Voluntary Parental Mediclaim and Top Up Policy 2025-26

This form collects information about employee's dependents for Parental Mediclaim and Parental Top-Up Cover enrolment. 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 completely and identity proofs are uploaded to avoid delays in processing. Refrain from uploading Aadhaar cards.
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 *

Employee Name *

Parental Premium Type *

Parental for In Laws Premium Type *

Please select the Parental Premium Cover *

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

Do you wish to avail Parental Top Up Premium *

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

Father's Name

Father's Date of Birth

Upload supporting identity proof (Aadhar card is not allowed)

Click or drag a file to this area to upload.

Mother's Name

Mother's Date of Birth

Upload supporting identity proof (Aadhar card is not allowed)

Click or drag a file to this area to upload.

Father-In-Law's Name

Father-In-Law's Date of Birth

Upload supporting identity proof (Aadhar card is not allowed)

Click or drag a file to this area to upload.

Mother-In-Law's Name

Mother-In-Law's Date of Birth

Upload supporting identity proof (Aadhar card is not allowed)

Click or drag a file to this area to upload.

Ensure all fields are filled completely and supporting documents are uploaded to avoid delays in processing.
The Voluntary Parental Premium and Top-Up costs are to be borne by the employee.