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HEALTH CARE INSURANCE

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Inpatient Medical Claim Form

Male
Female
Employee
Dependent

Filled In By The Treating Doctor

(Only Fill if you can obtain signatures from doctor)

CONGENITAL
INFERTITLITY
PSYCHIATRIC
COSMETIC
SUCIDE
CONTRACEPTIVE
OTHERS

Incase Of Maternity Claims

  • Add the amount of payment receipts
  • Attach All payment Receipts Original and Photocopy of all other documents with the form

  • Make sure there is no duplicate payment receipts while adding amount
  • No Lab test claim will be granted unless doctor prescription of test is also attached
  • Medicines claims are purely subjective on scruitnization
  • !!! Calculation is done on Jubilee's end and it entirely depend on them what amount they approve !!!