HDFC ERGO Claim Form
This is an HDFC Ergo Claim form for Health Insurance Policies other than Travel and Personal Accident issued by the HDFC Insurance Company and this form can be obtained from the nearest office of the HDFC Ergo or it can be download from the link given below.
This claim form can be used for the person who has been hospitalised in hospital which are not in pannel. This form also be used by the person for before and after hospitalised expense of the patients.
Details to be Mention in HDFC ERGO Claim Form
- Name of the Applicants
- Address
- Policy Number
- Company/TPA ID No.
- Details of Insurance History
- Details of Insured Person Hospitalised
- Details of Hospitalised
- Details of Claim
- Insured bank Account Detail
- And any Other Details
Documents Required
- Please submit the following documents in case of claim amount exceeds Rs. 100,000
- Passport / PAN Card/ Voter’s Identity Card/ Driving License/ Letter from a recognized public authority or public servant verifying the identity and residence of the customer
- Telephone bill/ Bank account statement/ Letter from any recognized public authority/ Electricity bill/
- Ration cardDuly filled and signed Claim Form
- Hospital Main Bill
- Copy of intimation letter, if any
- Hospital Break Up bill
- Hospital Bill Payment Receipt
- Pharmacy Bill
- Hospital Discharge Summary
- Operation Theater Notes
- ECG
- Doctor’s Prescription
- Doctor’s Request for Investigation
- Investigation Reports (Including
- CT, MRI/USG/HPE)
- Others
You can download the HDFC ERGO Claim Form in PDF format using the link given below.
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