HDFC ERGO | AMS | UPLOAD CLAIM DOCUMENTS

Pre-Post Claim (Upload Pending Documents)

Customer Details

Customer Name

Policy No

Email Id

Mobile No

Claim Details

Claim No.

Patient Name

Approx Claim Amount *

Date Of Admission

Date Of Discharge

Remark

Hospital Details

Hospital State

Hospital City

Hospital Name

Hospital Address

Hospital Telephone No

Hospital PIN Code

List of Health Claim Document Required Patient ID Proof

Proposer Cancelled cheque/Bank Passbook copy

Original Discharge Summary

Bills and Payment Receipt

Others

Additional Info Hard Coppy of X-Ray,MRI and CT Scan Would be required if any,please send it to

HDFC ERGO General Insurance Company Ltd.

5th Floor,Tower 1, Stellar IT Park, C-25, Sector-62, Noida 201301, State : Uttar Pradesh

Uploaded Documents List

	PreAuthDocs	H_23031_6482403117_34_13_kanchan sethi pa.pdf	-	Uploaded
	Letter	PreAuthQueryLe_RC-HS21-12675821_20211021180554906.pdf	-	Uploaded
	Letter	PreAuthQueryLe_RC-HS21-12675821_20211022163624236.pdf	-	Uploaded
	QueryReply	KANCHAN.pdf	-	Uploaded
	QueryReply	QueryReply_H_23031_6482403_3.pdf	-	Uploaded
	Letter	AuthorizationLetter_RC-HS21-12675821_20211023130748247.pdf	-	Uploaded
	Bills and Payment Receipt	BILL BREAKUP-min.pdf	-	Uploaded
	Bills and Payment Receipt	MED BILLS-min.pdf	-	Uploaded
	Bills and Payment Receipt	PAY RECIEPTS-min.pdf	-	Uploaded
	Bills and Payment Receipt	FINAL BILL-min.pdf	-	Uploaded
	ClaimForm	DigitalClaimForm.pdf	-	Uploaded
	Patient ID Proof	kanchan pan.jpeg	-	Uploaded
	Others	CLAIM FORM-min.pdf	-	Uploaded
	Others	MRI-min.pdf	-	Uploaded
	Others	KYC-min.pdf	-	Uploaded
	Others	REPORTS-min.pdf	-	Uploaded
	Others	UNUTILISED-min.pdf	-	Uploaded
	Proposer Cancelled cheque/Bank Passbook copy	kanchan cheq.jpeg	-	Uploaded
	Original Discharge Summary	DISCHARGE-min.pdf	-	Uploaded
	Patient ID Proof	kanchan adhar.jpeg	-	Uploaded
	ClaimForm	DigitalClaimForm.pdf	-	Uploaded
	Patient ID Proof	kanchan pan.jpeg	-	Uploaded
	Letters	8.pdf	-	Uploaded
	Legal Docs	6.pdf	-	Uploaded
Total Documents: 24 X Clear All Documents
♦ All Files size should be less than 20 MB. (Uploaded Files Size : 0 MB ) ♦ Only jpeg, jpg, png, gif, pdf extensions files allowed.

Upload Pending Documents