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    AAR - Reimbursement Application Form

    Uploaded by

    Cargo Ree
    AAR Insurance requires applicants to complete a reimbursement application form providing personal details, membership number, claimed amount, preferred payment method, and payment details. By completing the form, applicants consent to AAR Insurance collecting, processing, and storing their personal data according to the Data Protection Act of 2019 and EU General Data Protection Regulation. The form also requires applicants to provide documentation like medical reports, invoices, certificates, and identification documents to support their reimbursement claim. Upon review, the claims department will determine the reimbursable amount based on AAR insurance rates and policies. The medical assessor and manager must approve the reimbursement before payment.

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    AAR - Reimbursement Application Form

    Uploaded by

    Cargo Ree
    212 views1 page
    AAR Insurance requires applicants to complete a reimbursement application form providing personal details, membership number, claimed amount, preferred payment method, and payment details. By completing the form, applicants consent to AAR Insurance collecting, processing, and storing their personal data according to the Data Protection Act of 2019 and EU General Data Protection Regulation. The form also requires applicants to provide documentation like medical reports, invoices, certificates, and identification documents to support their reimbursement claim. Upon review, the claims department will determine the reimbursable amount based on AAR insurance rates and policies. The medical assessor and manager must approve the reimbursement before payment.

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    Application for Reimbursement from AAR

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    AAR Insurance requires applicants to complete a reimbursement application form providing personal details, membership number, claimed amount, preferred payment method, and payment details. By completing the form, applicants consent to AAR Insurance collecting, processing, and storing their personal data according to the Data Protection Act of 2019 and EU General Data Protection Regulation. The form also requires applicants to provide documentation like medical reports, invoices, certificates, and identification documents to support their reimbursement claim. Upon review, the claims department will determine the reimbursable amount based on AAR insurance rates and policies. The medical assessor and manager must approve the reimbursement before payment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    212 views1 page

    AAR - Reimbursement Application Form

    Uploaded by

    Cargo Ree
    AAR Insurance requires applicants to complete a reimbursement application form providing personal details, membership number, claimed amount, preferred payment method, and payment details. By completing the form, applicants consent to AAR Insurance collecting, processing, and storing their personal data according to the Data Protection Act of 2019 and EU General Data Protection Regulation. The form also requires applicants to provide documentation like medical reports, invoices, certificates, and identification documents to support their reimbursement claim. Upon review, the claims department will determine the reimbursable amount based on AAR insurance rates and policies. The medical assessor and manager must approve the reimbursement before payment.

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    of 1

    REIMBURSEMENT

    APPLICATION FORM
    PLEASE COMPLETE THIS APPLICATION AND ANSWER ALL QUESTIONS.
    MPESA PAYBILL NO: 333200
    Data collection consent: Pursuant to the data protection act, 2019 (“DPA”) and the European Union General Data Protection Regulation (“EUGDPR”), AAR
    Insurance (K) Limited (“AAR Insurance”), in its capacity as a data controller and/or processor under the DPA and EU GDPR must obtain your explicit, affirmative,
    and informed consent before it can collect or process any personal data for a lawful basis. AAR Insurance shall only use your personal data to administer applied
    products and services requested from AAR Insurance. In order to provide you with the above services, AAR Insurance will need to collect, process and store
    your personal data for the duration of the product. If you consent to us storing your personal data for this purpose, please tick the check box.

    I agree to AAR Insurance's collecting, processing and storage of my personal data.

    1. Member Details:
    Name: Membership Number:

    Mobile Number: Claimed amount:

    Corporate Name: (If Applicable):

    Preferred Mode of Payment: Bank Mpesa

    NB: Amounts payable via M-pesa is KShs.70,000 and below.


    Payment Details: Bank Name: Branch: Swift code

    Account Name: Account Number:

    Mpesa Payment Details: Mpesa Number

    Pay From: Fund Insurance (OP, IP) Ex- Gratia Signature:

    2. Name of Relationship Manager

    Name:
    3. Re-imbursement checklist:
    Medical report attached Where Applicable:
    Invoice/ receipt attached has all breakdowns Medical Card of the Deceased
    If overseas only emergency and evacuation are covered. OP not covered Death Certificate / Death Notification
    If overseas only covered if within 90 days since leaving East Africa Police Abstract / Medical Report
    If IP, was admission reported? Bank Details & National ID Copy of the next of kin
    If IP, attach Reimbursement pre-authorization letter?
    4. To be filled by Claims Dept:
    If IP Accrued? How Much? Charges as per AAR rates? NHIF rebate is deducted
    5. Reimbursement Amount
    Foreign Currency Exchange Rate Ksh.

    6. Approved by:
    Foreign Currency Name Signature
    Medical Assessor
    Medical Services Manager
    I consent to my phone and email contacts being used to receive:
    1. Communication related to my policy. 2. Company communication and marketing information.

    wwww.aar-insurance.co.ke
    +254 703 063000
    AAR_Insurance

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