IFRC

1IFRC
2Costs informations
3
4Invoices / Receipts / Prescription
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IFRC

Please make your requests for refunds regularly and do not mix up invoices from different years. Invoices older than one year from the invoice date will not be refunded.

Who are you?

Title

Please use your business email address (@ifrc.org)

Patient informations:

Relationship

Salutation

Date of birth

Costs informations

Does the invoice(s) relate to a hospitalization?

Admission date

Discharge date

Does this claim relate to an accident?

Have you reported the case to the Insurance Unit? only for active employees

Please contact the insurance unit.

Do you have a reference number for the accident in question?

Date of the accident

Part of the body affected

Affected side of the body

Type of injury

Do you have a claim number for the year in question?

Some notes:

- We ask you to provide invoices corresponding to a calendar year (e.g. 2023) or an accident, without mixing treatment years. Only one PDF document per claim.

- Invoices issued more than one year ago are not eligible for reimbursement. The period of validity starts from the date of issue of the invoice.

- You can select the number of invoices to enclose with your statement.

- Please send each invoice with its receipt or prescription (for example: Invoice 1 = Consultation, Invoice 2 = Pharmacy costs, etc).

- The "Nature of medical cost" tab must be specified.

- Copies of invoices and medical prescriptions (prescriptions and supporting documents) must be added to the electronic form in PDF or JPEG format.

Number of invoices

Invoice 1

Date

Currency

Nature of medical cost (Certain treatments are subject to the deductible and the annual excess, e.g. Code 50)

Nature of medical treatment

Indicate the number of sessions charged to the invoice

Invoice 2

Date

Currency

Nature of medical cost (Certain treatments are subject to the deductible and the annual excess, e.g. Code 50)

Nature of medical treatment

Indicate the number of sessions charged to the invoice

Invoice 3

Date

Currency

Nature of medical cost (Certain treatments are subject to the deductible and the annual excess, e.g. Code 50)

Nature of medical treatment

Indicate the number of sessions charged to the invoice

Invoice 4

Date

Currency

Nature of medical cost (Certain treatments are subject to the deductible and the annual excess, e.g. Code 50)

Nature of medical treatment

Indicate the number of sessions charged to the invoice

Invoice 5

Date

Currency

Nature of medical cost (Certain treatments are subject to the deductible and the annual excess, e.g. Code 50)

Nature of medical treatment

Indicate the number of sessions charged to the invoice

Invoice 6

Date

Currency

Nature of medical cost (Certain treatments are subject to the deductible and the annual excess, e.g. Code 50)

Nature of medical treatment

Indicate the number of sessions charged to the invoice

Invoice 7

Date

Currency

Nature of medical cost (Certain treatments are subject to the deductible and the annual excess, e.g. Code 50)

Nature of medical treatment

Indicate the number of sessions charged to the invoice

Invoice 8

Date

Currency

Nature of medical cost (Certain treatments are subject to the deductible and the annual excess, e.g. Code 50)

Nature of medical treatment

Indicate the number of sessions charged to the invoice

Invoice 9

Date

Currency

Nature of medical cost (Certain treatments are subject to the deductible and the annual excess, e.g. Code 50)

Nature of medical treatment

Indicate the number of sessions charged to the invoice

Invoice 10

Date

Currency

Nature of medical cost (Certain treatments are subject to the deductible and the annual excess, e.g. Code 50)

Nature of medical treatment

Indicate the number of sessions charged to the invoice

Invoice 11

Date

Currency

Nature of medical cost (Certain treatments are subject to the deductible and the annual excess, e.g. Code 50)

Nature of medical treatment

Indicate the number of sessions charged to the invoice

Invoice 12

Date

Currency

Nature of medical cost (Certain treatments are subject to the deductible and the annual excess, e.g. Code 50)

Nature of medical treatment

Indicate the number of sessions charged to the invoice

Medical transport
Transport by ambulance if medically necessary

Special pregnancy services
The first four prenatal check-ups, 5 breastfeeding classes, 1 postnatal, prenatal courses

Psychotherapy 15a
Psychotherapy if medically prescribed

Speech therapy 15b
Speech therapy and language correction if medically prescribed

Annual check-up
A basic, preventive medical examination, without symptoms or medical prescription

Vaccines
Vaccines - consultation and products

Alternative medicine
Alternative medicine, provided by a recognised doctor with a medical prescription to be attached to the invoice - as per the exhaustive list above.

Dental treatment
Dental care (excluding orthodontics and cosmetic treatments)

Optician costs
Glasses, frame and lenses, if medically prescribed, please enclose the medical prescription with the invoice

Hospitalisation
Only if your stay lasted longer than 24 hours - otherwise enter code 50

Inpatient spa stays
Spa stays as agreed with the AXA and medical prescription Enclose invoice

Outpatient treatment (50)
Medical consultations, specialist check-ups, physiotherapy, pharmacy costs, contraception, home nursing care, X-rays, MRI, etc.

Cures
Spa stay and cure in a hospital with AXA's agreement and medical prescription to be added to the invoice

Invoices / Receipts / Prescription

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