Health Insurance Intimation Application – Insurance Intimation Letter Sample Format

The Concerned Authority,
________________ (Insurance Company Name),
________________ (Address)

Date: __/__/____ (Date)

Subject: Intimation regarding mediclaim

Respected Sir/Madam,

Respected, I am __________ (Name) and I do carry a ________________ (Policy Name – If any) policy of your company having the policy number _______________ (Policy Number) in the name of __________ (policyholder name) _______ (relationship with policyholder). TPA ID is _______________ (Company TPA ID – If applicable). My permanent residential address is ______________ (Address).

He/she is being admitted in ____________ (Hospital Name) on ________ (admission date and time), having ___________ (Room type) due to the reason of _______________ (Reason for Hospitalization). Kindly consider this as an intimation letter for the mediclaim purpose for ____________ (Name of patient).

The following are the details of the patient:

Name: _______________ (Name)
Policy Number: _______________ (Policy Number)
Contact Details: _______________ (Contact Number)

I am hereby attaching ____________ (Medical Card/ ID Proof/ Address Proof/ Treatment Prescription with Bill Estimation – Any other document if applicable).

Respectfully, I shall be grateful for your favor if you proceed with the Mediclaim approval procedure at the earliest and get it done without any delays.

Thanking you,
______________ (Signature)
______________ (Name),
______________ (Contact Number)

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