The Concerned Authority,
________________ (Insurance Company Name),
Date: __/__/____ (Date)
Subject: Intimation regarding mediclaim
Respected, I am __________ (Name) and I do carry a ________________ (Policy Name – If any) policy of your company having the policy number _______________ (Policy Number) in the name of __________ (policy holder name) _______ (relationship with policy holder). TPA ID is _______________ (Company TPA ID – If applicable). My permanent residential address is ______________ (Address).
He/she is being admitted in ____________ (Hospital Name) on ________ (admission date and time), having ___________ (Room type) due to the reason of _______________ (Reason for Hospitalization). Kindly consider this as an intimation letter for the mediclaim purpose for ____________ (Name of patient).
The following are the details of the patient:
Name: _______________ (Name)
Policy Number: _______________ (Policy Number)
Contact Details: _______________ (Contact Number)
I am hereby attaching ____________ (Medical Card/ ID Proof/ Address Proof/ Treatment Prescription with Bill Estimation – Any other document if applicable).
Respectfully, I shall be grateful for your favor if you proceed with the Mediclaim approval procedure at the earliest and get it done without any delays.
______________ (Contact Number)