Customer Care: 1860-425-3232 For Senior Citizen: 1800-102-9919 customer.care@ghpltpa.com Claim Status Claim Intimation E-Card

Submit claims in soft copy During the COVID 19 Lockdown period

* INSURANCE COMPANY NAME

POLICY NO

Special characters are not allowed (Ex: OG-10-FDS/234 as OG10FDS234)

Corporate name (applicable for corporate policies)

Special characters are not allowed (Ex: ABC-ABC as ABCABC)

Employee ID (applicable for corporate policies)

Special characters are not allowed (Ex: FA-123 as FA123)

* GOOD HEALTH ID

Special characters are not allowed (Ex: GH-01/02-03 as GH010203)

* NAME OF THE INSURED

* NAME OF THE PATIENT

* GOOD HEALTH ID OF THE PATIENT

Special characters are not allowed (Ex: GH-01/02-03 as GH010203)

* AGE OF THE PATIENT

* RELATIONSHIP WITH THE INSURED

* MOBILE NO

* please enter proper mobile no as it is used for OTP verification

* EMAIL ID

* please enter proper email id as it is used for OTP verification

Claim Document Checklist for scanned copy submission

BROWSE Files (FOR DOCUMENTS UPLOAD)

Special characters are not allowed. Allowed only _

DECLARATION BY THE INSURED

DURING SUBMISSION OF SOFT COPIES OF REIMBURSEMENT CLAIM DOCUMENTS

I, , aged years, enrolled in Good Health Insurance TPA Limited (TPA)vide GHITL card ID hereby accept the following conditions:

1. I herewith understand that TPA or insurer is not liable to pay by mere submission of my claim documents.
2. The TPA/insurer reserves the right to process the claim as per terms and conditions of the policy.
3. The insurer reserves its right to settle the claim either on soft copies itself or following submission of hard copies.
4. The TPA or insurer reserves its right to recover the settled amount in case of any misrepresentation of facts or fraud is committed by me.
5. I agree to submit the original documents as soon as the lock down is lifted or whenever the TPA /insurer summons for the same even after settlement of the claim.

**** submitted on 08-03-2021 23:43:25 from IP ADDRESS 192.168.250.1