Cashless Claim Reference Number: (31965374)

(Please quote this reference number in all future correspondence)

Date :09 Mar 2023

Dear Insured,

Your Claim has been received. The details of the claim are as follows:

Patient Details

Patient Name Simmi Kalra

Insurance Company Manipal Cigna Health Insurance Company Limited

Medi Assist ID 5034172561

Policy Holder Simmi Kalra

IP No. 34.93.40.101

Policy No. PROHLR410013127_2023

Primary Beneficiary Simmi Kalra

Employee ID 1

Insurer Claim No

Insurer Member ID 1000372416

QUICK LINKS:

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Warm Regards,

Medi Assist Insurance TPA Pvt. Ltd

(Formerly known as Medi Assist India TPA Private Limited) CIN: U85199KA1999PTC025676. Regd Off: Tower "D", 4th floor, IBC Knowledge Park, 4/1, Bannerghatta Road, Bangalore - 560
029.
Helpline: 080-22068666 | Email: hospital.medibuddy@mediassistindia.com

Disclaimer: The TPA extends the cashless facility subject to the standard terms & conditions of the policy and the information provided in the cashless request form. We suggest that the
patient continues with the treatment as advised by the treating doctor, irrespective of the pre-authorization/cashless facility.

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