Welcome to MDIndia Healthcare Services (TPA) Pvt. Ltd. Toll Free Customer Care No.: 1 800 233 11 66 / Toll Free Cashless No.: 1 800 233 45 05
UAN Fax No.: 1 860 233 44 49 /    Email ID: customercare@mdindia.com / authorisation@mdindia.com
For Senior Citizen: 020-25300126 /    Email ID: seniorcitizen@mdindia.com
Download Forms

MDIndia do not charge from the hospital for the empanelment, in case of such a demand please contact our nearest branch or our Head office at Toll Free No : 1800 233 11 66

Download Claim Form
Select City

Claim Intimation Format
IRDA - Claim Form for Medical Insurance Policies
Other Forms

Provider Empanelment Kit
The New India Assurance Company Limited Forms
ECS Form  
Standard Discharge Summary Format
Standard Bill Format
Pune PPN MOU
Documents Request Form


Request For Authorisation Letter
IRDAI - Request for Cashless Hospitalisation for Medical Insurance Policy
Check List

Discharge Voucher


Discharge Voucher

You could down load and fill the forms mentioned below for empanelment of your Hospitals / Nursing Homes with us.


Provider Empanelment Kit
Covering Letter
Agreement
Provider Information
Schedule Of Charges
Undertaking Declaration from Hospital

Future Generali India Insurance Company Ltd.
Claim Form
Request For Authorisation Letter


National Insurance Company Limited
New Mediclaim


The New India Assurance Company Limited
Family Floater
Group Mediclaim
Janata Mediclaim
Mediclaim 2007
New Mediclaim
Senior Citizen
Steel Authority of India Limited
SAIL - GuideBook
   
SBI General Insurance Company Limited
  Claim Form
   
Birla Sun Life Insurance
  Claim Form
  Preauthorization Request Form
  Reimbursement Claim - Claimant's Statement
  Reimbursement Claim - Hospital Treatment Certificate
   
Reliance General Insurance
  Heath Claim Form
   
L&T General Insurance Company Ltd
  Claim Form


HDFC ERGO General Insurance Co.
  Claim Form
   
Bharti Axa General Insurance Company Limited
  Claim Form
  Preauthorization Request Form
   
Note: If you have trouble viewing the above mentioned forms, you may need to download the Acrobat Reader on your computer.