Medical Expense Reimbursement Form
If you received medical care and need a reimbursement, download and complete the form for your company.
BMI del Ecuador
International Medical Assistance
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Complete it to request reimbursement of your medical expenses if you have an individual international medical assistance plan.
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Complete it if your international medical assistance plan was purchased by your company.
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Complete it if you authorize your reimbursement to be paid to a third party.
BMI Igualas Médicas
Local Coverage
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Complete it to request reimbursement of your medical expenses if you have an individual international medical assistance plan.
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Complete it if your international medical assistance plan was purchased by your company.
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Complete it if you authorize your reimbursement to be paid to a third party.
