This information is for those clients who have paid for outpatient treatment by direct reimbursement!
For the successful processing of your insurance claim, please send the completed Claim Reporting form for Foreigners‘ Health Insurance along with scanned supporting documents in PDF format to the email address LPU@maxima-as.cz.
It is no longer necessary to print the form.
Documents needed to make a claim:
- Please, fill in the Claim Reporting form for Foreigners‘ Health Insurance, including the account number of the bank in the Czech Republic to which we will send the insurance claim, if applicable.
- Medical report (doctor's report of examination)
- Evidence of payment for treatment (proof of payment)
For successful processing of your insurance event, send the necessary documents to the address of the insurance company:
Information for medical facilities:
Please send guarantee requests to LPU@maxima-as.cz, tel. : 273 190 434
Invoices for health care, including medical reports, should be sent to the insurance company:
Maxima pojišt'ovna a.s.
Italská 1583/24
120 00 Prague 2 Vinohrady
Documents for claim processing
To speed up the claim settlement, please submit legible supporting documents in PDF format together with the claim notification
Without the documents listed below, the insurance benefit cannot be paid.
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Medical treatment
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- Medical report
- Proof of payment for medical treatment
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Dental care
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- Dental report describing the medical condition
- Proof of payment
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Laboratory tests
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- Medical report from the examination during which the tests were indicated / laboratory request form
- Proof of payment
- Prescription medication
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- Medical report from the examination during which the medication was prescribed, or a doctor’s prescription (not an e-prescription)
- Itemized receipt from the pharmacy listing individual medications
- MaxCare – premium healthcare and support program
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- Medical report (not mandatory)
- Proof of payment
- Other care
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- Medical report
- Proof of payment
