MDINDIA HEALTHCARE SERVICES (TPA) PVT. LTD.

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Online Claim Intimation

Type of Policy :
Policy No :
OR
MDID : Ex:MDI5-XXXXXXXXXX
 

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Policy Details:
IC Name *
Policy No * MDID Number *
Patient Name * Email ID *
Contact No. * Sex *
Hospitalization Information:
Diagnosis * Approximate Claim Amount *
Admission Date * dd/mm/yyyy Expected Date of Discharge * dd/mm/yyyy
Hospital Name * Hospital Address *
State * City *
submitted By
Attach Policy Copy






Terms and Conditions

I hereby authorize MDIndia HealthCare Services(TPA) Pvt.Ltd / Insurance Company / Representative of Insurance Company to obtain my medical record / information from Hospital / Nursing Home / Treating Medical Professionals / family Physicians / diagnostic Centers / Medical Shops Necessary to Process the Claims.

  1. Photo identity of the patient has to be carried to hospital during hospitalisation.
  2. Sign/Stamp of hospital on all papers are mandatory while submitting the file.
  3. Photo identity of the patient has to be attached along with Claim Intimation / Documents.
  4. Non submission of the claim Intimation within stipulated time of policy terms will result the claim as NO CLAIM
 
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