Hospital Indemnity Claim Form - Transamerica 2026

1. Click ‘Get Form’ to open the Hospital Indemnity Claim Form in the editor.
2. Begin with Section 1, where you will enter the Insured’s Full Name, Date of Birth, and Social Security Number. Ensure all details are accurate for processing.
3. Continue filling out the mailing address and contact information. If the mailing address differs from the street address, provide both.
4. Move to Section 2 for Patient’s Information. Fill in the Patient’s Full Name, Date of Birth, and their relationship to the employee. Attach an itemized statement as required.
5. In Section 3, complete the Attending Physician’s Statement by providing details about services rendered, including diagnosis and procedure codes. Ensure that all fields are filled accurately.
6. Finally, review your entries for accuracy before submitting. Once completed, save your form and submit it via email or fax as instructed.

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