HALLESCHE Krankenversicherung

auf Gegenseitigkeit

auf Gegenseitigkeit
Krankenversicherung

____________________________________
policy number

____________________________________
HALLESCHE surname, first name
Krankenversicherung
auf Gegenseitigkeit ____________________________________
address
70166 Stuttgart
____________________________________
address

Claim List

Number of Invoices handed in Total value in €

Please transfer the reimbursement amount

 onto account n°:

IBAN BIC

bank

 on the following acc.:

IBAN BIC

bank

Invoice-Check – Refund of Premiums/Deductible

Applies to unpaid medical invoices from 150 € invoice amount on.
 I wish no reimbursement. Please check my unpaid medical invoice(s) for correctness of fees and calculative correctness and
inform me of the result (e. g. because the total is less than the deductible or refund of premiums)

Tentative Treatment Plan/Estimate

 Please check the dental tentative treatment plan
 Please check the estimate for remedies or support me with your remedy service

Notes:

LG 39e 10.13
How to hand in Invoices Invoice Check Health Hotline
To make it easier for you to hand in your in- If you (first) do not wish to get a reimbursement Telephone +49 (0)7 11/66 03-20 00
Daily 24 Hours
voices we ask you to use this form. Please send of your invoice – for example because you have
us back the form filled in together with your not reached your deductible or because you A team of doctors and medical experts is avail-
receipts. You also find this form on our German wish to profit from the refund of the premium – able for your questions concerning your health
homepage: www.hallesche.de > Kundenser- we offer you an invoice check of your medical around the clock. Here you receive information
vice > Ihre Arztrechnungen. and dental receipts: our experts check your and advice to the following topics:
Please consider the following for a smooth invoice for its correctness free of charge.  Addresses of medical service providers
handling: Please always send us the original (e.g. doctors, hospitals)
The invoice check functions like this: Please
invoices. Please do not staple your receipts.  Individual health information, such as dia-
send us your invoice together with this form to
Deductible: betes, overweight, high blood pressure
HALLESCHE. Our specialists will then check,
If you have agreed a premium reducing deduct-  Medicaments, for example in case of ques-
if your invoice is according to the requirements
ible, we ask you to send us the receipts only tions in the package insert
of the scale of charges and if it is calculationally
when the amount has been surpassed.
correct. We shall inform you immediately of the
Refund of Premium: result. Please read further information of the Service Telephone
Do you have a claim of a refund of your premi- invoice check on our German homepage Telephone 0 800/30 20 100
um? Please consider this amount as well! www.hallesche.de > Kundenservice > Ihre Mon-Fri 8 a.m. to 8 p.m. (free of charge).
Example: Assuming that you have a claim of a Arztrechnungen. From abroad: +49 (0)7 11/66 03-36 69
refund of premiums of € 500 and your tariff has In case of questions concerning your insurance
a deductible of € 300. Then you should send Service for Aids coverage our service telephone is there to sup-
your invoices, if they surpass the amount of € port you. We are available Monday to Friday
In the frame of our health services we support
800. If these are less than € 800 you will profit from 8 a.m. to 8 p.m. This team is responsible
you choosing and obtaining medical aids and
from a refund of your premiums. for
care products. Our cooperation partners which
Medicaments: are active throughout Germany offer you ad-  Questions to your insurance benefits and
Please take care that the prescriptions give proof vantages in the price besides an extensive con- statements
of the pharmacy stating the date and stamp of sultation.  Information of refunds of premiums and
the pharmacy. Please contact directly your service centre. You modifications

Remedies and Aids: will also find the contact data in the internet:  Update of addresses, names or accounts
Please hand us in the medical prescription www.hallesche.de > Kontakt > Adressen &  Ordering health brochures
together with the invoice. Hotlines.

Please find further information to your con-

Dentures:
Please send us your tentative treatment plan of
Health Portal tract and to our health offers in the internet on

your dentist – we shall inform you of the www.hallesche-gesundheitsportal.de www.hallesche.de

amount of your claim. Our health portal offers you German up-to-date,

Civil Servants: well-founded and high quality information

As per our experience the public allowance about diseases, symptoms, examination practic-

authorities accept invoice copies – without any es, lab values, medicaments, doctors, hospitals

remarks of reimbursement. We therefore ask and emergency pharmacies. Another extra free

you to send us the original invoice and the of charge is the weekly newsletter for registered
HALLESCHE Krankenversicherung
members. Thus you keep yourself updated in auf Gegenseitigkeit
public allowance authority the copy. Thus you 70166 Stuttgart
are sure to get a quick reimbursement of both health and fitness matters. [email protected]
www.hallesche.de
institutions. ALTE LEIPZIGER – HALLESCHE Konzern