- 2 Claim Forms
- 5 Cancellation Form
- 6 HIPPA Form
1 Insurance Enrollment
Insurance Enrollment Essentials
No cancellation or refund is available on or after effective date of insurance.
India Network Foundation membership must be active in order to enroll. The $10 membership fee is not cancellable or refundable and is good for one year
Rates based on total days times Daily Rate. Daily Rate based on monthly premium divided by 30 days.
Couple rates are calculated based on the individual rate multiplied times 2 individuals.
The member’s date of birth and passport are requested entries during enrollment process. Medical records are not required.
Accident and Sickness coverage applies while visiting the US.
Call (408)540-3600 if you have questions regarding enrollment.
2 Claim Forms
3 India Network
Insurance Enrollment Forms
Insurance Re-Enrollment Form
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
5 Cancellation Form
Applicable only if cancellation occurs before start date of coverage.
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).
6 HIPPA Form