RSForms & Resources

Pre-Authorization Forms & Resources.

A generic cashless pre-authorization request format, a document checklist, and a reference directory of insurers and TPAs operating in India.

Generic Cashless Pre-Authorization Request Form

This is a generic reference format. Each insurer / TPA may require its own official form — always confirm the exact format with the relevant insurance desk or TPA.

CASHLESS PRE-AUTHORIZATION REQUEST FORM

Generic reference format — Healthcare Solutions (healthcare awareness initiative)

Hospital Details

Hospital Name:

City / Location:

Hospital Insurance Desk Contact:

Patient Details

Patient Full Name:

Age / Gender:

UHID / IPD Number:

Mobile Number:

Policy Details

Insurance Company / TPA Name:

Policy Number:

Policy Card / Member ID:

Policy Period:

Clinical Details

Treating Doctor:

Provisional Diagnosis:

Proposed Treatment / Procedure:

Expected Date of Admission:

Room Category:

Estimated Treatment Cost (Rs.):

Declaration: I hereby authorize the hospital to share my medical and policy-related information with the insurer / TPA for the purpose of processing this cashless pre-authorization request. I understand that approval is subject to policy terms and the final decision of the insurer / TPA.

Patient / Attendant Signature

Treating Doctor

Hospital Insurance Desk

Cashless Claim Document Checklist

01Health insurance policy copy / e-card
02Photo ID proof of the patient (Aadhaar / PAN / voter ID)
03Treating doctor's consultation papers and admission advice
04Relevant investigation reports (lab, imaging)
05Previous medical records related to the condition
06Duly filled and signed pre-authorization request form
07Hospital estimate with expected line of treatment

Insurance Companies & TPA Directory

A reference list of health insurance companies and Third Party Administrators (TPAs) operating in India, to help hospitals and patients identify the relevant contact for their policy.

Health & General Insurers

Star Health & Allied InsuranceHDFC Ergo General InsuranceICICI LombardNiva Bupa Health InsuranceCare Health InsuranceTata AIG General InsuranceBajaj Allianz General InsuranceNew India AssuranceOriental InsuranceUnited India InsuranceNational InsuranceSBI General InsuranceAditya Birla Health InsuranceManipalCigna Health InsuranceReliance General InsuranceGo Digit General InsuranceCholamandalam MS General InsuranceIFFCO Tokio General InsuranceFuture Generali India InsuranceKotak Mahindra General Insurance

Third Party Administrators (TPAs)

Medi Assist Insurance TPAVidal Health Insurance TPAParamount Health Services & Insurance TPAFamily Health Plan Insurance TPA (FHPL)Heritage Health Insurance TPAMDIndia Health Insurance TPARaksha Health Insurance TPAEast West Assist Insurance TPAVipul MedCorp Insurance TPAHealth Insurance TPA of IndiaGenins India Insurance TPASafeway Insurance TPA

This directory is published for general information and navigation only. Listing of any insurer or TPA does not indicate any partnership, empanelment, authorization or endorsement between Healthcare Solutions and the listed organization. All names and trademarks belong to their respective owners. Empanelment, cashless approval and claim decisions rest solely with the respective insurer / TPA as per policy terms.

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