HDFC ERGO Claim Form PDF

This is an HDFC ERGO Claim Form specifically tailored for Health Insurance Policies, excluding Travel and Personal Accident plans, issued by HDFC Insurance Company. You can quickly obtain this important claim form from the nearest HDFC ERGO office or conveniently download the PDF from the link below.

This claim form is essential for individuals who have been hospitalized in non-panel hospitals. It can also be used to claim expenses incurred before and after the hospitalization of the patient.

Important Details to Include in Your HDFC ERGO Claim Form

• Name of the Applicant
• Address
• Policy Number
• Company/TPA ID No.
• Insurance History Details
• Details of the Insured Person Hospitalized
• Hospitalization Details
• Claim Details
• Insured Bank Account Information
• Any Other Relevant Details

Required Documents for Claim Submission

• If the claim amount exceeds ₹100,000, please submit the following documents:
  • Passport / PAN Card / Voter’s ID / Driving License / Letter from a recognized public authority or public servant verifying the identity and residence of the customer
  • Telephone bill / Bank statement / Letter from any recognized public authority / Electricity bill
• Duly filled and signed Claim Form
• Hospital Main Bill
• Copy of the intimation letter, if any
• Break-up Bill from the Hospital
• Hospital Bill Payment Receipt
• Pharmacy Bill
• Hospital Discharge Summary
• Operation Theater Notes
• ECG Report
• Doctor’s Prescription
• Doctor’s Request for Investigation
• Investigation Reports (Including CT, MRI, USG, HPE)
• Other Relevant Documents

You can easily download the HDFC ERGO Claim Form in PDF format using the link provided below. 📥