FREE 10+ Hospital Indemnity Claim Form Templates in PDF

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Emergencies always come unannounced. It’s therefore wise to keep an insurance claim as your backup so that you can use it whenever the need be. Hospitalization Indemnity Claim form eases the process of claiming hospital benefits from the insurance company for all the medical services, as required. If you want to draft such claim forms for your clients, then you should use form templates to get a ready-made structure for your use!

5 Steps to Draft a Hospital Indemnity Claim Form

Step 1: Certificate holder Details

The first section to include in a claim form is the details of the certificate-holder. Ask for the name, certificate number(as with the insurance company), date of birth, address(including zip code), contact number and email address so that they can get in touch with your as required.

Step 2: Details of Patient

The next section should include the patient information for whom the insurance claim is being made. Inquire about the patient’s details like name, home address, zip code, date of birth and gender and cell phone number. You also need to ask the relation between the certificate holder and the patient for verification.

Step 3: Hospitalization Details

This section of hospitalization contains the information of the patient’s admission summary. Include the dates of Admission and Discharge along with the hospital name. Add the city and state in case both belong to different places.

Step 4: Fraud Warning

Before the certificate holder signs the document, you need to inform about some of the rules and regulations about the claims of insurance. These protocols differ from state to state, so make sure you inform the respective state’s regulations to the certificate holder.

Step 5: Signature and Certification

After the holder has read through the fraud warnings and filled in all the necessary details, it’s time to draft the signature page. Include acknowledgments and provide space for authorization, the insurance holder and the power of attorney at the below where the signatories will sign after accepting the terms and conditions.

10+ Hospital Indemnity Claim Form Templates

1. Hospital Indemnity Claim Form Template

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File Format
  • PDF

Size: 338.5 KB

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If you are planning to claim for the insurance money that you were saving for years, then this is the right time. Get hold of this Hospital Indemnity Claim form template in PDF and enjoy the ease of drafting a personal claim form without any doubt. Its usability makes it accessible even to beginners. You will find the feasibility with this file with all the editing software you have!

2. Basic Hospital Indemnity Claim Form

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File Format
  • PDF

Size: 31.9 KB

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When you have a serious emergency, you should not think about the costs, especially when you already have claims to hospital benefits. Make sure you have a proper form template like this Basic Hospital Indemnity Claim Form that gives you the necessary structure to fill up your details and provide to the insurance agent. If you want to try out other file formats for your convenience then you can check our forms in Pages format for Apple devices!

3. Hospital Indemnity Insurance Claim Form

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File Format
  • PDF

Size: 1.0 MB

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You can’t do anything about falling sick or terminally affected by a serious disease. But what you can do is get your hospital bills affordable. Our Hospital Indemnity Insurance Claim Form is available in PDF format, which allows you the liberty to create a claim form that you require. It is customizable so no need to worry about that, moreover, it is adaptable with all editing devices as well!

4. Simple Hospital Indemnity Claim Form

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  • PDF

Size: 279.2 KB

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If you are willing to reduce your medical bills, then first you need an insurance claim. After that make sure you draft a claim form where you apply for the hospital benefits. Download our Simple Hospital Indemnity Claim Form on your device immediately to avail of this opportunity. All the health benefits, insurance claims will be covered and displayed in the medical certificate to avoid any miss communication!

5. Sample Hospital Indemnity Claim Form

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File Format
  • PDF

Size: 125.7 KB

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This Sample Hospital Indemnity Claim Form has been designed to provide you the chance of claiming for the insurance that you have been planning for. An emergency is the opportunity to claim such benefits without a doubt. Our wide range of forms in Google Docs and other files are very customizable to all portable devices and instantly printable too!

6. Hospital Indemnity Benefits Claim Form

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File Format
  • PDF

Size: 412.7 KB

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It’s indefinite how often people fall sick, and when things do get serious, you need to get admitted to the hospital for immediate treatments. However, it’s not always possible to be able able to afford the medical bills. Don’t worry, use this Hospital Indemnity Benefits Claim Form in PDF form and apply for a hospital insurance claim. Our highly compatible files are also available in various other formats like forms in MS Word so that you can make changes accoridngly!

7. Printable Hospital Indemnity Claim Form

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File Format
  • PDF

Size: 132.6 KB

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Do you require an editable and a printable form for your use? Download this Printable Hospital Indemnity Claim Form, custom-made for any such emergency so that you can use it to fill up the required details as needed and get rapid treatment. Insurance claims are available for this purpose only do that you get the necessary treatment without worrying about costs!

8. Hospital Indemnity Insurance Claim Form Template

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File Format
  • PDF

Size: 548.8 KB

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Are you in need of useful indemnity claim forms for your hospitalized relative? You can use a ready-made Hospital Indemnity Insurance Claim Form Template to give the details of your insurance and the required patient so that the health benefits can be used for their purpose. You can also try out some of our forms in MS Excel along with the other files, as they are compatible with all Microsoft users!

9. Hospital Indemnity Claim Form Sample

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  • PDF

Size: 646.2 KB

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The biggest problem that one faces when require hospitalization is the overpriced bill. This Hospital Indemnity Claim Form Sample is accessible in PDF format that you can easily download and get on your device to get your insurance claim. We also provide our easy-to-use and edit forms in Number so that you can use its versatile features and add the details that will help you claim for your insurance.

10. Hospital Indemnity Claim Form Format

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File Format
  • PDF

Size: 240.5 KB

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The best part about using a pre-loaded claim form is that you can download it instantly whenever you need it and use the compatible file format to serve your emergency purposes. This Hospital Indemnity Claim Form Format allows you to make changes to your claim form by adding the required details of the hospital, your insurance well as the patient’s information so that you can avoid creating one manually from scratch!

11. Sample Hospital Indemnity Insurance Claim Form

Details
File Format
  • PDF

Size: 79.1 KB

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No more of cribbing over high hospital bills and medical facilities. Once you have made an insurance claim, you can use it to apply for your hospital benefits and get your medical bills taken care of. This Sample Hospital Indemnity Insurance Claim Form is one such file template that helps you to include your details in one single document and get your claims done within a snap! You will also like to try some of our forms in Google Sheets with the same customizable features!

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