Subject: Fw: Payment processed for claim no 220202323569 against Account reference number ACC24112101760 in the name of SAYED HUMERA ABDUL REHMAN.
From: "Swati Shukla (LSM ACCOUNTS)" <[email-masked]>
To: Ashish Dabral <[email-masked]>
Date: Thu, 25 Nov 2021 04:38:17 +0000

Best Regards,

Swati Shukla

Asst. Manager (Accounts)

8882991655

________________________________
From: [email-masked] <[email-masked]>
Sent: Wednesday, November 24, 2021 7:17 PM
To: Swati Shukla (LSM ACCOUNTS) <[email-masked]>
Subject: Payment processed for claim no 220202323569 against Account reference number ACC24112101760 in the name of SAYED HUMERA ABDUL REHMAN.

[IL Logo]       [IL_iHC_Logo_New]
SETTLEMENT LETTER

Date : [DATE]

To,

SAYED HUMERA ABDUL REHMAN
FIRST FLOOR A 72 SEC 2 NOIDA,,,NOIDA,Uttar Pradesh,201301 Tel: 9999999999 Mob:
Dear SAYED HUMERA ABDUL REHMAN,
CLAIM NO        AL NO   EMPLOYEE/MEMBER ID      EMPLOYEE NAME   MEMBER NAME     UHID
220202323569            CPU100  SAYED HUMERA ABDUL REHMAN       SAYED HUMERA ABDUL REHMAN       IL19316637100
DOA     HOSPITAL NAME   REQUESTED AMOUNT        NET SANCTIONED AMOUNT   CO-PAYMENT AMOUNT       DISALLOWED AMOUNT       DISALLOWED REASONS
16-AUG-2021     HAH Centenary Hospital  20298   20298   0       0
Note: If there are any deductions due to non-submission of reports or bills, the same will be re-considered upon submission of required documents. Please submit the required documents within 30 days from the receipt of this letter.
On behalf of ICICI Lombard General Insurance Co. Ltd, we thank you for preferring ICICI Lombard as your health insurance partner.
We write to you with reference to above health claim Number, we wish to inform you that we have received the papers & documents submitted by you. We have perused the documents and your claim is being settled for an amount of Rs. 20298 . We enclose a Cheque/ EFT vide ref. no. CMS2253608661 dated 24-NOV-21 towards the full and final settlement of the claim. This includes an amount of 0 towards the service tax & education Cess, against the claimed amount of 0. The amount deducted under TDS is 0.The Company hereby stands discharged of liabilities arising out of this claim...

Thank you for having given us an opportunity to be of service to you. In case of any further clarification, please feel free to write to us at the below mentioned address, or e-mail us at [email-masked]<mailto:[email-masked]> according to your preference, quoting the above claim No, and we shall be pleased to assist.

In case you are not satisfied with the resolution provided, you may visit our website https://www.icicilombard.com/content/ilom-en/ServiceCouncil/SQindex.html for Grievance Redressal procedure and Insurance Ombudsman office details for the resolution of your grievance.

[i_Signature]

Associate Vice President- Health Claims

For ICICI Lombard General Insurance Company Ltd
ICICI LOMBARD HEALTH CARE
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
;

        [IL Logo]

ANNEXURE  I  :  220202323569

 Claim No :        220202323569  AL No :
 UHID NO :         IL19316637100         Relationship : &n! bsp;           SELF
 Name of the Patient :     SAYED HUMERA ABDUL REHMAN     Policy No :!      4016/X/221916670/00/000
 Policy Start Date :        31-JUL-21   &n! bsp;Polic y End Date :          19-APR-22
 Type Of Claim :           FRESH CLAIM   Requested Amount i! n Rs :&nb sp;          20298
 Name Of Hospital :        HAH Centenary Hospital        Address of the Hospital ! :< /strong>     Jamia Hamdard, Hamdard Nagar, Gali Number 7, Block A, Tigri Extension, Sangam Vihar
Delhi,Delhi-110062
 Date Of Admission :       16-AUG-21     Date Of Discharge :        20-AUG-21
 Policy Name :     LIVESALESMAN

SR No   Charges Details Claimed Deductions      Paid    Reason for Deductions
1       Consultation Visit Charges      400     0       400
2       Investigation Charges   13700   0       13700
3       Medicines Pharmacy Charges      1367    0       1367
4       Others  1731    0       1731
5       Room Nursing Charges    3100    0       3100                    Total   20298   0       20298

 Diagnosis :     LAPROSCOPIC CHOLECYSTECTOMY
 Final Amount Settled in Rs. :

 20298

 Claim Status :          PAID