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-66444754 / 55,E-mail -
contact.phs@paramounttpa.com

Deficiency Letter
Without Prejudice

To, Date : 01/07/2019

BLUESTAR LTD,
C/O NEENU P NAIR,

Email id: neenunair@bluestarindia.com

Mobile No. : 8147510487

Policy & Member Details Claim Details

Insurance Company : United India Insurance Company Ltd. CCN No. : 4323471 Ext: Partial :

Policy No. : 021500/28/18/P1/11894078 Name of Patient :B/O GREESHMA G KRISHNAN

Policy Validity : 01/12/2018 to 30/11/2019 Date of Admission :29/05/2019

Employee Name : NEENU P NAIR Date of Discharge :03/06/2019

PHS ID.No. : 24623304 Employee No. : E140985

Provider Name:LIFELINE SUPER SPECIALITY HOSPITAL
Insurance Claim No:0215002819C050701001

Ailment : Term Aga Newborn

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
1 make the Electronic Transfer of the claim amount to the insured person's account. Original Cancelled cheque in the name of : Yes Pending
neenu p nair

IRDA CLAIM FORM: IRDA claim form Part 'A' & 'B' filled and signed by the Insured and the Hospital respectively. NOTE : This
2 Yes Pending
form can be downloaded from (link / Paramount website)

3 MAIN HOSPITAL BILL Hospital Name Bill No Bill Date Amount

Original final hospital bill with breakup of (details/amt), LIFELINE SUPER SPECIALITY
a 2008 03/06/2019 4919 Yes Pending
as submitted is a Xerox.. HOSPITAL

4 INVESTIGATION REPORTS Particular Bill No Bill Date Amount

Original investigation report - as submitted is Xerox

a 1 Yes Pending
report

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