Reporting a hospital stay…

…without Medi-Assistance

Freshly discharged from the hospital? Or a procedure scheduled in the near future?

AG Employee Benefits will quickly and painlessly reimburse you for out-of-pocket medical expenses associated with your hospital stay. First you advance the funds to settle the hospital bill and all other expenses, and then forward the bills to AG Insurance’s claims handling department for a refund.

To report a hospital stay, you can use the medical claim form below. Be sure to fill it out carefully: the more details you provide, the faster we can process your claim. All you have to do is send us your claim form along with documentary evidence of the costs incurred in connection with your hospital stay (the hospital bill, but also doctors’ appointments, medication, physiotherapy sessions, etc.). Subsequent invoices are also eligible for reimbursement. To find out more about the most effective way to send in your expenses, read through the document "Procedure for submitting medical expenses" . The information is also available for review in the file below.

1) Claim report form

Complete this form as completely as possible to report your hospital stay. Send it in along with proof of payment for medical expenses, either by e-mail or regular post. Only one claim report per hospital stay is required

2) Pre-admission and post-discharge medical expenses

Procedure for submitting medical expenses" form contains all the necessary information to expedite processing of your claim. Send in the completed form together with your receipts.

Send in your claim and all receipts to:

AG Insurance
Health Care Department
Bd Emile Jacqmain 53
1000 Bruxelles



Tip: We recommend sending in your claim form together with your hospital bill as well as proof of payment for any other medical expenses. This way, our claims handling department will have all the necessary information to bring your claim to closure quickly and more effectively.