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  • Intimation Format

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    Kamal Meena
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    This document is a notification from MedSave Healthcare (TPA) Ltd. to an insurance company regarding a claim for hospitalization of an insured person. It provides details of the policy such as the number, holder, period, insured person's name and sum. It also lists the date of admission, hospital name and address, contact details of the insured and hospitalization reason/disease. The estimated amount of the claim is also mentioned.

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    Intimation format

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    This document is a notification from MedSave Healthcare (TPA) Ltd. to an insurance company regarding a claim for hospitalization of an insured person. It provides details of the policy such as the number, holder, period, insured person's name and sum. It also lists the date of admission, hospital name and address, contact details of the insured and hospitalization reason/disease. The estimated amount of the claim is also mentioned.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    3 views1 page

    Intimation Format

    Uploaded by

    Kamal Meena
    This document is a notification from MedSave Healthcare (TPA) Ltd. to an insurance company regarding a claim for hospitalization of an insured person. It provides details of the policy such as the number, holder, period, insured person's name and sum. It also lists the date of admission, hospital name and address, contact details of the insured and hospitalization reason/disease. The estimated amount of the claim is also mentioned.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    INSURANCE COMPANY:

    To, FROM:
    MedSave Healthcare (TPA) Ltd.
    _______________________
    ____
    _______________________

    DATE: _________________

    Dear Sir,

    SUB: INTIMATION FOR MEDICLAIM

    1. POLICY NO. :

    THE FOLLOWING INSURED PERSON HAS BEEN ADMITTED IN THE


    HOSPITAL
    THE REQUIRED DETAISL ARE AS UNDER:

    2. NAME OF POLICY HOLDER :

    3. POLICY PERIOD :

    4. NAME OF HOSPITALISED PERSON :

    5. SUM INSURED :

    6. DATE OF ADMISSION IN THE HOSPITAL :

    7. NAME & ADDRESS OF THE HOSPITAL :

    CONTACT NO. :

    8. INSURED’S CONTACT NO. : (O) (R)


    MOBILE:

    9. DISEASE / REASON OF
    HOSPITALISATION :
    10. ESTIMATED AMOUNT :

    YOURS SINCERELY,

    (SIGNATURE)

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