Hospitalization Claim

Following are the list of documents you will require to raise a Health Claim:  Download Health Card

Fixed benefit hospitalization claim for ICICI Pru Hospital Care / ICICI Pru Hospital Care II

  • Claimant's statement / Claim intimation form(Download Form)
  • Cancelled Cheque
  • Copy of Medical Records (Admission Notes, Discharge Summary and Test Reports)
  • Attending Doctor's Certificate
  • Pre-authorization form (for cashless facility)(Download Form)
  • Health check-up Form (for ICICI Pru Hospital Care II(Download Form)

Indemnity Hospitalization Claim applicable for ICICI Pru MediAssure / ICICI Pru Health Saver:

  • Claimant's statement / Claim intimation form
    (Download Form)
  • Original Hospital/ Pharmacy Bills & Payment
    Receipts and Records
  • Original Discharge Card
  • Cancelled Cheque
  • Original Investigation Reports
  • Pre-authorization form (for cashless facility)(Download Form)
  • Health check-up Form (for ICICI Pru Health Saver(Download Form)
  • Health Saving Benefit Form (for ICICI Pru Health Saver)(Download Form)

Critical Illness Claim/ MSAR/ ADBR applicable for ICICI Pru Crisis Cover / Rider Claim:

  • Claimant's statement / Claim intimation form
    (Download Form)
  • Copy of Medical Records (Admission Notes, Discharge Summary and Test Reports)
  • Cancelled Cheque
  • Original Policy Certificate
  • Attending Doctor's Certificate