Printable Forms | Visitors Health Insurance | India Network Health Insurance
India Network - Member Area

India Network Foundation's Member's Area provides convenient access to on-line claim processing, insurance enrollments, membership updates, print friendly forms to mail or fax, First Health Network providers and Teladoc Program to the India Network Foundation members participating in AXIS BasicCare Insurance Program. Links are provided in the Members Area for accessing the membership benefits.

Additional services are also available including:

  • Discount Cards for Dental, Vision and RX through Aetna or the Careington network of providers
  • Increased maximum medical coverage from $250,000 to $1,000,000 through Trawick International.

Select a Topic to Learn more Program Details

CHUBB Insurance Policy Claims (fixed and network plans) Insurance Reenrollments
Membership Updates FirstHealth Network
Consult a Physician for BasicCare Policy holders with numbers SRPO... Consult a Nurse for CHUBB Policy holders with numbers GLM...
Dental and Vision Discount Cards Insurance Application for Print and Faxing (Printable Forms)
Cancellation Policy

Claims

India Network offers programs underwritten by CHUBB American Insurance Company and AXIS Insurance Company.

CHUBB Insurance Policy Claims (fixed and network plans)

Administrative Concepts, Inc. (ACI) administers claims for policy numbers starting with GLM. For customer service, eligibility verification, plan information, or to file a claim, contact:

Administrative Concepts, Inc. (ACI)
994 Old Eagle School Rd., Suite 1005
Wayne, PA 19087-1706
Toll Free: 888-293-9229 (from inside the U.S.)
 Phone: 610-293-9229 (from outside the U.S.)
Fax: 610-293-9299
Web: http://www.visit-aci.com
EDI Payor#: 22384

In case of accidental or natural death of insured person, BEFORE YOU DO ANYTHING ELSE, PLEASE CALL AXA Travel Assistance Services at 855-327-1414 for 24-hour access.

Online Claim Form for Policy Numbers GLM xx

AXIS BasicCare Insurance Policy (25/50/75/100K) Claims

WebTPA Claims
PO Box 99906
Grapevine, TX 76099-9706
Fax: 469-417-1989
EDI Payor #: 75261

Web: http://www.webtpa.com

In case of accidental or natural death of insured person, BEFORE YOU DO ANYTHING ELSE, PLEASE CALL Europ Assistance Services at 877-243-4134 for 24-hour access or call collect at (240) 330-1528.

Online Claim Form for Policy Numbers SRPO xx

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Insurance Reenrollments
Please use the on-line insurance enrollment form for re-enrollment of an existing plan. You may re-enroll for up to 12 months of continuous coverage. Complete the form in its entirety. The last step will produce Summary of Benefits and Insurance ID Cards. If you have problems with online enrollment forms or need assistance in completing the forms, please contact our office for assistance at 408-540-3600 or 408-540-3600.

CHUBB Standard Plan Reenrollment Form

CHUBB Premier Plan Reenrollment Form

CHUBB Network Reenrollment Form

AXIS BasicCare Fixed Plan Reenrollment Form

 

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Membership Updates
Please use the on-line links to add existing visitors, update a membership or to change your address. If your membership has expired and you want to purchase health insurance for a visitor, use the Online Health Insurance Enrollment form and check "Please Renew my India Network membership ($10)" when prompted in Step 1 of the online application form. Contact our office for assistance at 408-540-3600 if you have questions.

Membership Form

 

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Cancellation Policy:
Cancellation is applicable only if occurs before start date of coverage, and it requires $25 processing fee. Please fill out the cancellation form, and fax your completed form to 408-520-4967.
Cancellation or refund are not offered on or after effective date of insurance.
Note: Cancellation applies to the whole policy (regardless of number of people insured).

First Health Network
India Network Foundation’s Standard and Premier Insurance Plans allow insureds to choose a doctor or hospital of their choice. To help our insureds enrolled in the CHUBB Network Coverage find a provider participating in a network, India Network provides access to the First Health PPO Network. contact First Health at 888-293-9229.

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Consult a Physician for AXIS BasicCare policy holders
The Teladoc program is to help visiting parents and others who need to consult a physician during their stay in the United States or Canada for questions on medications, or pre-existing ailments such as Diabetic, Blood Pressure, Pain management, and for minor non-emergency physician consultations. This service is provided for the benefit of the BasicCare Plan Participants. Program is available 24 x7 and can be reached Teladoc office by 1-800-TelAdoc.

24 X7 Teladoc Physican Assistance  

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Consult a Nurse for CHUBB Policy holders with numbers GLM..
The purpose of this program is to help visiting parents and others who need to consult a medical professional such as a Registered Nurse during their stay in the United States or Canada for questions on medications, or pre-existing ailments such as Diabetic, Blood Pressure, Pain management etc. . This service is provided for the benefit of the India Network Health Insurance Participants. Program is available 24 x7 and can be reached a RN by calling 1-855-428-3425.

24 X7 Nurse Line Assistance  

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Dental and Vision Discount Cards
Aetna offers a discount card for dental, vision and RX benefits for US and Non US Citizens. The discount card is priced at a very low affordable level of $7.99 per month. If you wish to review and apply for the Aetna Discount Card, please click on the Vital Savings by Aetna link.

Vital Savings by AETNA

 

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Trawick International
Trawick International is ideal for travelers going outside their home country looking for medical coverage from $250,000 up to $1 million. This program is designed for trips of 5 days up to a maximum of one year and provides coverage for emergency evacuation, medical expense, and trip interruption. Safe Travels USA is for travelers to the USA and Safe Travels International is for worldwide travel outside the USA and is recommended for travelers applying for a Schengen Visa. A Group Health Insurance for travel outside the USA is also available through Safe Travels Groups.

Collegiate Care (for students coming to USA
Safe Travels USA (USA and Worldwide)
Safe Travels USA Cost Saver (USA and Wordwide)
Safe Travels International (outside USA Worldwide)

 

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Insurance Applications for Print and Faxing

 

Membership Forms

Membership (pdf) -  Membership (doc)

Insurance Enrollment Form

Insurance (pdf) -  Insurance (doc)

Accidental Death and Dismemberment Enrollment Form

AD&D Enrollment(pdf)

Insurance ReEnrollment Form

Reenrollment (pdf)  - Reenrollment (doc)

Print the required form(s) and mail the completed documents to:
India Network Services
7065 Westpointe Blvd, Suite 209
Orlando, FL 32835-8758

Include (2) checks. One for Insurance Premium to India Network Services and one for
$10 membership fee payable to 'India Network Foundation' or Fax Completed Forms to 408-520-4967

Applicable only if cancellation occurs before start date of coverage.

Cancellation Form (pdf)

Insured must complete the first page of claim form (according to policy number) and file with Administrative Concepts, Inc. (ACI) directly or along with provider office. A notarized affidavit duly signed by visitor to authorize US person to discuss claim status/questions with Administrative Concepts, Inc. (ACI).

Administrative Concepts, Inc. (ACI) Forms

CHUBB Claim Form (pdf)

CHUBB Accidental Death Claim Form (pdf)

CHUBB Dismemberment Claim Form (pdf)

   

Please Complete the HIPPA Form if you wish to discuss claim status on behalf of the visitor.

HIPPA Form (pdf)

*The India Network Visitors insurance provides limited accident and sickness benefits on a short-term limited duration basis for non-U.S. citizens traveling in the US