{"id":243,"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/hindi/Hindi_Health_Saver_Health_Savings_Benefit_Claim_Form.pdf","sha256":"f13b783cb2aec7078b0c2d79a82c0d774dcfc3ec8d31d396674af1d1a08a19a2","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 or incorrect forms may delay claim processing.","Contact customer care at 1860-266-7766 for assistance between 9:00 AM to 9:00 PM on all days except public holidays."],"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, Customer Service Department, 1089 Appasaheb Marathe Marg, Prabhadevi, Mumbai - 400025"},"purpose":"claim","sections":[],"deadlines":["Submit the claim within 3 years from the date of hospitalization or treatment"],"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","Policy document copy"],"declarations":["The claimant declares that the information provided is true and correct.","The claimant consents to the insurer obtaining medical information from hospitals or doctors for claim assessment."],"dropped_labels":11},"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/243-icici-pru-health-saver-health-savings-benefit-claim-form"}