{"id":238,"title":"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/oriya/Oriya_Health_Saver_Health_Savings_Benefit_Claim_Form.pdf","sha256":"fcbfea496b7f24ac0f559280f834ac8eb80168c05fe9fac11559dbce110004a9","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is used by policyholders to claim the Health Savings Benefit under the ICICI Prudential Health Saver policy.","notes":["Use block letters to fill the form.","Attach original bills and receipts only.","Incomplete or unsigned forms will delay claim processing.","Keep a copy of the filled form and documents for your records."],"title":"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 - 400025"},"purpose":"claim","sections":[],"deadlines":["Submit the claim form and documents within 30 days of discharge from hospital"],"applies_to":"Health Savings Benefit claims under ICICI Prudential Health Saver policy","attachments":["Original hospital bills and receipts","Discharge summary","Doctor’s prescription and reports","Copy of policy document"],"declarations":["I hereby declare that the information given above is true and correct to the best of my knowledge and belief.","I authorize the company to seek any medical information or records required for processing the claim.","I agree that the company may reject the claim if any information is found to be false or misleading."],"dropped_labels":12},"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/238-health-savings-benefit-claim-form"}