Paramount Health Services & Insurance TPA Pvt. Ltd.

Cashless Request Form	Filled Sample Claim Form

Public Sector Insurance Companies

United India Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form
Super Top-up Claim Form
Top-up Claim Form
GIPSA PPN Network Declaration Form
www.uiic.co.in

New India Assurance Co. Ltd
Cashless Request Form
Reimbursement Claim Form
GIPSA PPN Network Declaration Form
Declaration Form for Network Hospital (Other than PPN)
www.newindia.co.in

National Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form
Request for Cashless Hospitalisation
GIPSA PPN Network Declaration Form
www.nationalinsurance.nic.co.in

The Oriental Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form A
Reimbursement Claim Form B
Request for Cashless Hospitalisation
GIPSA PPN Network Declaration Form
www.orientalinsurance.org.in

Private Sector Insurance Companies

Aditya Birla Health Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form A
Reimbursement Claim Form B
Claim Form - OPD
CKYC form
www.adityabirlacapital.com

Bajaj Allianz Life Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form
NEFT Mandate Form
www.bajajallianz.com

Cholamandalam General Insurance Co. Ltd
Cashless Request Form
Reimbursement Claim Form
www.cholainsurance.com

HDFC Ergo General Insurance Co. Ltd.
Cashless Request Form
Group Mediclaim Claim Form
Reimbursement Claim Form
www.hdfcergo.com

ICICI Lombard
Cashless Request Form
Reimbursement Claim Form
www.icicilombard.com

IFFCO Tokio General Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form
Medishield Claim Form
www.iffcotokio.co.in

Liberty General Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form
www.libertyinsurance.in

Niva Bupa Health Insurance Co. Ltd.
Cashless Request Form
Pre-authorization Form (Cashless)
Reimbursement Claim Form
www.nivabupa.com

Reliance General Insurance Co. Ltd
Cashless Request Form A
Reimbursement Claim Form A
Reimbursement Claim Form B
Cashless Request form
www.reliancegeneral.co.in

Care Health Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form
www.careinsurance.com

Royal Sundaram Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form
Reimbursement Claim Form Guidelines
NEFT Mandate Form
www.royalsundaram.in

SBI General Insurance Co. Ltd.
Cashless Request Form
Group Health Claim Form
CKYC form
Retail Health Claim Form
www.sbigeneral.in

Star Health and Allied Insurance Co Ltd
Cashless Request Form
Reimbursement Claim Form
https://www.starhealth.in/

Tata AIG General Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form
CKYC - For Employee NEFT more than 1 Lac
CKYC - Legal Entity-For Corporate NEFT more than 1 Lac
www.tataaig.com

Universal Sompo General Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form
NEFT Mandate Form
www.universalsompo.com

Navi General Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form
www.navi.com

ManipalCigna Health Insurance Co. Ltd.
Cashless Request Form
Request for Cashless Hospitalisation
Reimbursement Claim Form A
Reimbursement Claim Form B
www.manipalcigna.com

Zuno General Insurance Co. Ltd.
Cashless Request Form
Request for Cashless Hospitalisation
Reimbursement Claim Form A
Reimbursement Claim Form B
Group Health Claim Form A
Group Health Claim Form B
Top Up Insurance - Claim form A
Health Insurance - Claim form A
Arogya Sanjeevani - Claim form A
www.hizuno.com

Magma HDI General Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form A
Reimbursement Claim Form Part B
www.magmahdi.com

ZURICH Kotak General Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form A
Reimbursement Claim Form B
www.zurichkotak.com

Go Digit General Insurance Ltd.
Cashless Request Form
Reimbursement Summary Format
www.godigit.com

Future Generali India Insurance Company
Cashless Request Form
Reimbursement Claim Form
general.futuregenerali.in

Raheja QBE General Insurance Co. Ltd.
Reimbursement Claim Form
Cashless Form Part-c
Cashless Form Part-d
www.rahejaqbe.com

Private Sector Life Insurance Companies

Bandhan Life Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form
www.bandhanlife.com

HDFC Life Insurance Co. Ltd.
Cashless Request Form
Reimbursement Claim Form A
Reimbursement Claim Form B
www.hdfclife.com

Max Life Insurance Co.
Cashless Request Form
Reimbursement Claim Form
www.maxlifeinsurance.com