IMA TS Health Scheme Application Form

IMA Telangana State Health Scheme, for members active in the FSS, FBS or PP&WS schemes. Spouse, parents up to 70 years and dependent children between 5 and 25 years can join individually. Reimbursement only, there is no cashless facility.

Option 1

Manual submission

Print the form, fill it, sign it, have it verified by your Local Branch President or Secretary, and send it with the Xerox copies and your Cheque or DD to the Hon. Secretary, IMA Telangana Health Scheme.

Download Blank Form

Option 2

Fill online

Fill the form below. Use Export PDF any time to download it filled in. Log in to save it, submit it and edit it later.

Fill Online

Applicant details

Name of the applicant

Date of birth

Age proof SSC certificate, Passport or PAN.

Communication address

Permanent address is the same

Permanent address

Mobile number You will need this to check your application status.

Alternate mobile number

IMA and scheme membership

The Health Scheme is open to members active in at least one of these three schemes.

IMA Life Membership No

Local Branch

IMA APPA FSS membership

IMA FBS membership

IMA PP&WS membership

Complimentary Health Benefit (Rs. Lakhs) Subject to verification of the 3 schemes.

Nominees

Family members

Choose Yes to apply for them in this same application.

Spouse application

Children application

Parents application

Payment

Payment details

Cheque or Demand Draft in favour of "IMA TELANGANA STATE HEALTH SCHEME", payable at Hyderabad.
Address it to the Hon. Secretary, IMA Telangana Health Scheme, Room No 6, Ground Floor, IMA Building, Koti, Hyderabad 500027.

How will you pay?

Amount including 18% GST (Rs.)

Documents

JPG, PNG or PDF, up to 5 MB each.

Photograph of the applicant

IMA Life Membership Certificate

IMA Schemes Membership Certificate (FSS, FBS or PP&WS)

Proof of Date of Birth SSC certificate, Passport or PAN copy.

Declaration I hereby state that the details furnished by me are true to the best of my knowledge with sound state of mind and body. I further state that I shall abide by the rules and regulation of the IMA Telangana State Health Scheme which may amend time to time.

Your typed details are kept when you log in or create an account. Files need to be selected again.