{"id":2375,"title":"Tata AIG ElderCare","purpose":"claim","insurer":{"slug":"tata-aig-general-insurance","name":"Tata AIG General Insurance Company Limited"},"source_pdf":"https://www.tataaig.com/s3/tata_aig_eldercare_e4cb9d0820.pdf","sha256":"f8f48b3d8f63779a13117252250cf22cb21ff730642b2021bcbfc6ed6ae5af5d","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is for submitting health insurance claims under Tata AIG ElderCare policies. It is filled by the insured person (policyholder) and the hospital for hospitalization claims.","notes":["Fill all forms in CAPITAL LETTERS.","Submit original financial documents (bills and receipts).","Use separate claim form for each type of claim.","In case of multiple bills, attach a separate sheet listing them.","Fill dates in DD-MM-YYYY format.","For KYC, attach certified copies of ID and address proofs as per instructions.","Pre-authorization request form must be included with hospital form.","For claims above 1 Lakh, KYC documents are mandatory.","Track claim status online at www.tataaig.com using Policy Number/Member ID/Claim Number."],"title":"Tata AIG ElderCare","submit":{"to":"Health Claims Hub, Tata AIG General Insurance Co. Ltd., Door No. 615, 616, 5th and 6th Floor, Imperial Towers, Ameerpet, Next to Ameerpet Metro Station, Hyderabad - 500016, Telangana","how":"post or in person","address":"Health Claims Hub, Tata AIG General Insurance Co. Ltd., Door No. 615, 616, 5th and 6th Floor, Imperial Towers, Ameerpet, Next to Ameerpet Metro Station, Hyderabad - 500016, Telangana"},"purpose":"claim","sections":[{"title":"Claim Checklist","fields":[{"help":"Attach a cancelled cheque with printed details","type":"attachment","label":"Copy of cancelled cheque for the proposer - Account holder’s name, account number and IFSC code should be printed on the submitted copy","options":[],"required":true,"pdf_field":""},{"help":"Attach CKYC form, photo, PAN and address proof if claim > 1 Lakh","type":"attachment","label":"If the claimed amount is more than 1 Lakh; CKYC Form along with Photograph + PAN Card Copy of the Proposer + Address Proof","options":[],"required":false,"pdf_field":""},{"help":"Attach health card or policy copy","type":"attachment","label":"Tata AIG Health Card or Policy Copy","options":[],"required":false,"pdf_field":""},{"help":"Attach ID, address and age proof of patient","type":"attachment","label":"ID, Address & Age Proof of the Patient","options":[],"required":false,"pdf_field":""},{"help":"Attach hospital discharge or daycare summary","type":"attachment","label":"Discharge/ Daycare Summary from the hospital indicating the presenting complaints, diagnosis, treatment given and past medical history","options":[],"required":true,"pdf_field":""},{"help":"Attach original hospital final bill with itemized breakup","type":"attachment","label":"Hospital Final Bill along with breakup of the individual items","options":[],"required":true,"pdf_field":""},{"help":"Attach original payment receipt","type":"attachment","label":"Proof of payment paid at hospital - cash receipt","options":[],"required":true,"pdf_field":""},{"help":"Attach invoice and sticker for implants","type":"attachment","label":"In case of Implants being used - Please share relevant Invoice & Sticker","options":[],"required":true,"pdf_field":""},{"help":"Attach pharmacy and lab bills","type":"attachment","label":"Pharmacy & Lab Bills","options":[],"required":false,"pdf_field":""},{"help":"Attach diagnostic and lab reports","type":"attachment","label":"Diagnostic/ Lab Reports for submitted bills","options":[],"required":false,"pdf_field":""},{"help":"Attach doctor prescriptions for pharmacy bills","type":"attachment","label":"Doctor Prescriptions for submitted pharmacy bills","options":[],"required":false,"pdf_field":""},{"help":"Attach medical records and consultation papers before hospitalization","type":"attachment","label":"Medical records and consultation papers prior to hospitalization","options":[],"required":false,"pdf_field":""},{"help":"Attach previous settlement letters if applicable","type":"attachment","label":"Any previously approved settlement letter from other insurance (if any)","options":[],"required":false,"pdf_field":""},{"help":"Attach MLC and FIR for accidental injuries","type":"attachment","label":"In case of accidental injuries, please submit Medico-Legal Certificate (MLC) /First Information Report (FIR)","options":[],"required":false,"pdf_field":""},{"help":"Attach nominee details and ID proof if proposer is deceased","type":"attachment","label":"In case of death of the proposer, details of nominee (as per policy schedule), along with address & ID proof of nominee","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Claim Form - Part A (To be filled by the insured)","fields":[{"help":"Enter your policy number","type":"text","label":"Policy No.*","options":[],"required":true,"pdf_field":""},{"help":"Enter Unique Health ID if applicable","type":"text","label":"UHID","options":[],"required":false,"pdf_field":""},{"help":"Enter intimation number if available","type":"text","label":"Intimation Number","options":[],"required":false,"pdf_field":""},{"help":"Enter your full name in capital letters","type":"text","label":"Name*","options":[],"required":true,"pdf_field":""},{"help":"Enter your full address","type":"text","label":"Address*","options":[],"required":true,"pdf_field":""},{"help":"Enter your registered email","type":"email","label":"Registered E-mail ID*","options":[],"required":true,"pdf_field":""},{"help":"Enter your registered phone number","type":"phone","label":"Registered Phone Number*","options":[],"required":true,"pdf_field":""},{"help":"Pre-filled as Tata AIG General Insurance Company Ltd.","type":"text","label":"Company Name*","options":[],"required":true,"pdf_field":""},{"help":"Select if you have other health insurance","type":"yes-no","label":"Currently covered by any other Mediclaim/Health Insurance","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter other insurer's company name if applicable","type":"text","label":"If yes, Company Name","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Have you been hospitalized in the last four years since inception of the contract?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter diagnosis if hospitalized previously","type":"text","label":"Diagnosis","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Insurance History (Section B)","fields":[{"help":"Enter previous policy number if any","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured amount","type":"amount","label":"Sum Insured (`)","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Previously covered by any other Mediclaim/Health Insurance","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter other insurer's company name if applicable","type":"text","label":"If yes, Company Name","options":[],"required":false,"pdf_field":""},{"help":"Enter policy number","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured","type":"amount","label":"Sum Insured (`)","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Hospitalization (Section D)","fields":[{"help":"Select reason for hospitalization","type":"choice","label":"Hospitalization due to","options":["Illness","Injury"],"required":false,"pdf_field":""},{"help":"Enter hospital name","type":"text","label":"Name of Hospital where admitted","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Insured Person Hospitalized (Section C)","fields":[{"help":"Enter full name of hospitalized person","type":"text","label":"Name","options":[],"required":false,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender","options":["Male","Female","Other"],"required":false,"pdf_field":""},{"help":"Select relationship","type":"choice","label":"Relationship to Primary Insured","options":["Self","Spouse","Child","Father","Mother","Other (Please Specify)"],"required":false,"pdf_field":""},{"help":"Enter date of birth","type":"date","label":"Date of birth","options":[],"required":false,"pdf_field":""},{"help":"Enter age in years and months","type":"number","label":"Age (Years, Months)","options":[],"required":false,"pdf_field":""},{"help":"Select occupation","type":"choice","label":"Occupation","options":["Service","Self Employed","Homemaker","Student","Retired","Other (Please Specify)"],"required":false,"pdf_field":""},{"help":"Enter alternate phone number","type":"phone","label":"Alternative Phone Number","options":[],"required":false,"pdf_field":""},{"help":"Enter admission date","type":"date","label":"Date of Admission","options":[],"required":false,"pdf_field":""},{"help":"Enter discharge date","type":"date","label":"Date of Discharge","options":[],"required":false,"pdf_field":""},{"help":"Select cause of injury if applicable","type":"choice","label":"If Injury, give cause","options":["Self Inflicted","Road Traffic Accident","Substance Abuse/Alcohol Consumption"],"required":false,"pdf_field":""},{"help":"Select if case is medico legal","type":"yes-no","label":"If Medico legal","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Attach MLC and FIR if medico legal","type":"yes-no","label":"MLC Report & Police FIR attached","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select system of medicine","type":"choice","label":"System of Medicine","options":["Allopathy"],"required":false,"pdf_field":""},{"help":"Select if reported to police","type":"yes-no","label":"Reported to police","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Claim (Section E)","fields":[{"help":"Enter date of claim form signing","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Bills Enclosed (Section F)","fields":[{"help":"Select applicable claim types","type":"choice","label":"Type of claims","options":["In-Patient Treatment","Pre & Post-Hospitalization Expenses","Day Care Procedures","High End Diagnostics","Road Ambulance Cover","Home Care Treatment Cover"],"required":false,"pdf_field":""},{"help":"Enter total expenses for each claim type","type":"amount","label":"Total expenses","options":[],"required":false,"pdf_field":""},{"help":"Enter grand total amount claimed","type":"amount","label":"Grand Total","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Primary Insured Bank Account (Section G)","fields":[{"help":"Enter PAN of primary insured","type":"text","label":"PAN","options":[],"required":false,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Account No.","options":[],"required":false,"pdf_field":""},{"help":"Enter bank name and branch","type":"text","label":"Bank Name and Branch","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Cheque/DD Payable Details","fields":[{"help":"Enter payee details","type":"text","label":"Cheque/DD Payable details","options":[],"required":false,"pdf_field":""},{"help":"Attach cancelled cheque with printed payee name","type":"attachment","label":"Please provide a Cancelled cheque of Proposer (with printed Payee Name)","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code of bank branch","type":"text","label":"IFSC Code","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Hospital Details and Declaration (Part B)","fields":[{"help":"Enter hospital name","type":"text","label":"Name of the Hospital","options":[],"required":true,"pdf_field":""},{"help":"Enter ROHINI ID if applicable","type":"text","label":"ROHINI ID","options":[],"required":false,"pdf_field":""},{"help":"Enter treating doctor's name","type":"text","label":"Name of the treating Doctor","options":[],"required":false,"pdf_field":""},{"help":"Enter hospital phone number","type":"phone","label":"Phone No.","options":[],"required":false,"pdf_field":""},{"help":"Enter hospital registration number","type":"text","label":"Registration No. (with State Code)","options":[],"required":false,"pdf_field":""},{"help":"Enter patient name","type":"text","label":"Name of the Patient","options":[],"required":true,"pdf_field":""},{"help":"Enter inpatient registration number","type":"text","label":"IP Registration Number","options":[],"required":false,"pdf_field":""},{"help":"Enter patient's date of birth","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Enter admission date","type":"date","label":"Date of Admission","options":[],"required":true,"pdf_field":""},{"help":"Enter discharge date","type":"date","label":"Date of Discharge","options":[],"required":true,"pdf_field":""},{"help":"Select type of admission","type":"choice","label":"Type of Admission","options":["Planned","Emergency","Day Care","Maternity"],"required":false,"pdf_field":""},{"help":"Select discharge status","type":"choice","label":"Status at time of discharge","options":["Discharge to home","Discharge to another hospital","Deceased"],"required":false,"pdf_field":""},{"help":"Enter total claimed amount","type":"amount","label":"Total claimed amount `","options":[],"required":false,"pdf_field":""},{"help":"Enter gravida status if maternity claim","type":"text","label":"Gravida Status: G, P, L, A","options":[],"required":false,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender","options":["M","F"],"required":false,"pdf_field":""},{"help":"Enter hospital PAN number","type":"text","label":"Hospital PAN","options":[],"required":false,"pdf_field":""},{"help":"Enter number of beds","type":"number","label":"Number of in-patient beds","options":[],"required":false,"pdf_field":""},{"help":"Fill only if hospital is non-network","type":"text","label":"Additional Details in case of Non-Network Hospital (Name, Address, City/Town, District, Pin Code, State)","options":[],"required":false,"pdf_field":""}],"filled_by":"hospital"},{"title":"Hospitalization due to injury details","fields":[{"help":"Select if injury due to substance abuse or alcohol","type":"yes-no","label":"Substance abuse / alcohol consumption","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Attach test report if yes","type":"yes-no","label":"If injury due to Substance abuse/alcohol consumption, Test Conducted to establish this","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if pre-authorization obtained","type":"yes-no","label":"Pre-authorization obtained","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter pre-authorization number","type":"text","label":"Pre-authorization Number","options":[],"required":false,"pdf_field":""},{"help":"Select if medico legal case","type":"yes-no","label":"If Medico legal","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter FIR number if applicable","type":"text","label":"FIR No.","options":[],"required":false,"pdf_field":""},{"help":"Explain reason if not reported","type":"text","label":"If not reported to police, give reason","options":[],"required":false,"pdf_field":""},{"help":"Select if reported to police","type":"yes-no","label":"Reported to Police","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"hospital"},{"title":"KYC Application Form (Part C)","fields":[{"help":"Fill current address details","type":"text","label":"Current Address Details","options":[],"required":true,"pdf_field":""},{"help":"Sign or provide thumb impression","type":"signature","label":"Applicant Declaration","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":["Submit claim documents within 30 days from date of discharge","In case of delay beyond 30 days, provide a covering letter explaining the reason"],"applies_to":"health insurance claims including In-Patient Treatment, Day Care Procedures, Post Operative Care, High End Diagnostics, Pre & Post-Hospitalization expenses, AYUSH Benefit, Compassionate Care, Home Physiotherapy, Home Care treatment Cover","attachments":["Cancelled cheque of proposer with printed details","CKYC Form with Photograph + PAN Card Copy + Address Proof (if claim > 1 Lakh)","Claim form","Tata AIG Health Card or Policy Copy","ID, Address & Age Proof of the Patient","Discharge/ Daycare Summary from hospital","Hospital Final Bill with breakup","Proof of payment at hospital (cash receipt)","Invoice & Sticker for implants (if any)","Pharmacy & Lab Bills","Diagnostic/ Lab Reports","Doctor Prescriptions for pharmacy bills","Medical records and consultation papers prior to hospitalization","Previously approved settlement letter from other insurance (if any)","Medico-Legal Certificate (MLC) / First Information Report (FIR) for accidental injuries","Nominee details with address & ID proof in case of death of proposer","Hospital Registration Certificate","Pre-authorization request form (for hospital)","KYC documents as per instructions"],"declarations":["The information furnished in this Claim Form is true and correct to the best of my knowledge and belief.","False or untrue statements or concealment of material facts will forfeit the right to claim reimbursement.","Consent and authorize TPA/insurance company to seek necessary medical information from hospitals or doctors.","All bills and receipts for the claim are included and no supplementary claim will be made except pre/post-hospitalization claims.","Hospital declaration that information furnished is true and correct and false statements will forfeit claim rights.","Prohibition of rebates as per Section 41 of Insurance Act, 1938 applies.","Applicant declares KYC details are true and consents to receiving information from Central KYC Registry."],"dropped_labels":17},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"TATA AIG General Insurance Company Limited, 5th and 6th Floor, Imperial Towers, H.No 7-1-6-617/A, GHMC No - 615,616, Ameerpet, Hyderabad – 500016, Telangana","label":"Claims Submission Address","level":null,"hours":null,"applies_to":"health","source_url":"https://www.tataaig.com/s3/medicare_select_cis_e7df7ce2ec.pdf","quote":"tion or procedure. Submit claim documents within 15 days of occurrence of incident. Kindly send the claim documents to: TATA AIG General Insurance Company Limited, 5th and 6th Floor, Imperial Towers, H.No 7-1- 6-617/A, GHMC No - 615,616, Ameerpet, Hyderabad – 500016, Telangana, Phone-040-66864900 Assistance: 1. Website www.tataaig.com or Call 24*7 Customer Support No.: 022 6489 8282/1800 267 1","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"healthclaimsupport@tataaig.com","label":"Health Claims Support Email","level":null,"hours":null,"applies_to":"health","source_url":"https://www.tataaig.com/s3/medicare_select_prospectus_efd23b0ad6.pdf","quote":"al Towers, H.No 7-1-6-617/A, GHMC No - 615,616, Ameerpet, Hyderabad – 500016, Telangana, Phone: 040-66864900\nEmail ID | healthclaimsupport@tataaig.com\nCustomer Support Number: | 022 6489 8282 / 1800 267 1955 (nly for senior citizen policy holders)\nWebsite | www.tataaig.","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"040-66864900","label":"Claims Administrator Phone","level":null,"hours":null,"applies_to":"health","source_url":"https://www.tataaig.com/s3/medicare_select_prospectus_efd23b0ad6.pdf","quote":"th and 6th Floor, Imperial Towers, H.No 7-1-6-617/A, GHMC No - 615,616, Ameerpet, Hyderabad – 500016, Telangana, Phone: 040-66864900\nEmail ID | healthclaimsupport@tataaig.com\nCustomer Support Number: | 022 6489 8282 / 1800 267 1955 (nly for senior citi","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/tata-aig-general-insurance/2375-tata-aig-eldercare"}