Follow the steps to successfully complete the claim form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing information regarding pre-authorization. Indicate whether pre-authorization was obtained by selecting ‘Yes’ or ‘No.’ If ‘Yes’ is selected, fill in the Pre-Authorization Number. If ‘No,’ provide the Claim Intimation Number.
3. For the details of the primary insured, enter the Policy Number, Name (First and Last), Address, City, State, Landline, Email, Pin Code, and Mobile Number.
4. In the insurance history section, indicate whether you are currently covered by any other health insurance. If yes, provide the insurer’s name, policy number, sum insured, and the date of commencement.
5. Documents concerning hospitalization history over the last four years should be recorded, including the date and details of any treatments received.
6. Complete the details of the insured person who was hospitalized, including their Title, Name, Member ID, Age, Date of Birth, Relationship with the primary insured, Occupation, Address, City, State, Landline, Email, Pin Code, and Mobile Number.
7. Fill in the details of hospitalization, including hospital name, room category, type of hospitalization (injury, illness, maternity), dates of injury/admission/discharge, and the method of admission.
8. In the claim details section, document the treatment expenses claimed along with the pre-hospitalization, hospitalization, and post-hospitalization expenses. Fill in the total claims.
9. Provide a checklist of the original claim documents you are submitting, ensuring each required document is included.
10. Input bank details for the primary insured, specifying bank name, account number, branch, PAN, and preferred payment mode.
11. Finally, read the declaration statements, sign, and date the forms as required. Ensure to check for any additional comments or attachments that may be required.
12. Once all sections are filled out accurately, save the changes, download, print, or share the completed form.

Start completing your Vipul Pre Post Claim Form online now for a seamless claim process.