{"id":353,"title":"Explore Protect Plus- Claim Form","purpose":"claim","insurer":{"slug":"care-health-insurance","name":"Care Health Insurance Ltd"},"source_pdf":"https://cms.careinsurance.com/cms/public/uploads/download_center/explore-protect-plus--claim-form.pdf","sha256":"237489495faf6f6b411bf478e3e4fcc3269c8c1e5675ae89f5e403e54a94a096","pages":3,"collected":"2026-10-20","instructions":{"about":"This form is used by the policyholder or claimant to submit a claim under the Explore Protect Plus insurance policy. It collects details about the insured, the claim, and requires declarations and supporting documents.","notes":["Claim form must be completely filled, signed and submitted in original.","Provide at least two contactable mobile numbers and an email ID.","Claim processing will be delayed without original documents.","Claim payments are made only through Online Bank Transfers; provide bank details and cancelled cheque in Section G.","If claim amount exceeds Rs 1 Lakh, additional documents are required.","Use additional sheets if required.","Submission of documents or bank details does not imply admission of liability.","Transaction charges for RTGS/NEFT are borne by the policyholder.","Track claim status online or via SMS as instructed.","Use original bills and documents only.","The form includes sections for different claim types such as visa fee refund, trip cancellation, loss of baggage, and burglary."],"title":"Explore Protect Plus- Claim Form","submit":{"to":"Care Health Insurance-Claims Department, Vipul Tech Square, Tower C, 3rd Floor, Golf Course Road, Sector-43, Gurugram-122009 (Haryana)","how":"post","address":"Care Health Insurance-Claims Department, Vipul Tech Square, Tower C, 3rd Floor, Golf Course Road, Sector-43, Gurugram-122009 (Haryana)"},"purpose":"claim","sections":[{"title":"Section A - Details of The Policy","fields":[{"help":"","type":"text","label":"Certificate of Insurance Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Add-on Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Base Policy Number","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section B - Details of Insured Person / Claimant","fields":[{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Provide at least two contactable mobile numbers and an email ID for communication","type":"phone","label":"Contact Number","options":[],"required":null,"pdf_field":""},{"help":"Provide at least two contactable mobile numbers and an email ID for communication","type":"email","label":"E-mail","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Application","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section C - Details of Claim","fields":[{"help":"If applicable, provide date in DD/MM/YYYY format","type":"date","label":"Refund of Visa Fee - Visa rejection Date","options":[],"required":false,"pdf_field":""},{"help":"Explain reason for visa rejection","type":"text","label":"Reason of Visa rejection","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rs","type":"amount","label":"Visa Application/documentation fees","options":[],"required":false,"pdf_field":""},{"help":"Enter claim amount in Rs","type":"amount","label":"Claim Amount","options":[],"required":false,"pdf_field":""},{"help":"Name of airline or transport provider","type":"text","label":"Name of Common Carrier","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Scheduled departure: Date","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Scheduled arrival: Date","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Actual departure: Date","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Actual arrival: Date","options":[],"required":false,"pdf_field":""},{"help":"Starting location of travel","type":"text","label":"Common Carrier route: From","options":[],"required":false,"pdf_field":""},{"help":"Briefly describe the incident leading to claim","type":"text","label":"Description of incident","options":[],"required":false,"pdf_field":""},{"help":"Total amount of expenses claimed in Rs","type":"amount","label":"Total expenses","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Loss of Checked-in Baggage","fields":[{"help":"Number each lost item","type":"number","label":"Serial No.","options":[],"required":false,"pdf_field":""},{"help":"List each lost item","type":"text","label":"Description of Items Lost","options":[],"required":false,"pdf_field":""},{"help":"Value of each lost item in Rs","type":"amount","label":"Amount(Rs)","options":[],"required":false,"pdf_field":""},{"help":"Name of airline or transport provider","type":"text","label":"Name of Common Carrier","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY and time HHMM","type":"date","label":"Date and time of arrival","options":[],"required":false,"pdf_field":""},{"help":"Indicate if police complaint was filed","type":"choice","label":"Police complaint lodged","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide date/time if complaint filed","type":"text","label":"Date and time of Police complaint, if lodged","options":[],"required":false,"pdf_field":""},{"help":"Indicate if claim was lodged with carrier","type":"choice","label":"Claim lodged on carrier","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate if police report was lodged","type":"choice","label":"Police report lodged","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Is the insured the sole owner of: a) The property lost or damaged?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Location where passenger disembarked","type":"text","label":"Port of disembarkation","options":[],"required":false,"pdf_field":""},{"help":"Attach report if available","type":"choice","label":"Property irregularity report by carrier attached","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY and time HHMM","type":"date","label":"Date and time of loss","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY and time HHMM","type":"date","label":"Date and time of departure","options":[],"required":false,"pdf_field":""},{"help":"Describe loss and list stolen/damaged articles","type":"text","label":"Give brief details of loss occurred with list of article stolen / damaged","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section D- Declaration","fields":[{"help":"Location where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing (DD/MM/YYYY)","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign to confirm declarations","type":"signature","label":"Signature of the Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"","attachments":["Original claim form","Original documents as specified in Section E (not provided in text)","Original cancelled cheque for bank details","Indoor Case Papers","Hospital Discharge Summary","Payment Receipts","Consultation Papers","Police complaint and reports if applicable","Property irregularity report by carrier if applicable"],"declarations":["The information/statements given in this claim form are true, correct and complete.","No material information relevant to the claim has been withheld or not disclosed.","If any false or fraudulent statement is made, the policy shall be void.","The claimant authorizes physicians, hospitals, police, and agencies to provide information to Care Health Insurance Limited.","The claimant authorizes Subrogation Agency to inquire and obtain information regarding the accident and release records as necessary.","The receipt of this claim form or documents does not imply admission of liability by the company.","The claimant undertakes to refund any excess amount credited in error within 7 days of notification."],"dropped_labels":6},"pdf_fields":null,"fillable_pdf":false,"send_to":[],"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/care-health-insurance/353-explore-protect-plus-claim-form"}