Vidal Health Insurance TPA Private Limited

CLAIM INTIMATION		NOTE * Fields marked in red are Compulsory You can visit our website for list of network hospitals or PPN Hospitals with whom we have packages for various procedures. You are requested to avail cashless facilities through these hospitals. In case you prefer to take treatment in other hospitals , our settlement would be limited to the rates in our Network / PPN hospitals. Please note that insurance policy provides for payment of medical expenses which are reasonably & necessarily incurred.

*Corporate ID / Policy No:
*Vidal ID Card No:
*Patient Name:
*Hospital Name:
*Hospital State:
*Hospital City:
*Hospital Type:
*Hospital Address:
Hospital Phone No:
*Admission Date:
Expected Discharge Date:
Intimation Date:
*Diagnosis:
*Estimated Cost:
*Mobile No:
Email Id: