Voluntary Parental Mediclaim Policy Renewal 2024-25

Step 1 of 2

This form collects key information about employee dependents for Parental Top-Up Cover enrollment. Existing policies will continue by default, but please note that premiums may increase in the event of a claim. Complete the form accurately to ensure timely processing and coverage inclusion.

Instructions:

Enter the Name and Date of Birth exactly as they appear on the Aadhaar card to avoid issues with future claims.
Ensure all fields are filled out completely to avoid delays in processing.
Double-check the dependent’s relationship to the employee for accurate coverage assignment.
The Voluntary Parental Premium and Top-Up costs are to be borne by the employee.
Voluntary Parental Premium and Top Up Chart

Employee Code: Prefix HFSL *

Employee Name *

Parental Premium Type *

Parental for In Laws Premium Type *

Please provide the details of your parents for the Voluntary Parental Cover (As per Aadhar Card)

Father's Name

Father's Date of Birth

Mother's Name

Mother's Date of Birth

Father-In-Law's Name

Father-In-Law's Date of Birth

Mother-In-Law's Name

Mother-In-Law's Date of Birth

Please select the Parental Premium Cover *

2,00,000
3,00,000
5,00,000