FHPL Claim Form - Pazcare

FHPL Claim Form

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FHPL claim form for group medical insurance

The FHPL reimbursement claim form for a group health insurance policy contains two parts. FHPL claim form part A, which is duly filled by the policyholder or the primary insured. The second part is the FHPL claim form part B, which is filled by the non-network hospital where the treatment was taken.

Download the FHPL Claim form

How to fill FHPL claim form for your group medical policy?

  1. Firstly, intimate the FHPL TPA about the hospitalisation. The FHPL claim form can be downloaded from the Pazcare dashboard or https://www.fhpl.net/ under the downloads section.
  2. Fill in the group health insurance policy number followed by the FHPL TPA Id number. These details will be present on your TPA Id card or your group health insurance Id card.
  3. Then fill in your details like name, address, phone number, state, city and all the other necessary details mentioned in your FHPL TPA reimbursement claim form.
  4. In the next section - “Details of insurance history” please mention if you are covered by any other health insurance plan. If not, then this section can be omitted. 
  5. Next, fill in the information about the insured person hospitalised along with details like name of the hospital, room type, date of admission, the reason for hospitalisation and others mentioned under the section - “Details of the insured person hospitalised” in your FHPL claim form part A.
  6. Then, mention the details of the claim. This includes pre and post-hospitalisation expenses, hospitalisation expenses, ambulance charges, hospital daily cash, and other details that applies to your group health insurance policy.
  7. Along with this please enclose the other required documents mentioned in your FHPL reimbursement claim form.
  8. Make sure you fill in the bank account details of the insured along with a cancelled cheque leaf for the reimbursement claim.
  9. The FHPL claim form part B will be filled out by the hospital where the treatment was taken.

Also read: Health insurance claim process

FHPL reimbursement claim form filled sample 

FHPL reimbursement claim form filled sample - Pazcare

FHPL claim process

After you fill out the FHPL claim form, here is how you will file for the reimbursement claim.

  1. A reimbursement claim is filed when the insured is admitted to a non-network hospital of a health insurance company or the FHPL TPA.
  2. Inform the TPA within 24 hours of the hospitalization of the insured. Make sure you collect all the necessary documents to file a reimbursement claim. This also includes all the original copies of hospital bills and a duly filled FHPL claim form.
  3. Also, make sure you have xerox copies of all the attached documents for your reference.
  4. You can submit these documents online/offline based on your convenience. If offline, send the original copies of the necessary documents to the FHPL TPA office.
  5. The FHPL TPA verifies the claim raised and if it finds the claim valid then the claim is forwarded to the health insurance company for claim approval. 
  6. The FHPL claim status can be reviewed on the FHPL insurance website. They also inform the claim status via SMS/email.

Download the FHPL Claim form

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