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Form - MIP Vanbreda Claim for Reimbursement of Medical and Dental Expenses

Access the Vanbreda Medical / Dental Claim Form

  • Claim submission options:
    • Via the address indicated on the form,
    • Via e-mail to,
    • By fax to +32 3 6632857,
    • Through Vanbreda website To log on to Vanbreda website, click Member’s Access and enter the Vanbreda International reference number and personal password.

  • Remember to include the signed and dated claim form together with the receipted invoices and all other documentation justifying reimbursement. 

  • In-network pharmacy discounts are taken at the time of purchase of the medicine at a pharmacy affiliated with Medco; no claim forms are filed as long as you can show your member ID card. For other pharmacies, submit the claim to Vanbreda using the form above.


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