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PLEASE ALLOW POP-UPS BEFORE YOU START
WORKING ON THE FORMS
NEW
LIMITS FOR PRE-EX COVERAGE - EFFECTIVE 5/1/2010
1. Membership Form
- $10.00 per year - Required to take Health Insurance. Please complete
this before you proceed to insurance form.
2.
India Network Health Insurance Form-
Please use this for new insurance as well as renewal of existing
insurance.
Complete the above form in its entirety
(4 steps). The last step will produce ID card on the screen. If the php script forms give
trouble, please access the html form by replace the php at the end
of secure form link with html or contact our office for
assistance at 407-243-8760.
3.
Online Claim
Submission Form - Submit Only once for each sickness.
4.
CLAIM
STATUS QUERY FORM - To
know the status of your claim filed with Chartis Claims office.
5.
Add new
Visitors (current members only)
6.
Address Change Form (current members only)
7.
Doctor Consultation
Form - $35 per consultation by phone by a US Board
Certified Internal Medicine Physician. Please provide all
information requested on the form and be available at the
phone number given for the 24 hours following the form
submission. The Physician make every effort to reach the
patient by phone within 24 hours during week days. This is
not a part of insurance and can be used for any kind of
consultation including consultation with respect to
pre-existing conditions, refill of prescriptions,
prescription for blood work etc.
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