Get Claim Form - Part A

This guide provides a comprehensive overview of how to complete the CLAIM FORM - PART A online. Carefully following these steps will ensure that your submission is accurate and complete, aiding in the smooth processing of your claim.

Follow the steps to successfully complete the CLAIM FORM - PART A.

1. Click the ‘Get Form’ button to access the form and open it in your preferred digital document viewer.
2. In Section A – Details of Primary Insured, fill in your policy number, certificate number, and TPA ID number. Ensure you enter your full name, address, and contact information in the provided fields.
3. In Section B – Details of Insurance History, indicate whether you are currently covered by any other health insurance, and provide details of your insurance history including dates and policy numbers as needed.
4. In Section C – Details of Insured Person Hospitalized, input the relevant information for the person being insured, including their full name, gender, date of birth, and relationship to the primary insured.
5. In Section D – Details of Hospitalization, include the name of the hospital, room category, dates of admission and discharge, and specific reasons for hospitalization. Make sure to tick the correct options as applicable.
6. In Section E – Details of Claim, specify the expenses claimed, including pre-hospitalization and post-hospitalization costs. Ensure you check the box for any domiciliary hospitalization if applicable.
7. In Section F – Details of Bills Enclosed, list all bills you are submitting with the claim, ensuring that amounts are correctly entered in rupees.
8. In Section G – Details of Primary Insured’s Bank Account, provide your PAN, account number, bank name, and IFSC code to facilitate claim reimbursements.
9. In the Declaration section, read through the declaration statement carefully. Enter the date and place, then sign to certify that all information is true and accurate.
10. After completing all sections, review your entries for accuracy. You can then save changes, download, print, or share the form as needed.

Complete your CLAIM FORM - PART A online today for a smooth claim experience.