Get Form No: Hi / Claim Intimation

Filling out the Form No: HI / Claim Intimation is an essential step in initiating your health insurance claim. This guide will provide clear, step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to download the Claim Intimation Form and open it for editing.
2. In the first section, provide the particulars of the Principal Insured. Fill in the name of the policy holder or claimant, policy number, address for communication, telephone number, mobile number, and email ID. Make sure all provided information is accurate.
3. Next, enter the details of the Third Party Administrator (TPA). Include the name of the TPA and the UHID number that they have allotted.
4. In the section regarding the insured member for whom the claim is being preferred, provide the name, relationship with the principal insured, date of birth, sex, and present occupation of the insured person.
5. Fill in the hospitalization details. Start by entering the name and full address of the hospital, including pin code and state/union territory. Also, include the date of admission.
6. Complete the information regarding the attending doctor by writing down their name, qualification, registration number, and telephone number.
7. Indicate the nature of the disease or ailment for which the insured was admitted, along with the date when the ailment was first diagnosed. If applicable, input the nature and date of any injury sustained.
8. If a surgical procedure is suggested, please provide detailed information regarding the surgery.
9. Review all the details filled in the form to ensure accuracy. Correct any mistakes if necessary.
10. Finally, sign the form, indicating your agreement to the statements made, and submit it to the TPA. Ensure you keep a copy for your records. After submission, you can download or print the form for your convenience.

Complete your health insurance claim process online by filling out the Claim Intimation Form now.