Claim Approval Letter Date: 19-JAN-2022

To,
SACHIN KAMITHKAR
PLOT NO 14, ASIA HOUSE, SOPAN BAUG,
BALEWADI, PUNE, PUNE, MAHARASHTRA,
411045,
Insured Details
Policy Number OG-22-2001-8403-00000152
Claim Number OC-22-1002-8403-00196054
Claim ID 4959263
Policy Period From: 14-AUG-21 To: 13-AUG-22
Name Of The Company COGITECH SOLUTIONS PRIVATE LIMITED
Joining Date 26-APR-2021
Name Of The Employee/ Insured SACHIN KAMITHKAR
ID Card No GMC-22200130152-TI072A
Employee No TI072
Name Of The Patient SHRADDHA SACHIN KHAMITKAR
Age 23
Relation SPOUSE
Hospital Name Krishna - Mai Nursing Home Pvt. Ltd
Period Of Hospitalisation DOA: 22-NOV-2021 DOD: 26-NOV-2021
Final Diagnosis Maternity-LSCS
Claimed Amount Details
Note: **** Field are to be considered as a deduction and should not be added in the Bill Amount.
Particular Bill Amount Disallowed Approved Amount Disallowance Reason
Amount
Miscellaneous 36229 1850 34379 Admission charges , Razor , Plain drape , Gloves ,
Under pad , Uro Bag ,
Room Charges 2000 0 2000
Doctor Charges 1500 0 1500
Surgeon Charges 35000 0 35000
OT Charges 13150 0 13150
Nursing Charges 740 0 740
Pharmacy Charges 2510 0 2510
Pathology Charges 900 0 900
Non-Medical Charges 0 0 0 1200/-ADMISSION
Premium*** 0 0 --- dEF
Other Deduction*** 40179 40179 --- Maximum limit of indemnity for the LSCS Exhausted
Payment Details
Claimed Amount 92029

Total Approved Amount 50000

Disallowed Amount 42029

Beneficiary Name SACHIN KAMITHKAR

* Said approved amount will be remitted in the account within 2-3 working days

Health Administration Team - Bajaj Allianz General Insurance Company Limited.

2nd Floor, Bajaj Finserv Building, Survey No: 208/1B, Behind Weik Field IT Park, Viman Nagar, Pune. Maharashtra-411014
Toll Free: 1800-103-2529 Phone: (020) 30305858 Fax: (020) 30512224/6/7
Email: hat@bajajallianz.co.in Website: www.bajajallianz.com
Regd. & Head Office: GE Plaza, Airport Road, Yerawada, Pune 411006. Toll Free: 1800-209-5858 Email: bagichelp@bajajallianz.co.in
CIN No.: U66010PN2000PLC015329 UIN No.: IRDA/NL-HLT/BAGI/P-H/V.I/47/13-14
In case of any query, kindly contact us at hat@bajajallianz.co.in or 020-30305858
If you are still not satisfied with the claim decision of the Insurance Company, you may approach the Insurance Ombudsman, established by the
Central Government for redressal of grievance. The Insurance Ombudsman is empowered to adjudicate on personal line insurance claims up to
Rs.20 lacs. Detailed process along with list of Ombudsman offices are available at http://www.policyholder.gov.in/Ombudsman.aspx
With warm regards,

Authorised Signatory
For Bajaj Allianz General Insurance Co. Ltd
Health Administration Team

Health Administration Team - Bajaj Allianz General Insurance Company Limited.

2nd Floor, Bajaj Finserv Building, Survey No: 208/1B, Behind Weik Field IT Park, Viman Nagar, Pune. Maharashtra-411014
Toll Free: 1800-103-2529 Phone: (020) 30305858 Fax: (020) 30512224/6/7
Email: hat@bajajallianz.co.in Website: www.bajajallianz.com
Regd. & Head Office: GE Plaza, Airport Road, Yerawada, Pune 411006. Toll Free: 1800-209-5858 Email: bagichelp@bajajallianz.co.in
CIN No.: U66010PN2000PLC015329 UIN No.: IRDA/NL-HLT/BAGI/P-H/V.I/47/13-14
 Health Administration Team - Bajaj Allianz General Insurance Company Limited.
2nd Floor, Bajaj Finserv Building, Survey No: 208/1B, Behind Weik Field IT Park, Viman Nagar, Pune. Maharashtra-411014
Toll Free: 1800-103-2529 Phone: (020) 30305858 Fax: (020) 30512224/6/7
Email: hat@bajajallianz.co.in Website: www.bajajallianz.com
Regd. & Head Office: GE Plaza, Airport Road, Yerawada, Pune 411006. Toll Free: 1800-209-5858 Email: bagichelp@bajajallianz.co.in
CIN No.: U66010PN2000PLC015329 UIN No.: IRDA/NL-HLT/BAGI/P-H/V.I/47/13-14
 Health Administration Team - Bajaj Allianz General Insurance Company Limited.
2nd Floor, Bajaj Finserv Building, Survey No: 208/1B, Behind Weik Field IT Park, Viman Nagar, Pune. Maharashtra-411014
Toll Free: 1800-103-2529 Phone: (020) 30305858 Fax: (020) 30512224/6/7
Email: hat@bajajallianz.co.in Website: www.bajajallianz.com
Regd. & Head Office: GE Plaza, Airport Road, Yerawada, Pune 411006. Toll Free: 1800-209-5858 Email: bagichelp@bajajallianz.co.in
CIN No.: U66010PN2000PLC015329 UIN No.: IRDA/NL-HLT/BAGI/P-H/V.I/47/13-14
 Health Administration Team - Bajaj Allianz General Insurance Company Limited.
2nd Floor, Bajaj Finserv Building, Survey No: 208/1B, Behind Weik Field IT Park, Viman Nagar, Pune. Maharashtra-411014
Toll Free: 1800-103-2529 Phone: (020) 30305858 Fax: (020) 30512224/6/7
Email: hat@bajajallianz.co.in Website: www.bajajallianz.com
Regd. & Head Office: GE Plaza, Airport Road, Yerawada, Pune 411006. Toll Free: 1800-209-5858 Email: bagichelp@bajajallianz.co.in
CIN No.: U66010PN2000PLC015329 UIN No.: IRDA/NL-HLT/BAGI/P-H/V.I/47/13-14
With warm regards,

Authorised Signatory
For Bajaj Allianz General Insurance Co. Ltd
Health Administration Team

Health Administration Team - Bajaj Allianz General Insurance Company Limited.

2nd Floor, Bajaj Finserv Building, Survey No: 208/1B, Behind Weik Field IT Park, Viman Nagar, Pune. Maharashtra-411014
Toll Free: 1800-103-2529 Phone: (020) 30305858 Fax: (020) 30512224/6/7
Email: hat@bajajallianz.co.in Website: www.bajajallianz.com
Regd. & Head Office: GE Plaza, Airport Road, Yerawada, Pune 411006. Toll Free: 1800-209-5858 Email: bagichelp@bajajallianz.co.in
CIN No.: U66010PN2000PLC015329 UIN No.: IRDA/NL-HLT/BAGI/P-H/V.I/47/13-14