Nas Insurance Reimbursement Form

For each member of the family.

Nas insurance reimbursement form. 1 of 2 reimbursement claim form please read the instructions and guidelines on page 2 before filling this form. Nas has carved a unique niche in the regional healthcare sector because of its excellent service standards and innovative solutions. National health insurance company daman pjsc p o. Insurance card no of the person who received treatment it is different.

Reimbursement claim form please retain a copy for your records please use blockletters to fill this form. Acute work related chronic accident hereditary congenital pregnancy lmp. Dd mm yyyy q life medical insurance company llc incorporated at qatar financial centre license no. 1 date of issue.

Please refer to page 2 for instructions on how to fill the form. Reimbursement claim form provider. Box 128888 abu dhabi u a e. Welcome my nas.

Nas creates innovative insurance solutions to address emerging risks and gaps in typical coverages. Reimbursement claim form. Suq co i s cobà a cooagljc ausl bs lgljle cslg 10 qecnaa suq 01 collgcr i coljegij co sljq snwollag suq co w suq qgcislg bg14gcrugle spoag 10 we peel. Please ensure that all sections are fully completed and attach all original receipt s showing the diagnosis and a full breakdown of cost for each condition being claimed.

141 authorized by qfc regulatory authority a qic group company. For the required supporting documentation use the attached summary table as cover sheet. One claim form per person family members must apply individually. Nas has over 40 years of experience as a long standing lloyd s coverholder.

Employee no staff id. Administrative section to be completed fully by the employee guardian employee name. 97126149550 doc ctrl no. We are extremely customer focused.

Company name of the employee.