WHA Claim Form

You are making a claim for the following benefit*
For this benefit, you must have been discharged from the hospital. If you have not yet been discharged, please wait until your hospital stay is complete before submitting your claim.

Please complete the benefit claim form with a hospital stamp and official signature, take a photo, and upload it. Alternatively, you can attach a MED10 certificate or hospital discharge note. A MED10 confirms your hospital stay, you can get it from the hospital's admissions or discharge department. Just ask the medical team when you leave.
Date of Accident

DayMonthYear
Please provide as much information as possible for accurate review. We’ll reach out if we need more details. If you don’t hear from us, a personal accident form will be sent in the post to you.*

0/2000
For this benefit, please provide a copy of the birth certificate(s) and, if applicable, supporting evidence of a hospital stay, like a MED10 certificate or hospital discharge note.

If you are in hospital for a total of more than seven days, from the eighth day onwards we will pay benefit at the hospital inpatient rate for each completed period of 24 hours spent in hospital, up to the maximum hospital inpatient benefit.
Where did the birth take place

HospitalHome
Town of Birth
Date Birth Took Place

DayMonthYear
Number of Children

Single ChildTwinsOr more
Admission Date

DayMonthYear
Discharge Date

DayMonthYear
Number of nights in hospital
Please note that we can only accept claims for overnight stays. Unfortunately, same-day admissions are not eligible for this benefit
If you've joined us in the last 12 months, we will need to send you a medical certificate by post for your GP to confirm your condition isn't pre-existing. Please take it to your surgery for completion (or attach it with your other receipts if you already have this)
Please provide details for at least 3 visits, along with supporting evidence, in a continuous period of six months. To submit, fill out the benefit claim form with a hospital stamp and official signature, then take a photo and upload it.
Please provide details for at least 4 visits, along with supporting evidence, in a continuous period of six months. To submit, fill out the benefit claim form with a hospital stamp and official signature, then take a photo and upload it.
Treatment Date #1

DayMonthYear
Amount Paid #1
Treatment Date #2

DayMonthYear
Amount Paid #2
Treatment Date #3

DayMonthYear
Amount Paid #3
Treatment Date #4

DayMonthYear
Amount Paid #4
Treatment Date #5

DayMonthYear
Amount Paid #5
Treatment Date #6

DayMonthYear
Amount Paid #6
Treatment Date #7

DayMonthYear
Amount Paid #7
Treatment Date #8

DayMonthYear
Amount Paid #8
Treatment Date #9

DayMonthYear
Amount Paid #9
Treatment Date #10

DayMonthYear
Amount Paid #10
Please click the "Upload Receipt(s) or Certificate(s)" button to upload a clear image of your receipt(s) or certification(s). Receipts must show your name, the date, practitioner's name, treatment details, and total amount paid to process your claim. Ensure the entire document is visible, including all four corners. For inpatient, outpatient, and maternity claims, only upload the certification.*

Cancelof

The dependent MUST be 18 years or under at the time of the claim for you to be able to make a claim for this person. You will not be able to submit this claim due to the age of the dependent you have entered
Should be Empty:

WHA Direct Cash Plan | Make Your Claim

WHA Healthcare Cash Plan | Make Your Claim

Dependent Information

Policy Holder Information