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 : 06/11/2019

KAMALENDU BHATTACHARYA,
Corporate Office, Pb No: 5555, 254-
260,Avvai Shanmugam Salai,
Royapettah,Chennai - 600014
Email id:
Mobile No. : 9831938326

Policy & Member Details Claim Details

Insurance Company : United India Insurance Company Ltd. CCN No. : 4446313 Ext: A Partial :

Policy No. : 500100/28/18/P1/11226217 Name of Patient :KAMALENDU BHATTACHARYA

Policy Validity : 01/11/2018 to 31/10/2019 Date of Admission :17/10/2019

Employee Name : KAMALENDU BHATTACHARYA Date of Discharge :17/10/2019

PHS ID.No. : 23607725 Employee No. : 12586

Provider Name:REVIVE NURSING HOME
Insurance Claim No:5001002819C418322002

Ailment : Cataract In Right Eye

Dear Sir/Madam,
We are in receipt of the documents forwarded by you pertaining to the captioned claim. On scrutinizing the documents,it is observed that the following
documents / information are required to process your claim:

Sr.No Deficiency Type Mandatory Status

1 Kindly provide all investigation reports for submitted bills from hospital. Yes Pending

You are requested to submit the original documents as mentioned above within 14 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/admissibility amount can only be decided once we have a full set of
original documents. Your co-operation in this regard shall be highly appreciated.
Kindly quote the CCN for all future correspondence regarding this claim.

Thanking You,

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

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