Subject: Fw: Query Claim Number 220202323569 - SAYED HUMERA ABDUL REHMAN
From: "Swati Shukla (LSM ACCOUNTS)" <[email-masked]>
To: Ashish Dabral <[email-masked]>
Date: Tue, 5 Oct 2021 12:57:22 +0000

Best Regards,

Swati Shukla

Asst. Manager (Accounts)

8882991655

________________________________
From: [email-masked] <[email-masked]>
Sent: Tuesday, October 5, 2021 6:26 PM
To: Swati Shukla (LSM ACCOUNTS) <[email-masked]>
Subject: Query Claim Number 220202323569 - SAYED HUMERA ABDUL REHMAN

[IL Logo]       [IL_iHC_Logo_New]
ADDITIONAL INFORMATION REQUEST FORM

Ref : CPU100
Date: 05-OCT-21
To,
SWATI SHUKLA
LIVE SALESMAN
FIRST FLOOR, A-72, SEC-2, NOIDA, Gautam Buddha Nagar,Uttar Pradesh, 201301
NOIDA,Uttar Pradesh-201301
Dear Sir/Madam,
        Claim Number    220202323569
        Claim of        SAYED HUMERA ABDUL REHMAN
        UHID    IL19316637100
        Policy Number   4016/X/221916670/00/000
        Policy Name     LIVESALESMAN
        Coverage Period 31-JUL-21 to 19-APR-22
        Date of Admission       16-AUG-21
        Date of Discharge       20-AUG-21
        Diagnosis       Cholelithiasis
        Hospital Name   HAH Centenary Hospital
        AL Number

On behalf of ICICI Lombard General Insurance Co. Ltd, we thank you for preferring ICICI Lombard as your health insurance partner.With reference to your claim intimated in our office we request you to send the following documents for further processing of your claim.

>

Sr No   Reason  Description
1       Document Deficiency

  1.  Kindly provide the date wise break up for the charges incurred in the final bill (investigations,procedure,consultation etc.) for further processing of the claim.

Note: C-KYC form can be download from the following link
http://www.icicilombard.com/downloads<www.icicilombard.com/downloads> -> Health Insurance -> Claims -> Central KYC form
“ALL ABOVE MENTIONED DOCUMENTS TO BE SUBMITTED IN ORIGINAL”
Please submit the documents to us within 7 days from the date of receipt of this letter at the below mentioned address to ensure speedy service. Please note that the conclusion regarding the eligibility of coverage /admissible amount can only be arrived on submission of the above mentioned documents. In case of any further clarification, please feel free to write to us at the below mentioned address. Please quote our claim number as mentioned above in all your claim correspondences. We look forward to your co-operation in helping us serve you better.
[i_Signature]

Associate Vice President- Health Claims

For ICICI Lombard General Insurance Company Ltd

"Is finding an appropriate hospital trouble for you and your family? Introducing Health Advisor by ICICI Lombard<https://healthadvisor.icicilombard.com/?utm_source=Query%20via%20Email&utm_medium=Email&utm_campaign=Query> to help you choose the right healthcare provider. (best viewed in Chrome)"

Contact Details:        Email: [email-masked]<mailto:[email-masked]>
Address:        Contact Us

ICICI Lombard GIC,
ICICI Lombard Health Care,
ICICI Bank Tower,
Plot No 12, Financial District,
Nanakram Guda, Gachibowli,
Hyderabad – 500032,
Telangana
IRDA Registration No. 115

Toll Free Helpline No.:

Toll Free Fax No.:
Fax No. Line 1:
Fax No. Line 2:         1800 2 666

1800 209 8880
040-66989160
040-66989161