Claim Forms

Expense Reimbursement Procedure
URGENT INCIDENT
Contact immediately the Assistance Provider. Dial the Assistance provider number that corresponds to your policy number (check the first 4 digits of your policy number):
EMPA TEL : +44 800 279 9734
UGPA TEL : +44 800 279 9733
The insurer is XL Catlin Insurance Company SE, underwritten by XL Catlin Services SE, Belgium Branch, and the claims are handled by Intrust Nederland BV, Postbus 40, NL-7900 AA Hogeveen.
Marsh is the insurance broker and does not handle any claim refunds. Due to data protection of medical and personal sensitive information, Marsh has no access to the claim cases.
All queries regarding the status of the refund request consequently need to be sent to Intrust Nederland. The email address is indicated in the claim form.
IN ALL CASES OF MEDICAL TREATMENT:
What is covered? Only urgent medical necessary treatments are covered. This means that check-ups or treatments that can wait until you're back in the home country will not be reimbursed.
Download the claim form below corresponding to your policy reference (UGPA is reserved for UGent).
Fill in the claim form.
- Add a copy of the doctor bills; invoices and all proof of costs (always KEEP the ORIGINAL bills at least 1 year after refund in your possession, in case the insurer will require these).
- Add a copy of the diagnosis and/or prescription of medication or appliances (always KEEP the ORIGINAL bills at least 1 year after refund in your possession, in case the insurer will require these).
- Add your account number including IBAN-code, BIC/SWIFT code and the name and address of your bank, as well as your home address.
- Clearly indicate date and description of the illness/injury. (If the Insurer doesn’t know why you went to the doctor they don’t reimburse).
Send a scanned copy of the claim form and other documents to the email indicated on the form. If you need to send original documents, the postal address is also indicated in the claim form. Your claim will be handled within 2 weeks.
IN CASE OF LOSS OR DELAY OF LUGGAGE/BAGGAGE:
Download the claim form below corresponding to your policy reference (UGPA is reserved for UGent).
- Add a copy of the bills of the replacement goods you bought, because you urgently needed them (always KEEP the ORIGINAL bills at least 1 year after refund in your possession, in case the insurer will require these).
- Add a copy of P.I.R. (Property Irregularity Report) you received from your airline company or a copy of the police report (always KEEP the ORIGINAL reports at least 1 year after refund in your possession, in case the insurer will require these).
- Add a copy of the boarding pass + baggage labels and a copy of your identity card or passport (always KEEP the ORIGINAL documents at least 1 year after refund in your possession, in case the insurer will require these).
- Don't forget to add your account number including IBAN-code, BIC/SWIFT code and the name and address of your bank, as well as your home address.
Send a scanned copy of the claim form and other documents to the email indicated on the form. If you need to send original documents, the postal address is also indicated in the claim form. Your claim will be handled within 2 weeks.
IN CASE OF A LIABILITY CLAIM:
Download the claim form below corresponding to your policy reference (UGPA is reserved for UGent).
Send a scanned copy of the claim form and other documents to the email indicated on the form. If you need to send original documents, the postal address is also indicated in the claim form. Your claim will be handled within 2 weeks.
General Data Protection Regulation (GDPR) For the purpose of placing and servicing your insurance policy, MARSH needs to process some of your personal data. Aside your name, birth date, email, etc. we occasionally may also have to process or store emails containing sensitive data you and the university that purchased the insurance for you, shared with MARSH. For instance, you may request our advice whether your specific physical condition is covered under the policy, or regarding an injury that occurred during your travel and/or stay, or when you copy us in emails addressed to the claims handler/insurer to request a refund for hospital and/or other medical cost related invoices. In accordance with the General Data Protection Regulation, we hereby inform you that when you send us a query containing sensitive personal date by email or through the CONTACT US section you are providing your consent to MARSH to process this type of medical data. You may withdraw that consent at any time. We inform you however that such withdrawal could imply that we or the insurer could no longer be in a position to continue to provide services.
Last update : 25.05.2018
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Pour toutes vos questions ou en cas de problème, vous pouvez vous adresser en premier recours auprès des bureaux mentionnés ci-avant.
Tel : (02)547.57.71 - Fax : (02) 547.59.75 - www.ombudsman.as
Le registre des intermédiaires en assurances est tenu par la FSMA, à 1000 Bruxelles, Rue du Congrès 12-14,
et peut être consulté sur www.fsma.be