MEDICAL EXPENSES REIMBURSEMENT CLAIM FORM (HITPA)

REIMBURSEMENT CLAIM FORM HITPA

https://drive.google.com/file/d/1G2vjfuZ4KEqu3vADGcJeOaVtoOOwxGO2/view?usp=sharing

PART OF FORM

1 CLAIM FORM - PART - A

2 GUIDANCE FOR FILLING CALIM PART - A TO BE FILLED IN BY THE INSURED

3 CLAIM FORM - PART - B

4 GUIDANCE FOR FILLING CLAIM PART - B TO BE FILLED IN BY THE HOSPITAL

5 CONSENT FORM

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INFORMATION FOR INSURANCE UNDERWRITING, CLAIM AND PENSIONERS

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