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CLAIM FORM – PART B TO BE FILLED IN BY THE HOSPITAL. 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 Hospital.
Claim documents to be dispatched to: ICICI Lombard Healthcare, ICICI Bank Tower, Plot No. 12, Financial District, Nanakram Guda, Gachibowli, Hyderabad, TS-500032. Your Claim details are just an SMS away, Please SMS <KEYWORD> to 57 57 58. imS.
ICICI Lombard Health Care Claim Form - Hospitalisation (Issuance of this form is not to be taken as an admission of liability) Part - A (To be filled by Insured)
Claim documents to be dispatched to: ICICI Lombard Healthcare, Varun Tower II, 1st, 4th, 5th & 6th Floor, Begumpet, Hyderabad, Telangana, Pincode – 500016. In case the policy is serviced by external TPA, please dispatch the claim documents to respective TPAs.
Claim documents to be dispatched to: ICICI Lombard Healthcare, ICICI Bank Tower, Plot No. 12, Financial District, Nanakram Guda, Gachibowli, Hyderabad, TS-500032 ALL CLAIM SETTLEMENTS SHOULD BE MADE THROUGH NEFT (AS PER IRDA CIRCULAR), PLEASE PROVIDE YOUR BANK ACCOUNT DETAILS.
ICICI Lombard Health Care Claim Form - Outpatient Department. (Issuance of this form is not to be taken as an admission of liability) ICICI Lombard Health Care. ALL CLAIM SETTLEMENTS SHOULD BE MADE THROUGH NEFT (AS PER IRDA CIRCULAR), PLEASE PROVIDE YOUR BANK ACCOUNT DETAILS. REFER TO PART C.
ICICI Lombard General Insurance Company Ltd. All rights reserved. Insurance is the subject matter of solicitation. IRDA Reg. No. 115.
