The RoamRight mark is used by Arch Insurance Company and owned by its affiliate, Arch Capital Group (U.S.). All insurance products offered and underwritten by Arch Insurance Company.
Medical Expense Claim Form
Do not use a public computer (e.g. internet cafe, public library) to complete this form
Complete the form with as much information as possible. Required fields are marked with an asterisk (ex: ). Some fields may be required based on your response to other questions.
On most modern web browsers, the data you enter will be periodically saved. If you need more time to complete this form, you can return to this computer and web browser later to complete the form. You must return to this computer and web browser to resume your claim form in progress - a different computer or different browser will not have your saved responses.
Clearing your browser cache may clear your saved claim form data
After completing the form, you will have an opportunity to upload documentation (ex: receipts) to support your claim.
Your policy provides excess medical insurance coverage providing benefits in excess of the benefits provided under your primary medical insurance policy. A Medicare Supplement policy would be considered a primary insurance policy. As such, you must first file your claim with your primary medical insurance company. If you are not fully reimbursed by your primary insurance company, you may file a claim for the unpaid medical expenses as noted in these instructions.
Please complete and sign the Medical Expense claim Form in full and return it with the documentation noted below.
For all claims, submit:
Copies of the insured's travel documents confirming the travel dates and itinerary.
Proof of payment of your initial trip deposit.
Copies of invoices or receipts for all claimed medical expenses. Invoices should show the date of service; the office or facility where the service was provided; the condition treated and the nature of the treatment received.
Proof of payment of the claimed medical expenses - copies of both sides of checks, copies of credit card statements or receipts for cash payments;