ICICI Lombard Health Care Claim Form – Hospitalization
This is an application form for ICICI Lombard Claim for health care issued by the ICICI Lombard and this form can be obtained from the nearest branch of ICICI Lombard or it can be downloaded from the link given below.
Details to be Mention in ICICI Lombard Health Care Claim Form
- Details of the Insured person
- Type of Claim
- Nature of disease/ illness contracted or injury suffered for which Insured was hospitalized
- Details of Claim
- And any other documents
Documents Required
- Claim form duly filled Original
- Discharge Summary/ Daycare Summary Original
- Final Hospital Bill Original
- Payment Receipts Original
- Investigation Reports Original
- Pharmacy Bills Original
- Implant Sticker/ Invoice Original
- Doctor Prescriptions Photocopy
- Consultation Paper Photocopy
- Age Proof Photocopy
- Indoor Case Paper Photocopy
- EFT (Copy of canceled cheque/self-attested ID poof/ Bank attested copy Photocopy of passbook with IFSC code
- And any documents
You can download the ICICI Lombard Health Care Claim Form – Hospitalization in PDF format using the link given below.