For claim from ICICI Lombard – Please download the form and sign on pages as mentioned in the link.
Documents to be submitted along with claim form
All original documents
- a) Prescriptions
- b) Test reports (Please note only observation report is required, X-ray, CT Scan film is not required)
- c) Discharge summary
- d) Final Bill with Break up
For ex- medicine charges is Rs. 100,000 below that details of medicines should be given, same break up for all the expenses should be mentioned in the final bill
- e) One ID proof
- f) Aadhar card, Pan Card, any government id proof mentioning date of birth of insured)
- g) Child Birth Certificate (in case of maternity)
- if birth certificate is not there, provide discharge summary)
- (h) One cancelled cheque of employee with name printed on it, if name is not printed on cheque than latest bank statement with cancelled cheque.