Contact form - Debt Collection Team - Medicover

What is your role in contacting us? (Required)

Payment date (Pole wymagane)

Attachment – transfer confirmation

file in jpg, png or pdf format (Required)

Was the transaction made via Medistore/mobile app/online purchase? (Pole wymagane)

Yes No

Online service and self-help

Help Assistant: here you will find answers to the most frequently asked questions about administrative contract support (Asystent pomocy - znajdź odpowiedź na swoje pytanie | Centrum Medyczne Medicover)
e-Member application: : (e-Member 2.0 - Login)
facilitates daily work for HR employees in independently managing employees’ medical care, e.g., enrolling employees for Medicover care, maintaining documentation, generating reports
The Occupational Medicine module enables issuing e-referrals for occupational health examinations
• Patient guide: here you will find step-by-step information on how to use our services (Patient's Handbook - Medicover - private health care)

Contact your Administrative Supervisor regarding::

Updating contact details
Information about contract terms (payments, invoices, prices, cost breakdown, deadlines, cooperation rules)
Issuing invoices, corrections, specifications
Questions about financial documents (invoices, corrections, specifications)
e-Member application support

Pytania ogólne / informacje o umowie

Pytania dotyczące OWU, OWŚU, polisy, umowy, formalności

Twój Opiekun biznesowy

Opinie /Utrudnienia techniczne/ dodatkowe informacje

Formularz kontaktowy | Centrum Medyczne Medicover

Wsparcie w korzystaniu z usług medycznych

Przewodnik Pacjenta | Centrum Medyczne Medicover

Please download the application (hyperlink with PDF to download – Wniosek_o_zwrot_nadpłaty CORP) , fill it out legibly, and stamp it with the company seal. The document should be sent by email to zwroty_nadplat@medicover.pl as a scan or a good-quality photo.

Please note that the refund message should be sent from the email address indicated in the contract as the financial contact person.

Please download the application , fill it out and sign legibly by hand. The document should be sent by email to zwroty_nadplat@medicover.pl as a scan or a good-quality photo. Please note that the instruction must be submitted by the person who is a party to the contract. Additionally, the refund message should be sent from the email address indicated as the correspondence address in the contract

First and last name (Required)

Company name (Required)

Are you a foreign client? (Pole wymagane)

No Yes

NIP Identifier (Required)

Do you have a PESEL number? (Required)

Yes No

PESEL Identity document number (e.g., passport or ID card): (Required)

Contact person

Invoice/policy numberNumer faktury (Required)

Wprowadź numer faktury i kliknij „Dodaj fakturę”. Jeżeli chcesz dodać więcej niż jedną, powtórz czynność.

Client number (Required) Numer Klienta można znaleźć w prawym górnym rogu załącznika (monitu) lub w temacie wiadomości otrzymanej z działu windykacji. Numer ten rozpoczyna się od liter CU lub CF.

Invoice number (Required)

Wprowadź numer faktury i kliknij „Dodaj fakturę”. Jeżeli chcesz dodać więcej niż jedną, powtórz czynność.

Faktury

E-mail (Required)

Contact phone (Required)

Message

The personal data administrator will be Medicover sp. z o. o, Al. Jerozolimskie 96, 00-807 Warsaw. We will process your personal data in order to handle complaints, opinions, and reports in connection with your completion of the contact form. You have the right to object to the processing of your data. Detailed information on the processing of personal data.