Applying for Reimbursements

In the case where you have had to pay for a medical service that is a covered benefit under your insurance policy, you will be required to submit your receipts, the original bill from the provider where it shows your payment, and the completed and signed claim form. Providing the correct documentation will expedite the processing of your claim.

How to submit a claim.

Please follow these steps:

  1. Please download the form below
    Atlas MOFA Reimbursement Form
  2. Complete the PDF document, print and complete the form by hand
  3. Attach all necessary supporting documents, including itemized bills, original receipts, proof of payment, medical records, certificates and X-rays, vouchers, bill statements.
  4. Please submit your claim to Reimbursements-AtlasMofa@globalexcel.com