Emergency Health Insurance Plan Claim Form
To submit a claim, you will need to download and complete the form, and ensure the form is signed and dated before submitting to Intrepid 24/7™. Please include any documents to support your claim. You must email your documentation to Intrepid 24/7™ at: claims@intrepid247.com.
You must include a copy of the emergency room report and all hospital records if the treatment was received at a hospital. Remember to keep a copy of all documents emailed for your records.
Download the International Emergency Health Insurance Plan Claim Form
Important:
- All claims must be reported to Intrepid 24/7™ with 30 days of occurrence.
- Written proof of claim must be submitted to Intrepid 24/7™ within 90 days of occurrence.
- You are responsible for all fees charged for any supporting documentation.
- Failure to complete and sign the form in its entirety or submit supporting documentation will delay claim processing.
How to submit claims
- Complete a Claim form
- Download the Claim form
- Complete the form electronically or print and fill out each section
- Fill out all required fields
- Once complete, print completed form, Sign and Date in Pen (all claim forms must be signed and dated to be processed)
- Gather your information related to your medical visit
- Collect all medical reports, documents, ER Tests, Referrals, follow up required; Confirmation of Receipt(s); anything that you received during your appointment
- Make a clear photocopy of your documents and scan (keep your originals)
- Submitting the Claim:
- Submitting a claim form when claims@intrepid247.com has requested that you complete one following a direct billing submitted on your behalf; or
- Submitting a claim form when you have paid out of pocket for your medical visit.
- Once your form is completed and applicable documents copied, email them at claims@intrepid247.com
- Follow up Status:
- Check your email for follow up documentation from claims@intrepid247.com that may be required by the Claims Department to process your claim. They will explain to you exactly what is missing from your submission.
- Provide any requested information as soon as possible.
- Call 1.866-883-9485 if you have any questions about your claim or to clarify what else is needed
- Follow up email: claims@intrepid247.com
- If your claim is denied, an explanation about the exclusion(s) will be provided by email.
Tip* Before leaving the clinic, or medical visit request a copy of your medical records, tests, referrals, follow up or doctors notes that were applicable. This will help in processing your claim, otherwise Studyinsured/Insurer will have to request you to complete an authorization form signed by you to obtain your medical records to process your claim.