01/01/1965

SPECIMEN

hospitalisation without financial worries

www.vanbreda.be

Your personal Medi-Link card

Responsible publisher: Bert Van Roy Vanbreda Risk & Benefits NV • Plantin en Moretuslei 297 • 2140 AntwerpenRPR Antwerpen • VAT BE 0404 055 676 • FSMA 13718 A-R • 2.54.015 (0713)

The Medi-Link contact details can be found on your Medi-Link card.

Every registered member of the family receives a personal Medi-Link card containing all the necessary details. Thus you will always have the correct information at hand.

All information concerning Medi-Link, as well as a more extensive description of the procedure, can be found on our website www.vanbreda.be.

You will also find the list of hospitals where the Medi-Link service is applicable.

Name, First name

0191990001234

Tel. 03 217 69 46

Don’t lose

sleep about

advance payments

or hospital bills anymore.

STEP 1You inform Vanbreda Risk & Benefits

You know in advance that you will be hospitalised

You inform us of the planned hospitalisation at the latest 14 days before the admission. This can be done in a letter, by e-mail, via our website or by telephone via our call center. You tell us the date, the reason for admission and the name of the hospital you selected.

• If we accept the admission (the reason for the admission falls within the guarantee), we will inform the hospital that they may send the invoice directly to us. You will receive a confirmation letter and the acceptance of the direct payment.

• If we are unable to accept the admission (because for example the reason for the admission does not fall within the guarantee), both the hospital and you will be notified that a third party payment system does not apply for the admission. In that case you must pay the invoices yourself.

• If we did not get enough information to decide whether the admission can be accepted, we will contact you for additional information. Based on this information that must reach us at the latest 7 days before the admission, we will inform you of our final decision.

You are admitted to the hospital unexpectedly

Some admissions are obviously not planned in advance. In that case you (or a relative) must inform us as soon as possible. We will immediately examine the details and inform the hospital whether the third party payment system applies or not.

STEP 2The hospital sends the invoice to Vanbreda Risk & Benefits and we make the payment

STEP 3You receive a statement

After the payment has been made to the hospital, we will send you a detailed statement, together with the original hospital invoice. Your statement gives you an overview of the costs that we have paid. You reimburse us for costs that are not covered by the medical plan (for example the excess, non-medical costs such as telephone charges or extra meals etc.) using the enclosed payment transfer form.

With Medi-Link, we pay the full amount of your invoice directly to the hospital! You refund us afterwards for the possible excess and any expenses that do not fall within the guarantee.

The Medi-Link efficiency lies in its simplicity. We would like to explain it to you in 3 steps.