India Network Health Plan
Forms1. Membership form InfMem.pdf
InfMem.doc
2. Insurance Enrollment Form
InsForm.pdf
InsForm.doc
3. Insurance Renewal Form
RenewalForm.pdf
RenewalForm.doc
Instructions: Print the forms
and mail completed forms to
India Network Services, PO Box 22, Windermere, FL 34786 along with checks for correct amount of premium and
membership fee ($10), payable to 'India Network Services'. or fax
completed forms to 407-479-3289 or 1-800-837-6384.
4.
Cancellation Form
(Only if cancellation occurs before start date of coverage).
5. Claim Form (in
pdf format) -
Insured must complete the first page of
claim form (according to policy number) and file with AIG
Claims Office either directly or along with provider office. Also,
get a notarized affidavit duly signed by visitor to authorize US
person to discuss claim status/questions with AIG.
