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This document is a request form for cashless hospitalisation under a medical insurance policy via HDFC ERGO General Insurance Company. It requires details from both the insured patient and the treating

How to fill out hdfc preauth form

How to fill out HDFC Ergo Preauth form:

1. Obtain the HDFC Ergo Preauth form from the insurance provider or download it from their official website.
2. Fill in the personal details section, including your name, address, contact information, and policy number.
3. Provide information about the patient for whom the preauthorization is being sought, such as their name, age, and relationship to the policyholder.
4. Specify the name and contact details of the treating doctor or hospital where the treatment is being sought.
5. Describe the medical condition or illness for which preauthorization is being requested.
6. Attach all relevant medical documents, including test reports, prescriptions, and any other supporting documents.
7. Sign and date the form to certify the accuracy of the information provided.

Who needs HDFC Ergo Preauth form:

1. Policyholders who have health insurance coverage with HDFC Ergo and need preauthorization for medical treatments.
2. Individuals undergoing planned or emergency medical procedures that require prior approval from the insurance provider.
3. Dependents of policyholders, such as spouses, children, or parents, who are covered under the policy and require preauthorization for medical treatments.

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What is request for cashless hospitalisation?

A request for cashless hospitalisation is a formal application submitted by a patient or their representative to secure medical treatment in a hospital without the need for upfront cash payments, allowing the expenses to be covered directly by the insurance provider.

Who is required to file request for cashless hospitalisation?

The request for cashless hospitalisation is typically filed by the insured patient or a designated representative, such as a family member or caregiver, who is seeking treatment at a network hospital covered by their health insurance policy.

How to fill out request for cashless hospitalisation?

To fill out the request for cashless hospitalisation, the patient or representative should complete the designated form provided by the insurance company or hospital, ensuring to include necessary details such as policy number, patient information, diagnosis, and the nature of the required treatment.

What is the purpose of request for cashless hospitalisation?

The purpose of the request for cashless hospitalisation is to facilitate immediate medical care without the patient having to bear the financial burden upfront, ensuring a smooth admission process and timely treatment.

What information must be reported on request for cashless hospitalisation?

The information required on the request for cashless hospitalisation generally includes the patient's name, contact details, insurance policy number, hospital admission date, details of the illness or injury, proposed treatment, and any relevant medical history.