Free form template · Word

Employee Insurance Addition Request

An employee insurance addition request is the document HR sends to the insurer or broker asking for new employees or new dependants to be added to the group policy by endorsement. It carries the member data, effective dates and premium adjustment against the cash deposit (CD) account.

Editable Word (.docx)
Made for India
23 fill-in fields highlighted
Free, no sign-up

Download Word (.docx) — free

Preview of the form

[Highlighted] = fill in

[Company Logo][Company Name]

REQUEST FOR ADDITION OF MEMBERS

Ref. No.:: [Reference Number]
Date:: [Date]

To,
[Insurer / Broker Name]
[Address]

Subject: Addition of members under Policy No. [Policy Number] – [Company Name]

Dear Sir/Madam,

Please add the following members to our group policy(ies) with effect from the dates mentioned below. Kindly adjust the applicable premium against our CD Account No. [Account Number] and share the endorsement copy and e-cards at the earliest.

Emp ID	Member Name	Relationship	Date of Birth	Gender	Effective Date	Policies (GMC/GTL/GPA)	Sum Insured (₹)
[Employee ID]	[Employee Name]	Self	[DD/MM/YYYY]	[M/F]	[Date of Joining]	[GMC, GTL, GPA]	[Amount]
[Employee ID]	[Member Name]	Spouse	[DD/MM/YYYY]	[M/F]	[DD/MM/YYYY]	[GMC]	[Amount]
[Employee ID]	[Member Name]	Child	[DD/MM/YYYY]	[M/F]	[DD/MM/YYYY]	[GMC]	[Amount]
[Employee ID]	[Employee Name]	Self	[DD/MM/YYYY]	[M/F]	[Date of Joining]	[GMC, GTL]	[Amount]

Summary

Total new employees	[Number]
Total new dependants	[Number]
CD balance before addition: ₹[Amount]
Reason for mid-term dependant addition (if any)	[Marriage / Birth / Other]

Supporting documents for life-event additions are enclosed. We confirm that the members listed are eligible under the policy terms. Please contact [HR Name] at [Phone / Email] for any clarification.

Thanking you,
Yours faithfully,

For [Company Name]
[Authorised Signatory]
[Designation]

Download Word (.docx) — free

What this template includes

Covering note to the insurer or broker with policy reference
Addition data table with date of joining or life event
Policies affected for each member
Pro-rata premium and CD account balance reference
Requested effective date
Authorised signatory of the policyholder company

When to use it

Monthly batch of new joiners who need to be added to group health, life and accident policies
A newborn or newly married spouse needs to be added mid-policy
An employee returns from a long leave and cover must be reinstated
A group company merger brings new employees under your policy

How to customise this template

1Add your broker's preferred data columns, often supplied as an Excel census format
2Enter your CD account number and current balance
3State the endorsement turnaround you expect
4Attach supporting proof for life-event additions

HR tips

Send additions promptly; delays can leave a gap in cover
Use one consolidated request per month to keep endorsements clean
Reconcile the insurer's endorsement copy against your list
Top up the CD account before it runs low so additions are not held

For HR & hiring managers

Experienced and fresher candidates across India — blue, grey and white collar. Post a job in 5 minutes and start receiving applications.

Post a job free See plans

Post in 5 minutesDescribe the role in one line — we write the job description.
Verified applicantsEvery applicant has a verified mobile number.
Resume databaseSearch experienced candidates by skill, city and experience.

Frequently asked questions

What is an addition endorsement in group insurance?+

It is the insurer's formal change to the policy adding new members. The premium for the remaining policy period is usually charged pro-rata.

What is a CD account in group insurance?+

A cash deposit account the policyholder maintains with the insurer, from which premiums for mid-term additions are adjusted.

From when is a new employee covered?+

It depends on the policy terms. Many group policies cover from the date of joining if the addition is notified within the agreed time, but check your policy.

All 50 employee benefits & insurance →

[Company Logo][Company Name]

REQUEST FOR DELETION OF MEMBERS

Ref. No.:: [Reference Number]
Date:: [Date]

To,
[Insurer / Broker Name]
[Address]

Subject: Deletion of members from Policy No. [Policy Number] – [Company Name]

Dear Sir/Madam,

We request you to delete the following members from our group policy(ies) with effect from the dates stated. Kindly deactivate their e-cards and credit any refundable premium to our CD Account No. [Account Number].

Emp ID	Member Name	Relationship	Deletion Date	Reason	Claim Pending (Y/N)
[Employee ID]	[Employee Name]	Self + Family	[Last Working Day]	Resignation	[Y/N]
[Employee ID]	[Employee Name]	Self	[Last Working Day]	Termination / Retirement	[Y/N]
[Employee ID]	[Member Name]	Child	[DD/MM/YYYY]	Age limit crossed	[Y/N]
[Employee ID]	[Member Name]	Spouse	[DD/MM/YYYY]	No longer eligible	[Y/N]

Where a claim is marked as pending, please continue processing it for treatment taken during the period of cover. Employee [Employee Name] has requested information on portability or conversion; kindly contact them at [Mobile / Email].

Letter · Word

Employee Insurance Deletion Request

Download .docx

[Company Logo][Company Name]

EMPLOYEE INSURANCE DETAILS FORM

Company:: [Company Name]
Record Date:: [Date]
Last Updated:: [DD/MM/YYYY]

Employee Information

Employee Name
Employee ID
Designation
Department
Work Location
Date of Joining
Mobile Number

Coverage Summary

Cover	Insurer	Policy No.	Member / E-card ID	Sum Insured (₹)	Valid Till
Group Mediclaim	[Insurer Name]	[Policy Number]	[Member ID]	[Amount]	[DD/MM/YYYY]
Group Term Life	[Insurer Name]	[Policy Number]	[Member ID]	[Amount]	[DD/MM/YYYY]
Group Personal Accident	[Insurer Name]	[Policy Number]	[Member ID]	[Amount]	[DD/MM/YYYY]
Voluntary Top-up	[Insurer Name]	[Policy Number]	[Member ID]	[Amount]	[DD/MM/YYYY]

Statutory Coverage

Form · Word

Employee Insurance Details Form

Download .docx

Form · Word
Employee Insurance Correction Form
Download .docx
[Company Logo][Company Name]
EMPLOYEE BENEFITS ENROLLMENT FORM
Company:
[Company Name]
Form No.:
[Reference Number]
Date of Submission:
[Date]
Enrollment Deadline:
[DD/MM/YYYY]
Please complete all sections within the enrollment window and return this form to [HR Name], Human Resources. Benefits will be activated only after HR verification.
Section A: Employee Details
Employee Name (as per PAN)
Employee ID
Designation
Department
Date of Joining
Work Location
Date of Birth
Gender
Mobile Number
Personal Email
PAN
Aadhaar (last 4 digits only)
Section B: Statutory Benefits
UAN (if already allotted)
Previous PF Account / Member ID
ESI IP Number (if applicable, for gross wages up to ₹21,000/month)
Opting for higher PF contribution: Yes / No
Form · Word
Employee Benefits Enrollment Form
Download .docx
[Company Logo][Company Name]
GROUP MEDICAL INSURANCE (GMC) ENROLLMENT FORM
Policyholder:
[Company Name]
Insurer:
[Insurer Name]
TPA:
[TPA Name]
Policy No.:
[Policy Number]
Policy Period:
[DD/MM/YYYY] to [DD/MM/YYYY]
1. Primary Member (Employee)
Employee Name (as per ID proof)
Employee ID
Date of Birth
Gender
Date of Joining
Work Location
Mobile Number
Email ID
2. Coverage Selection
Sum Insured Tier: ₹[Amount] / ₹[Amount] / ₹[Amount]
Basis: Family Floater / Individual
Voluntary Top-up: Yes / No, Sum Insured ₹[Amount]
Parental Cover: Parents / Parents-in-law / None
3. Family Members to be Covered
Form · Word
Group Medical Insurance Enrollment
Download .docx

Member Name (as currently on e-card)
Relationship
E-card / Member ID

Employee Name (as per PAN)
Employee ID
Designation
Department
Date of Joining
Work Location
Date of Birth
Gender
Mobile Number
Personal Email
PAN
Aadhaar (last 4 digits only)

UAN (if already allotted)
Previous PF Account / Member ID
ESI IP Number (if applicable, for gross wages up to ₹21,000/month)
Opting for higher PF contribution: Yes / No

Employee Name (as per ID proof)
Employee ID
Date of Birth
Gender
Date of Joining
Work Location
Mobile Number
Email ID

Sum Insured Tier: ₹[Amount] / ₹[Amount] / ₹[Amount]
Basis: Family Floater / Individual
Voluntary Top-up: Yes / No, Sum Insured ₹[Amount]
Parental Cover: Parents / Parents-in-law / None

[Company Logo][Company Name]

GROUP INSURANCE NOMINATION FORM

Company:: [Company Name]
Policy:: Group Term Life / Group Personal Accident
Insurer:: [Insurer Name]
Policy No.:: [Policy Number]
Date:: [Date]

Employee Details

Employee Name
Employee ID
Designation
Department
Date of Birth
Date of Joining
Marital Status

Nominee Details

Nominee Name	Relationship	Date of Birth	Address and Mobile	Share (%)
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address, Mobile]	[%]
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address, Mobile]	[%]
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address, Mobile]	[%]
Total				100%

Appointee (only if a nominee is a minor)

Form · Word

Group Insurance Nomination Form

Download .docx

[Company Logo][Company Name]
HEALTH INSURANCE CLAIM SUBMISSION FORM (INTERNAL)
Company:
[Company Name]
Insurer / TPA:
[Insurer Name] / [TPA Name]
Policy No.:
[Policy Number]
Internal Claim Ref.:
[Reference Number]
Date of Submission:
[Date]
Important: This form helps HR process your claim. The insurer's or TPA's official claim form must also be completed, signed and attached where required.
1. Employee Details
Employee Name
Employee ID
Department
Mobile Number
Email ID
2. Patient Details
Patient Name
Relationship to Employee
Age
E-card / Member ID
TPA Claim Intimation No. (if any)
Form · Word
Health Insurance Claim Form
Download .docx
[Company Logo][Company Name]
INSURANCE CLAIM ASSISTANCE REQUEST
Company:
[Company Name]
Request No.:
[Reference Number]
Date:
[Date]
Priority:
Urgent (in hospital) / Normal
Employee and Policy
Employee Name
Employee ID
Department
Mobile Number
Policy Type: Group Health / Group Personal Accident / Group Term Life
Patient / Insured Member Name
TPA / Insurer Claim Number
Nature of Assistance Needed
- Cashless approval pending
- Reimbursement claim delayed
- Claim rejected, request review
- Claim partly settled / deductions unclear
- Document query from TPA
- Other: [Details]
Claim Summary
Form · Word
Insurance Claim Assistance Form
Download .docx

Employee Insurance Addition Request

Preview of the form

Subject: Addition of members under Policy No. [Policy Number] – [Company Name]

Summary

What this template includes

When to use it

How to customise this template

HR tips

Frequently asked questions

Subject: Deletion of members from Policy No. [Policy Number] – [Company Name]

Employee Insurance Deletion Request

Employee Information

Coverage Summary

Statutory Coverage

Employee Insurance Details Form

Employee Details

Member Whose Data Needs Correction

Correction Details

Employee Insurance Correction Form

Section A: Employee Details

Section B: Statutory Benefits

Employee Benefits Enrollment Form

1. Primary Member (Employee)

2. Coverage Selection

3. Family Members to be Covered

Group Medical Insurance Enrollment

Employee Details

Nominee Details

Appointee (only if a nominee is a minor)

Group Insurance Nomination Form

1. Employee Details

2. Patient Details

Health Insurance Claim Form

Employee and Policy

Nature of Assistance Needed

Claim Summary

Insurance Claim Assistance Form

Patient Name
Relationship to Employee
Age
E-card / Member ID
TPA Claim Intimation No. (if any)

Employee Insurance Addition Request

Preview of the form

Subject: Addition of members under Policy No. [Policy Number] – [Company Name]

Summary

What this template includes

When to use it

How to customise this template

HR tips

Hire top talent from BetterJobs

Frequently asked questions

Related HR templates