{"id":738,"title":"CLAIM FORM FOR OneClick OPD","purpose":"claim","insurer":{"slug":"magma-general-insurance","name":"Magma General Insurance Limited"},"source_pdf":"https://www.magmainsurance.com/documents/5553002/45886537/Claim+form+OneClick+OPD.pdf/4fe77c22-b40b-13b3-896b-7f23529ee571?t=1789542317855","sha256":"1f4e35d55ea3a5e5553a642a8418f08db24c02095f18146de4977319df8defa3","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for the insured person to claim reimbursement for outpatient department (OPD) services under the OneClick OPD insurance plan.","notes":["Fill the form in block letters.","Attach a cancelled cheque leaf of the bank account in the name of the primary insured without fail."],"title":"CLAIM FORM FOR OneClick OPD","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"DETAILS OF PRIMARY INSURED","fields":[{"help":"Enter full name in block letters","type":"text","label":"Name of the Insured:","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Gender.:","options":["Male","Female","Third Gender"],"required":null,"pdf_field":""},{"help":"Enter date of birth in DD MM YYYY format","type":"date","label":"DOB:","options":[],"required":null,"pdf_field":""},{"help":"Enter age in years and/or months","type":"text","label":"Age","options":[],"required":null,"pdf_field":""},{"help":"Include STD code for landline if applicable","type":"phone","label":"Phone No:","options":[],"required":null,"pdf_field":""},{"help":"Enter full postal address","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"Enter member identification number","type":"text","label":"Member ID.:","options":[],"required":null,"pdf_field":""},{"help":"Enter policy number","type":"text","label":"Policy Number:","options":[],"required":null,"pdf_field":""},{"help":"Specify the plan type","type":"text","label":"Plan Type:","options":[],"required":null,"pdf_field":""},{"help":"Specify the identity proof document provided","type":"text","label":"Identity proof:","options":[],"required":null,"pdf_field":""},{"help":"Specify the address proof document provided","type":"text","label":"Address proof:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAILS OF CLAIM","fields":[{"help":"List all services claimed for; file separate claims for different dates or facilities","type":"text","label":"Requested Services:","options":[],"required":null,"pdf_field":""},{"help":"Enter the total amount claimed","type":"amount","label":"Requested amount.:","options":[],"required":null,"pdf_field":""},{"help":"Select the type of visit","type":"choice","label":"Visit Type OPD/IPD:","options":["OPD","IPD"],"required":null,"pdf_field":""},{"help":"Enter the place where reimbursement request is created","type":"text","label":"Reimbursement request Created at place:","options":[],"required":null,"pdf_field":""},{"help":"Name of the medical facility where services were availed","type":"text","label":"Facility Name:","options":[],"required":null,"pdf_field":""},{"help":"Address of the medical facility","type":"text","label":"Facility address:","options":[],"required":null,"pdf_field":""},{"help":"Enter invoice number for the services","type":"text","label":"Invoice Number:","options":[],"required":null,"pdf_field":""},{"help":"Attach all applicable documents","type":"checkbox","label":"Documents needed.:","options":["Invoice","Prescription","Lab report","Radiology report"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAILS OF PRIMARY INSURED’s BANK ACCOUNT","fields":[{"help":"Enter PAN number","type":"text","label":"PAN:","options":[],"required":null,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Account Number:","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name and branch","type":"text","label":"Bank Name and Branch:","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC code of the bank branch","type":"text","label":"IFSC Code:","options":[],"required":null,"pdf_field":""},{"help":"Details for cheque or demand draft payable","type":"text","label":"Cheque/ DD Payable Details:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DECLARATION BY THE INSURED","fields":[{"help":"Enter date of signing","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Insured:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"OneClick OPD claims","attachments":["Invoice","Prescription","Lab report","Radiology report","Cancelled cheque leaf of bank account in the name of primary insured"],"declarations":["The information furnished is true and correct to the best of the insured's knowledge.","False or untrue statements or concealment of material facts will forfeit the right to claim reimbursement.","Consent is given to TPA/insurance company to seek medical information from hospitals or medical practitioners.","All bills and receipts for the claim have been included."],"dropped_labels":1},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"Magma General Insurance Limited (Claims Hub), Srinilaya Cyber Spazio Suite 101, 102, Ground Floor, Road No. 2, Banjara Hills, Hyderabad, Telangana – 500034","label":"Claims Hub Address","level":null,"hours":null,"applies_to":"health","source_url":"https://www.magmainsurance.com/learn-about-claims","quote":"fe takes an unexpected turn. When that moment comes, a clear and dependable claims process makes all the difference. At Magma General Insurance, our aim is to make the process simple to understand, transparent to follow, and supportive at every step. This page explains how claims work across Health, Motor and Non‑Motor policies.\nClaim is easy at Magma General Insurance.\nRegister Claim\nHealth","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"customercare@magmainsurance.com","label":"Customer Care Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.magmainsurance.com/web/magmainsurance/claims","quote":"ma HDI General Insurance Company Limited) | All Rights Reserved\n| IRDAI Reg. No. 149 |\nwww.magmainsurance.com\n| E-mail:\ncustomercare@magmainsurance.com\n| Registered & Corporate Office: Equinox Business Park, Tower 3, Ambedkar Nagar, 2\nnd\nFloor, Unit Number 1B & 2B, LBS M","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 266 3202","label":"Claims Intimation Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.magmainsurance.com/web/magmainsurance/claims","quote":"surance Claims - Motor & Health Insurance Claim Process - Magma Insurance - Magma\nSkip to Content\nOne-Line-Hearder-Test\n1800 266 3202\nNavigation\nCustomer Service\nSenior Citizen Services\nRoad side Assistance\nAnnual Health Check-up\nPolicy Servicing assist","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/magma-general-insurance/738-claim-form-for-oneclick-opd"}