PARAMOUNT HEALTH SERVICES & INSURANCE TPA PRIVATE LIMITED

(IRDA License No.006) Validity: From 21-03-2020 to 20-03-2023

[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 : 02/06/2021

TRUMPF INDIA PVT LTD,
C/O KRISHNAKUMAR GURUMOORTHY,

Email id: krishnakumar.g@in.trumpf.com

Mobile No. :

Policy & Member Details Claim Details

Insurance Company : Aditya Birla Health Insurance Company Limited CCN No. : 5026300 Ext: Partial :

Policy No. : 81-20-00372-00-00 Name of Patient :K SWATHI

Policy Validity : 13/02/2021 to 12/02/2022 Date of Admission :02/04/2021

Employee Name : KRISHNAKUMAR GURUMOORTHY Date of Discharge :04/04/2021

PHS ID.No. : 16913552 Employee No. : 46966

Provider Name:S N HOSPITAL
Insurance Claim No:

Ailment : Primi Term Normal Delivery

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

NEFT DETAILS: As per the instruction from the Ins. Co., you are requested to submit the
following NEFT details in order to make the Electronic Transfer of the claim amount to the
1 Yes Pending
insured person's account. Original Cancelled cheque in the name of :KRISHNAKUMAR
GURUMOORTHY

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,

Medical Officer
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
 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PRIVATE LIMITED
(IRDA License No.006) Validity: From 21-03-2020 to 20-03-2023
[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

CLAIM ACKNOWLEDGMENT SHEET

Aditya Birla Health Insurance Company

Name of Insurer : CCN NO : 5026300
Limited
Insured Name : KRISHNAKUMAR GURUMOORTHY Policy No : 81-20-00372-00-00
PHS ID : 16913552 Patient Name : K SWATHI
Mobile No : Employee No : 46966

Name of Corporate :

Type of Claim (To be ticked) : Main Hospitalisation / Pre-Post Hospitalisation / OPD Claim
Total no of documents received 53
Sr No. Category Document received Yes/no No of documents
1 claim Form YES 9
2 KYC DOCUMENTS NO 0
3 NEFT DOCUMENTS YES 1
4 DELAY INTIMATION / SUBMISSION DOCUMENTS NO 0
5 DISCHARGE CARD /DEATH SUMMARY /TRANSFER SUMMARY YES 2
6 Indoor Case Paper NO 0
7 FINAL HOSPITAL BILL YES 3
8 FINAL HOSPITAL CASH RECEIPT YES 1
9 CONSULTATION CASH RECEIPT YES 1
10 INVESTIGATION CASH RECEIPT YES 5
11 INVESTIGATION REPORT YES 21
12 MEDICINE CASH RECEIPT YES 2
13 MEDICINE PRISCRIPTION NO 0
14 IMPLANT STICKER NO 0
15 64 VB DOCUMENTS NO 0
16 POLICY COPY NO 0
17 PAN CARD YES 1
18 AADHAR CARD YES 2
19 CKYC NO 0
20 Other YES 5