Emergency Hospital & Medical for Canadians
In the event of a medical emergency, Allianz Global Assistance must be notified prior to any surgery being performed or within 24 hours of admission to a hospital.
- Please print and fully complete the Hospital and Medical Claim Form. Once done, sign the form, and then mail the form, along with all applicable documents noted below, to the Claims department.
Allianz Global Assistance Claims Department
250 Yonge Street, Suite 2100
Toronto, Ontario, Canada M5B 2L7
- Please complete the appropriate provincial health claim forms.
Out-of-Country claim form
Application for Reimbursement and Power of Attorney
Newfoundland & Labrador
Out-of-Province Claim form
Application for Newfoundland Hospital Insurance Benefits
Schedule A and Schedule B
OHIP Authorization and Release Form
- Attach all original itemized bills and receipts to support your claim.
- Attach any medical records you may have been given at the time of treatment such as a copy of the ER report or written letter from your treating physician. For hospitalization claims we will require a complete copy of your medical records from the treatment facility.
- For Multi-trip travel health insurance Plans, attach proof of departure and return to your province of residence.
- For hospitalization claims we will require a complete copy of your medical records from the treating facility.
- Please include any additional information relevant to your claim. Depending on the claim, we may request more information.
- If you would like your agent or a third party to assist with your claim, be sure to complete and include a Privacy Release Form.
Third Party Privacy Release Form
Agent Privacy Release Form
To assist the processing of your claim, please provide the requested information, including a valid e-mail address. Please note that the security setting of your e-mail account needs to be properly set to avoid our e-mails being directed into your spam folders.