Get Statement Of Claim For Hospital Income Plan Under Policy No

This guide provides clear instructions on completing the Statement of Claim for Hospital Income Plan under Policy No. It is designed to assist you in accurately filling out the form online, ensuring that all necessary information is provided for efficient processing.

Follow the steps to complete your claim form accurately.

1. Click ‘Get Form’ button to access the claim form and open it in your preferred document editor.
2. Fill out the insured's information, including their name, birthdate, sex, phone numbers, and address. Ensure all details are accurate to prevent delays in processing.
3. Indicate the relationship of the patient to the insured. Select from options such as self, spouse, or child and provide the patient's name and birthdate.
4. Describe the claim in detail. Specify the nature of the injury or sickness leading to hospital confinement or outpatient surgery, and provide relevant dates for the onset of the condition and first treatment.
5. If applicable, check the box for confinement due to cancer and provide additional details about the patient’s employment and educational status if they are over 18 and under 27.
6. List information about the attending physician, including their name and address. Include details about any other physicians consulted within the past 12 months.
7. Document all hospitals where the patient received care for this or a similar condition during the past year.
8. Read and understand the authorization statement before signing. Both the insured and the patient need to provide their signatures and the date.
9. Review all filled-out sections for accuracy. Make any necessary changes before finalizing the form.
10. Once completed, you can save changes, download, print, or share the form as needed.

Take action now and complete your claim form online to ensure a smooth claims process.