MDIndia Health Insurance TPA Pvt. Ltd.
Registration No. 005 valid till 20/03/2026
Period Of Certification : 21/03/2023 to 20/03/2026
Toll Free Customer Care No.: 1 800 209 77 77 / Toll Free Cashless No.: 1 800 209 78 00
UAN Fax No.: 1 860 233 44 49 /    Email ID: /
For Senior Citizens: 020-25300126 /    Email ID:
Download Forms

MDIndia does not charge any money from Hospital empanelment, In case of such a demand, Please immediately contact nearest Branch or Head office on Toll Free No : 1800 209 77 77

Download Claim Form
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Claim Intimation Format
IRDA - Claim Form for Medical Insurance Policies (Reimbursement)

Recent uploads PPN Network - Declaration by Patient/Patients's Attendant  
Other Forms
Provider Empanelment Kit
The New India Assurance Company Limited Forms
ECS Form  
Standard Discharge Summary Format
Standard Bill Format
OPD Forms
Documents Request Form

Request For Authorisation Letter
IRDAI - Request for Cashless Hospitalisation for Medical Insurance Policy
Check List
Self Declaration Form
Self declaration / undertaking form for processing of claim on soft copy

Discharge Voucher

Discharge Voucher

You could down load and fill the forms mentioned below for empanelment of your Hospitals / Nursing Homes with us.

Provider Empanelment Kit
Covering Letter
Provider Information
Schedule Of Charges
Undertaking Declaration from Hospital

Future Generali India Insurance Company Ltd.
Claim Form
Request For Authorisation Letter

National Insurance Company Limited
New Mediclaim

The New India Assurance Company Limited
Family Floater
Group Mediclaim
Janata Mediclaim
Mediclaim 2007
New Mediclaim
Senior Citizen
Steel Authority of India Limited
SAIL - GuideBook
SBI General Insurance Company Limited
  Claim Form
Birla Sun Life Insurance
  Claim Form
  Preauthorization Request Form
  Reimbursement Claim - Claimant's Statement
  Reimbursement Claim - Hospital Treatment Certificate
Reliance General Insurance
  Heath Claim Form
L&T General Insurance Company Ltd
  Claim Form

HDFC ERGO General Insurance Co.
  Claim Form
ICICI Lombard General Insurance
  Claim Form
  Preauthorization Request Form
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