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GUIDANCE FOR FILLING CLAIM FORM - PART B (To be filled in by the hospital) DATA ELEMENT. DESCRIPTION. FORMAT. SECTION A - DETAILS OF HOSPITAL. a) Name of the hospital: Enter the name of hospital.
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As per the policy terms & conditions, intimation of claim is compulsory for all hospitalizations. Intimation can be done online using your Member id,Policy Number or Employee number. A Claim number will be generated and you will get an instant confirmation & alert.
CLAIM FORM FOR HEALTH INSURANCE POLICIES OTHER THAN TRAVEL AND PERSONAL ACCIDENT - PART A. TO BE FILLED IN BY THE INSURED. The issue of this Form is not to be taken as an admission of liability. (To be filled in BLOCK LETTERS) SECTION A - DETAILS OF PRIMARY INSURED. a) Type of claim Hospitalization Pre Hospitalization. Post Hospitalization.
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That, I am submitting via my registered email id or TPA/BAGI portal, all claim related documents in electronic format to Bharti AXA General Insurance Company limited (hereby referred as BAGI) with each and every page self-attested and cross checked.
Claim Form (To be filled by Insured)
Medi Assist allows you to submit your reimbursement claim online. Watch this video to learn more about online claim submission. Track Claims in real-time. Medi Assist allows you to track your claim in real-time, anytime and from anywhere – just click the Claims tile to check your claim status.
Name of TPA/ Insurance Company : Raksha TPA Pvt. Ltd] Toll free phone number . ... We confirm having read understood and agreed to the Declarations on the reverse of ...
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