Medical Insurance Approval Form Template

June 23, 2011

Medical insurance approval form templates are used by the insurance companies to approve the medical claims made by the clients. These types of templates contain the information related to the patient as well the insurance cover provided.

Sample Medical Insurance Approval Form Template

Medical Insurance Approval Form

___________Logo of the Insurance Company

________________ [Name of the Insurance Company]

[Name of the Person Insured]: _____________________________________

[Address of the person insured]  _________________________________

[Policy ID Number]: ___________________________________

[Name of agent]: ______________________________________

[Effectual date of policy]: _______________________________

[Attached Medical Reports ____________________

The insurance claim has been found valid for the following reasons:

  • ______________________________________________

Therefore, according to the rules and policies of ___________________________ [Name of the Company], _________________________ [Name of the Insured] will be paid an amount of __________________________ [amount of money to be paid].

Responsibility of the company: ________________________________________________

Financial policy of the company: ________________________________________________

Signature of Patient: _____________________________________________

Date: ___________________________

Download Medical Insurance Approval Form Template in Word Format




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