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Please do not upload the reply of Query Letter here.For Replying the query letter, please send it in our specified mails.

Before the documents are scanned for the purpose of submission to the TPAs, should be written on the face of the submitted documents with their Seal and/or Signatures with date in every documents as "Documents/ Bills/ Invoices Claimed from ___ NAME OF INSURANCE COMPANY"(E.g.: NICL,OIC,NIA,UII)

Check List of documents before submission of Cashless claim by Hospital :

• Please upload all claim documents in single PDf file.(Max File Size : 30MB)
• Part –B of Claim Form duly signed by the Patient Party
• Declaration form ( In case of PPN Hospital)
• For NIA other than PPN Hospital Network Declaration Form
• Hospital Final Bill and Break up Bill duly signed by Patient Party
• Patient Paid Money Receipt
• All relevant investigation reports
• Discharge Summary
• Invoice Copy ( In case of Implant)
• Patient's ID proof
• It is mandatory to attach the signed declaration form along with the PDF.
  The declaration form for cashless claim can be downloaded in PDF format and MS Word format.
  For PDF Format Click here . For MS Word Format Click here.

Check List of documents before submission of Reimbursement claim by Insured :

• Please upload all claim documents in single PDf file.(Max File Size : 30MB)
• Completed Claim form Part A duly signed by the insured.
• Discharge summary.
• Final Inpatient bill, detailed breakups of the final bill, Cash memos, payment receipts.
• All investigation, Test reports, X-Ray/ CT scan/ MRI reports
• Doctor's prescriptions supported by cash memo for medicines purchased
• Proposer's Bank Account Number, Name of Bank and Branch Name, IFSC code, Name of the Account Holder & a Cancelled Cheque Leaf.
• It is mandatory to attach the signed declaration form claim along with the PDF.
  The declaration form for reimbursement claim can be downloaded in PDF format and MS Word format.
  For PDF Format Click here . For MS Word Format Click here.

Check List of documents before submission of Reimbursement claim by Insured For ICICI Lombard GIC Ltd.:

• Please upload all claim documents in single PDf file.(Max File Size : 30MB)
• Completed Claim form Part A duly signed by the insured.
• Discharge summary.
• Final Inpatient bill, detailed breakups of the final bill, Cash memos, payment receipts.
• All investigation, Test reports, X-Ray/ CT scan/ MRI reports
• Doctor's prescriptions supported by cash memo for medicines purchased
• Proposer's Bank Account Number, Name of Bank and Branch Name, IFSC code, Name of the Account Holder & a Cancelled Cheque Leaf.
• ICICI Lombard GIC Ltd.-Group and Retail Cashless Claim Provider payment on Scan Documents. Click here
• ICICI Lombard GIC Ltd. Group Reimbursement claim processing on scan documents. Click here
• Health Claim Self Declaration format FY 21-22. Click here
• It is mandatory to attach the signed declaration form claim along with the PDF.
  The declaration form for reimbursement claim can be downloaded in PDF format and MS Word format.
  For PDF Format Click here . For MS Word Format Click here.