fund. In case you no longer receive these receipts from your health insurance fund, you can send us an overview list from your health insurance fund with the provided medical treatments only. General overview lists with other expenses will not be accepted.
- For pharmaceutical costs you provide us with the separate BVAC certificates you receive from your pharmacist. Overview lists from the pharmacist will no longer be accepted.
- Always provide us with the complete bill, with all the pages in the right order and perfectly legible. Do not join several documents in one picture or scan.
Possible documents: Receipts from the health insurance fund, proof of payment of fees actually paid (if not stated on the settlement from the health insurance fund), Mod. 704N forms or 'Certificate of pharmaceutical performances covered under an additional insurance' form from the pharmacist. I will keep the original of the (scanned) copy and will immediately make it available to Vanbreda Risk & Benefits if so requested. I hereby confirm that I will only request the reimbursement of these costs via Vanbreda Risk & Benefits. I will immediately inform Vanbreda Risk & Benefits if I receive a reimbursement of these costs in any other way. In that case I am not entitled to a reimbursement via Vanbreda Risk & Benefits.
Attention: Total size of uploaded files is limited to 8 MB.