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Medical Claims & Pre-Approval Forms Collapsed Expanded

These forms are required for:

  • Pre-approvals from Medical Providers (for medical card holders)  
  • Submitting a Medical Claim Reimbursement Request (for medical card holders)

Where should I send the completed form(s)?

You can submit them through myMetLife desktop or mobile app (Android / iOS).

Once you login, all you need to do is:

  • Complete the online claim form
  • Upload your supporting documents
  • Submit the online form

It's as simple as that!

If you are working offsite and do not have access to the internet, please contact your HR department to submit the documents.

Download Forms:

Individual Claim Forms Collapsed Expanded

These forms are required for:

Submitting a Claim. Not sure which form to use? Click here to learn on how to make a claim

Where should I send the completed form(s)?

Copies can be emailed to lifeclaims@metlife.ae

Originals to be sent by mail to:

Claims Department MetLife, Ubora Office Tower, Business Bay, PO Box 371916, Dubai, UAE

Note: Original documents are required to process any claim.

Download Forms:

Accident Benefits - Employer's Statement (English) / (Arabic)

Baggage Delays / Baggage Loss Claim Form

Beneficiary Endorsement

Final Proof of loss

Flight Delays Claim Form

Partial Disability / Accidental Dismemberment Claim Report – Physician & Claimant Statement Form - Form CL-20 (English) / (Arabic)

In Patient Medical Reimbursement Claim Form (English)  /(Arabic)

Permanent Total Disability – Claimant Statement - Form 321 (English) / (Arabic)

Permanent Total Disability – Physician’s Statement - Form 322 (English) / (Arabic)

Proof of Death – Claimant Statement - Form CL-39 (English) / (Arabic)

Proof of Death – Physician’s Statement - Form CL-40 - (English) / (Arabic)

Individual Policies Collapsed Expanded

These forms are required for:

  • Changing address
  • Amending existing policy(ies)
  • Taking advantage of some of your policy features (loan, partial surrender, etc...)

Where should I send the completed form(s)?

By mail to:

Customer Care MetLife, PO Box 371916, Dubai, UAE

Download Forms:

        Change of Address Form

        Declaration & Undertaking regarding a Lost Policy Form (English) / (Arabic)

        Policy Loan Request Form (English) / (Arabic)

        Policy Full Maturity and Release Form (English) / (Arabic)

        Policy Partial Maturity and Release Form

        Policy Partial Surrender and Release Form

        Policy Full Surrender and Release

        Request for addition of Recovery Benefit Plan Rider

        Request for Policy Change - Life (Change of Name, Beneficiary, Method of premium payment) - (English) / (Arabic)

        Request for Policy Change - Personal Accident (Change of Name, Beneficiary, Method of premium payment) - (English) / (Arabic)

        Specimen of Signature

Transfer between Sub-Accounts & Premium Allocation Form

Home Delivery of Medication Collapsed Expanded

This form is required for:

Delivery of your medications to your doorstep thanks to Aster Pharmacy

Where should I send the form & prescription(s)?

By email to Aster Pharmacy at metlife@asterpharmacy.com or by fax to +971 4 267 2946

Download form:

Home Delivery Order Form

Health Authority of Abu Dhabi (HAAD) – Forms & Requirements for Group Policies Collapsed Expanded

Circulars

The following documents are for your information and reference only:

HAAD Requirements Form for Group Medical Policies (designed by MetLife): This document provides you with all the information you may need to update the records for all your existing employees / dependents as well as any future employees / dependents.

Note: If you have any undeclared members who should be enrolled under a HAAD compliant scheme, kindly provide the required documentation as explained in the above document and send it to your respective insurance consultant’s email address.

HAAD Circular no. CEO/254/11: Document explaining the process related to Dependent Violation

HAAD Circular no. 32 (English) / (Arabic): Document providing details about theCertificate of Continuity of Health Insurance Scheme Coverage

HAAD Circular no. 35 (English) / (Arabic): Document providing details for the Issuance and Renewal of the Health Insurance Card

HAAD Circular no.41: Document providing details for the Issuance of the Health Insurance Card to newcomers

HAAD Circular no.DG48-14: Circular confirming that linking Emirates ID cards to the Pesonal Registration Database in "KEH" is now mandatory

Forms

The Forms, when completed, should be sent to your Insurance Consultant's e-mail address.

Declaration Form (to be signed, dated and stamped by your company): A mandatory form to be completed upon renewal for existing policies and on inception for new policy or new subgroup.

Undertaking Letter (to be printed on your company's letterhead): A document requested by HAAD to be completed by the employer or the sponsor for each "newcomer".

Dependent Violation Appeal Form: A HAAD document to be completed when appealing for a dependent violation

Updated Electronic Data Interchange (EDI): To be completed when amending any detail on the policy such as addition/deletion of an employee or dependent, salary update, etc...

Common Reporting Standard CRS Collapsed Expanded

CRS Form 

FAQs about CRS

Instructions to receive your funds by Wire Transfer (when applicable)

To prevent any delays in receiving your funds by Wire Transfer, please include the following details when confirming your payment instructions:

  • Bank Name
  • IBAN (Account Number if the country does not use IBAN)

Full name Swift code

Note: include IFSC if requesting the transfer to India.

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