FGH/CLM/RIM/10/02

Document Recovery Intimation

Arjit Gidwani Intimation Date : 13-Apr-17
Thane Belapur Road Mumbai
P-21, Ttc Industrial Area,
M I D C, Mhape
Navi Mumbai 400710
Maharashtra
Dear Sir/Madam,
We have received the following claim for assessment :

Insured Name : Schlumberger Asia Services Ltd Employee Code : 5066006

Policy Number : H0168666 Employee Name : Arjit Gidwani
Claim Number : H0311563 Patient Name : Arjit Gidwani
Claimed Amount : 2481 0 0 0
* Please refer to last claimed amount for latest claim. ID Card : H0168666-2532-A
Ailment : OPD/General Treatment
On scrutiny, we have found that the below mentioned documents are required to facilitate the processing of claim:

1. Original pharmacy bill towards cash memo no CA/10621 of Rs 1281/- dated 03/01/2017 Sai Medical &
General Stores. (Carbon copy submitted)
2. Completely filled NEFT form stating Branch MICR Code, Branch IFSC Code, Account type, Complete Account
Number duly signed by insured along with cancelled cheque or Bank authority and sealed by the bank. (All
Fields in the form are mandatory to process)
In case any of the above documents are not available, we request you to intimate us accordingly so that the
claim can be processed without them. However, kindly note that some documents (Discharge Summary, Indoor
Case Papers, Clarification from Treating Doctor etc.) may be mandatory to decide on the admissibility of a claim
and the claim may be closed without payment in case the same is not available.
You may send in the above documents to :
Document Recovery Dept.
Future Generali Health
Office No -3, 3rd Floor, "A" Building, G-O SQUARE, S. No. 249+250, Aundh – Hinjewadi link road, Near mankar
chowk, Wakad, Pune - 411 057 Toll Free Phone : 1800-103-8889 Toll Free Fax: 1800-103-9998
You will appreciate that the timely receipt of the aforesaid documents will help us to settle your claim at the
earliest.Kindly attach a copy of this communication along with your document to facilitate faster processing of
your claim.

In case the above documents have been sent to us before the receipt of this reminder, kindly ignore the same.

FGH Team endeavors to provide the best services to its customers at all times. If you have any queries
regarding the above, please feel free to contact Customer Service on Toll Free or send us a mail.

Look forward to an early revert from your end.

Document Recovery Department

Future Generali Health
Office No -3, 3rd Floor, "A" Building, G-O SQUARE, Aundh – Hinjewadi link road, Near mankar chowk, Wakad, Pune ‐ 411 057
Toll Free Phone : 1800-103-8889 Toll Free Fax: 1800-103-9998

Future Generali India Insurance Company Limited

Registered office address : Indiabulls Finance Centre, Tower 3, 6th Floor, Senapati Bapat Marg, Elphinstone (W), Mumbai-13
IRDAI Registration Number: 132 | Corporate Identity No. (CIN): U66030MH2006PLC165287
Telephone No : 022 4097 6666 and Fax No 022 4097 6900 Email: care@futuregenerali.in website: www.futuregenerali.in
“We are always listening. How you feel is important to us. Simply SMS “HAPPY” or ”UNHAPPY” to 9222211100 and we will be in touch with you.“
 FGH/CLM/RIM/10/02

Document Recovery Intimation

Document Recovery Department
Future Generali India Insurance Company Ltd. [ fgh@futuregenerali.in ]

Future Generali Health

Office No -3, 3rd Floor, "A" Building, G-O SQUARE, Aundh – Hinjewadi link road, Near mankar chowk, Wakad, Pune ‐ 411 057
Toll Free Phone : 1800-103-8889 Toll Free Fax: 1800-103-9998

Future Generali India Insurance Company Limited

Registered office address : Indiabulls Finance Centre, Tower 3, 6th Floor, Senapati Bapat Marg, Elphinstone (W), Mumbai-13
IRDAI Registration Number: 132 | Corporate Identity No. (CIN): U66030MH2006PLC165287
Telephone No : 022 4097 6666 and Fax No 022 4097 6900 Email: care@futuregenerali.in website: www.futuregenerali.in
“We are always listening. How you feel is important to us. Simply SMS “HAPPY” or ”UNHAPPY” to 9222211100 and we will be in touch with you.“
 FGH/CLM/RIM/10/02

Document Recovery Intimation

Quality Check List

Claim Form duly signed by the Claimant

Policy Copy (Retail) and Benefit Chart (Group)
Original Discharge Summary or Discharge Certificate
Original Final Hospital Bill
Original Paid Receipt against the final Hospital Bill (Reimbursemen
Original Pharmacy bills and copies of prescriptions
Original bills towards Investigations done or Laboratory Bills
Copies of Investigation Reports against Laboratory bills
Proposal Form (If needed in Retail Policies)
Death Certificate / Summary (In Death Case)

Quality check completion

Claim Assessor
.

11-Apr-17

Vijay Urit

Disclaimer:
Reimbursement claims could be subjected to investigation and verification of facts which could delay claim
assessment. Please utilize cashless facility for faster settlement of claims. Unless cashless facility is denied,
reimbursement claims should be avoided.
For more information, contact our Customer Service at 1800 209 1016 / 1800 103 8889 / fgh@futuregenerali.in

“Kindly note that if deficient documents are received after claim closure date i.e. 45 days from 1st Intimation
Date, then below deduction would be applicable on payable amount subject to the admissibility of claim”.

Days Deduction

0-30 25%
31-60 50%
61-90 75%
Above 90 Claim not Payable

Future Generali Health

Office No -3, 3rd Floor, "A" Building, G-O SQUARE, Aundh – Hinjewadi link road, Near mankar chowk, Wakad, Pune ‐ 411 057
Toll Free Phone : 1800-103-8889 Toll Free Fax: 1800-103-9998

Future Generali India Insurance Company Limited

Registered office address : Indiabulls Finance Centre, Tower 3, 6th Floor, Senapati Bapat Marg, Elphinstone (W), Mumbai-13
IRDAI Registration Number: 132 | Corporate Identity No. (CIN): U66030MH2006PLC165287
Telephone No : 022 4097 6666 and Fax No 022 4097 6900 Email: care@futuregenerali.in website: www.futuregenerali.in
“We are always listening. How you feel is important to us. Simply SMS “HAPPY” or ”UNHAPPY” to 9222211100 and we will be in touch with you.“