{"id":234,"title":"ICICI Pru Health Saver Health Savings Benefit Claim Form","purpose":"claim","insurer":{"slug":"prudential-hcl-health-insurance","name":"Prudential HCL Health Insurance Limited"},"source_pdf":"https://www.icicilife.com/content/dam/icicipru/download-centre/regionalforms/telugu/Telugu_Health_Saver_Health_Savings_Benefit_Claim_Form.pdf","sha256":"a257b4803f5fd55bec785752eb5e583c5ea611104dd71e18211bc6253676a60c","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is used by the policyholder to claim the Health Savings Benefit under the ICICI Pru Health Saver policy.","notes":["Use block letters to fill the form.","Attach original bills and receipts only.","Incomplete forms or missing documents may delay claim processing."],"title":"ICICI Pru Health Saver Health Savings Benefit Claim Form","submit":{"to":"ICICI Prudential Life Insurance Company Limited","how":"post","address":"ICICI Prudential Life Insurance Company Limited, 1089, Appasaheb Marathe Marg, Prabhadevi, Mumbai - 400 025"},"purpose":"claim","sections":[],"deadlines":["Submit the claim form and documents within 30 days of discharge"],"applies_to":"Health Savings Benefit claims under ICICI Pru Health Saver policy","attachments":["Original hospital bills and receipts","Discharge summary","Doctor's prescription and reports","Copy of policy document","Bank passbook or cancelled cheque"],"declarations":["I declare that the information given in this form is true and correct to the best of my knowledge.","I authorize the insurer to seek medical information from any hospital or doctor.","I agree that the insurer may reject the claim if any information is found to be false or incorrect."],"dropped_labels":13},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"customersupport@prudentialhealth.in","label":"Claims Support Email","level":null,"hours":null,"applies_to":"health","source_url":"https://prudentialhealth.in/how-to-claim","quote":"7th Floor, One Unity Center, Senapati Bapat Marg,\nDadar West, Lower Parel, Mumbai – 400013\nGet in Touch\n➔\n1800 268 2000\ncustomersupport@prudentialhealth.in\nInsurance Plans\nHealth Insurance Plans\nPRUHealth Edge\nPRUHealth Signature\nPRUHealth Protect\nPRUHealth Guardian\nTools &","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 268 2000","label":"Claims Support Toll-Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://prudentialhealth.in/how-to-claim","quote":"704 to 1708, 17th Floor, One Unity Center, Senapati Bapat Marg,\nDadar West, Lower Parel, Mumbai – 400013\nGet in Touch\n➔\n1800 268 2000\ncustomersupport@prudentialhealth.in\nInsurance Plans\nHealth Insurance Plans\nPRUHealth Edge\nPRUHealth Signature\nPRUHealth","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/prudential-hcl-health-insurance/234-icici-pru-health-saver-health-savings-benefit-claim-form"}