HOSPITALS AND COVERAGE Gorah Enrollee Refund Form Explore our network of trusted healthcare providers delivering quality care and medical support across Nigeria. First Name *Last Name *Email *Middle Name *Name of CompanyYour Date of BirthHome AddressGORAH Health Enrollee ID:StateCityName of ProviderDate of EncounterReason for Refund (Select one)Visited out of network provider in an emergencySelected provider requested payment for covered servicesOthersDescription of illness or injuryPlease include the following supporting documents in order to process the claimsMedical ReportsOriginal receipt of paymentOthersEmail AddressPhone NumberTotal Amount ClaimedA/C NumberAccount NameBank NameAttach Supporting DocumentChoose FileNo file chosenDelete uploaded fileSUBMIT Download our Health Plan Brochure Take the first step towards better healthcare coverage. Speak with our experts to find the perfect health plan tailored to your needs. +234813 278 3427