STAR HEALTH AND ALLIED INSURANCE CO. LTD.

No.15, SRI BALAJI COMPLEX,1st FLOOR, WHITES LANE,ROYAPETTAH,

CHENNAI-600014.Toll Free No: 1800 425 2255 / Toll Free Fax: 1800 425 5522, www.
starhealth.in

Date : 12-07-2019
To,
MR.C.RAJA REDDY
KOTAGUNDLA PALLE(VIL),
KANDUR (PO), SOMALA(MANDAL),
CHITTOOR (DIST), ANDHRA PRADESH - 517234.
KANDUR , Pincode : 517234
CHITTOOR, ANDHRA PRADESH
Telephone : 9441062861

Dear Customer,

Sub: Requirement of additional documents/information.

This has reference to the claim preferred on us as per details given below-

Policy No P/141126/01/2019/009650 Claim Intimation No CLI/2020/141126/0227959

Family Health Optima Insurance -

Product Name Name of the patient MR.C.RAJA REDDY
2017

Policy Period 06-12-2018 to 05-12-2019 DOA - DOD 04-06-2019 07-06-2019

ST.JOHNS MEDICAL COLLEGE

Policy Issuing Office Branch Office - Hebbal Hospital Name & City
HOSPITAL - BANGALORE

MR.MANOHAR REDDY S -
SM Name / Code
SH24715
Diagnosis DUODENAL ULCER WITH STENOSIS,
Intermediary Name / MRS.MANJULATHA M A -
Code BA0000244079

We require the following additional documents/information to enable us to process your claim further. Kindly send us the
documents/information within 15 Days on receipt of this communication.These are mandatorily required.

S.No. Description of documents required

As per discharge summary, patient has history of Epigastric pain since six months, kindly submit first and all past
1
consultations since symptomatic with past reports and treatment details.

2 All previous hospitalization records.

3 Complete set of indoor case papers copies with treatment chart.

4 Break up towards final bill.

Thanking you,
Yours faithfully,

Authorised Signatory.

IRDA Regn.No.129
Corporate Identity Number U66010TN2005PLC056649
Email ID : info@starhealth.in
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