Emergency Medical Claim

Important: When you called Assured Assistance Inc. at the time of your emergency, as stated under What must you do in a medical emergency? section of your policy, you were advised by Assured Assistance that we are final payors for all medical expenses. As such, please submit all your original expenses to your primary insurance carrier for review and reimbursement. Should there be any outstanding amounts due to you, we would require a completed claim form along with proof of reimbursement or denial from your primary insurer, for all expenses incurred.

1. Please print and fully complete the CLAIM AND AUTHORIZATION FORM. Once completed, sign a copy of the form, and then mail the form, along with all supporting documents noted below, to the Claims office.
   (This link opens a form in .pdf format. To read this form, you need Adobe^®1 Reader^®1 installed on your computer. You can download Adobe Reader from the Adobe website free of charge.)
   
   RBC Travel Protection
   P.O. Box 19093
   Greenville, SC 29602-9093
2. Please enclose the following supporting documents with the Claim and Authorization Form:
   1. Original Explanation of Benefits or check copies for payments issued by your primary insurer
   2. Copy of itemized physician bill(s) and receipt(s) of payment
   3. Copy of itemized hospital bill and receipt of payment
   4. Copy of prescription(s) and receipt(s) of payment
   In the situation where your primary insurer has denied benefits, we will require a copy of the denial letter along with all original medical bills for expenses incurred.
3. Attach copies of any medical records you may have been given at the time of treatment such as a copy of the Emergency Room report, Discharge Summary or written letter from your treating physician. For hospitalization claims we will require a complete copy of your medical records from the treatment facility.
4. Please include any additional information relevant to your claim. Depending on the claim, we may request more information.

If you have any questions, please contact our customer service at 1-866-305-5757.