Specimen of claim form India, Claim Forms - Raksha TPA Pvt Ltd, Claim form sample, Claim logding form from insurance company- Page1

Home

Author

	Insurance News Portability of Health Insurance Policy started on Oct 1,2011 Give with one hand take it away by other hand Role of Insurance in progress of Health care Aviva Health Plus - India's Health + Savings India's first Plan with Guaranteed Returns even on claims Swine Flu-is it covered or not by insurance companies Female don't get a discount from insurance company HIV Care Health Policy Launched by Star health and Allied Insurance Company Limited Shri.P.Chidambaram, Honorable Union Minister of Finance Launches Revised Universal Health Insurance Maternity Expenses are covered by Max Bupa, Apollo Munich, ICICI Lombard & Star Health but certain waiting periods are applicable. Diabetic and High Blood Pressure Patients are covered by few companies Most of Insurance Companies offer health policy for above 61 years peoples ⁄ senior citizens New Mediclaim premium won't rise even if you make claims − Good News New India launches new mediclaim policy (Mediclaim 2012) with offering higher sum insured upto Rs 8 lakhs for existing and new customers.

For Comparative Insurance Quote: Om Plaza, 430/7, 1st Floor, Sant Nagar, East of Kailash, New Delhi-65 Phone: 011-41324957, 41623784, Mob:+91-8447757651 & 53 Email: ria1@surekhae.com

Health Insurance Claim Procedures


(1)	Health Insurance Claim Procedure	(2)	Protect Your Interest
(3)	Claim Form to be Sent to TPA	(4)	Circumstances under which claims get Rejected
(5)	Claims not Allowed - Some Case Studies	(6)	Consumer Forum Cases in Health Insurance (Some Judgments)

3- Claim Form to be Sent to TPA (Specimen of a Claim Form TTK Health Care Services Private Ltd)

7 Jeevan Bheema Nagar Main Road,HALL IIIrd Stage,Bangalore-560 075

Claim Form

(Issuance of this Claim Form is not tantamount to acceptance of Liability by the Insurer)

TTK ID No:

Name & Address of the Insured :

(in whose name policy is issued)

Details of Insured Person:

(in respect of whom claim is made)

Name & relationship of the Insured

Present completed Age
Occupation
Contact Address
Phone No.
Mobile No.
E-Mail Address

Name of the Insurance Company ..................................
Policy No........................................... Serial No. Of the Schd/ Certificate No. :

AILMENT/ DISEASE/ INJURY :

Date of Injury sustained or disease / illness first detected :
Name of the Hospital :

Have you been insured under any mediclaim scheme earlier (held with us or any other insurance co.) If yes,xerox copies of previous years' policies MUST be enclosed.
Date of commencement of very first insurance for this person with continous insurance coverage.

Have you preferred any claim for the same insured under the mediclaim scheme earlier, if so, give the following details :

Previous claim file ref.no/office
Diagnosis
Whether settled/repudiated
Amount (if settled)
Date of Admission

:
:
:
Rs.
Date of Discharge

TOTAL AMOUNT CLAIMED : Rs.

If the claim is of Domiciliary Hospitalization please indicate

Date of Commencement of the treatment
Date of Completion of treatment
Name & Address of attending Medical Practioner with Telephone No. & Registration No.

Signature of the claimant

I have incurred the below expenses for the treatment of the disease / illness / accident and herewith as per schedule mentioned below: -

Schedule of Expenses incurred by the Claimant

				FOR TTK ONLY
Date	Bill No.	Description	Amount Claimed

1 - 2

Get Best Health Insurance Quotes
*
*
*
*
*
To eliminate spam, please add these numbers together before you submit: 10 + 9 = *

* required

Health Insurance

Family Floater Insurance

Senior Citizen Insurance

Senior Citizen Mediclaim

RIA Insurance Website

Sitemap

TPA Claim form Health Insurance