{"id":248,"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/bengali/Bengali_Health_Saver_Health_Savings_Benefit_Claim_Form.pdf","sha256":"9e3b9596905a56b77b344aa368390658f8e1a16767457e7a51f79143906461c3","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 may delay claim processing."],"title":"Health Savings Benefit Claim Form","submit":{"to":"ICICI Prudential Life Insurance Company Limited","how":"post or upload via the company website or TPA portal","address":"ICICI Prudential Life Insurance Company Limited, 1089 Appasaheb Marathe Marg, Prabhadevi, Mumbai - 400025"},"purpose":"claim","sections":[],"deadlines":["Submit the claim form 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","Policy copy"],"declarations":["I declare that the information provided is true and correct to the best of my knowledge.","I authorize the insurer to seek any medical information required to process this claim.","I understand that any false information may lead to rejection of the claim."],"dropped_labels":10},"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/248-health-savings-benefit-claim-form"}