PARAMOUNT HEALTH SERVICES & INSURANCE TPA PRIVATE LIMITED(IRDAI Lic no.

006)
[formerly known as PARAMOUNT HEALTH SERVICES(TPA)PVT.LTD]

Plot No.A-442,Road No-28.M.I.D.C Industrial Area,Wagale Estate,Ram Nagar, Vitthal Rukhumani Mandir,Thane-400604 Tel-66620808 ,Fax-68342454 / 55,E-mail -
contact.phs@paramounttpa.com

DEFICIENCY LETTER
Without Prejudice

To, Date : 24/12/2019

EXPORT - IMPORT BANK OF INDIA,

Policy & Member Details Claim Details

Insurance Company : United India Insurance Company Ltd. CCN No. : 2489925 Ext: Partial :

Policy No. : 120400/28/19/P1/01734725 Name of Patient :VIOLET CHINTHAMANI S

Policy Validity : 01/04/2019 to 31/03/2020 Date of Admission :11/12/2019

Employee Name : GIRIDARAN SUBRAMANIAN Date of Discharge :11/12/2019

PHS ID.No. : 25198725 Employee No. : 889

Provider Name:SPECTRA OPTICS
Insurance Claim No:

Ailment : ALL OTHER EYE DISORDERS

Dear Sir/Madam,

We have received claim documents pertaining to captioned claim.

We have scrutinized the documents and from the information gathered during the course,we observe that following documents/ information necessary for
futher processing is not provided:

Sr.No Deficiency Type Status

1 CONSULTATION CHARGES Particular Bill No Bill Date Amount

a Bills breakup required product wise details (glass & frame ) Spectra Optics 34727 11/12/2019 4450 Pending

You are requested to submit the original documents as mentioned above within 60 days from the receipt of this letter.so that we can proceed further and
process the claim.

*Please note that the conclusion regarding the eligibility of coverage / admissible amount can only be arrived at once we have a full set of original documents.

Kindly quote the CCN for all future correspondence regarding this claim.

Thanking You,

Dr. For Paramount Health Services & Insurance TPA Private Limited ()

Please Provide your Email Id. & Contact No. for future correspondence.

For complete guidance on your current claim status,please log on to our website www.paramounttpa.com