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Cashless Claim Form - Medi Buddy
j) Currently do you have any other medical claim/health Insurance: k) Do you have a family physician, if yes: Name: k.1) Contact no.: b) Contact no.: f.1) ICD 10 code: i.1) ICD 10 PCS code: h.1) Route of drug administration: a) Name of the treating doctor: c) Name of Illness/disease with presenting complaints: j) If other treatments provide ...
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TO BE FILLED BY THE INSURED The issue of this …
www.medibuddy.inguidance for filling claim form - part a (to be filled in by the insured) data element description format section a - details of primary insured
ANNEXURE IV List of Expenses Generally Excluded ('Non ...
www.medibuddy.inThoracic or Lumbar Spine. 16 Buds Not Payable 17 Barber Charges Not Payable ... 118 Expenses Related to Prescription on Discharge To be Claimed by Patient under Post -Hospitalisation where admissible ... 164 HIV Kit Payable - Pre-Operative Screening
(To be filled by the Insured/policy holder/Attendant)
www.medibuddy.inOn my own option, I wish to avail above facility and I hereby agree to pay on my free will, after being explained in detail by the Hospital authority in …
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