Karnataka

AOC

Services

TENDER FOR PROVIDING GROUP MEDICAL INSURANCE TO EMPLOYEES OF CENTRE FOR SMART GOVERNANCE

Centre for Smart Governance

Centre for Smart Governance office Bengaluru | Bengaluru Urban, Karnataka

Amount: ₹25.0 LCloses: 7 Feb 2026Closed

Timeline

Published30 Jan 2026
Closed7 Feb 2026
Awarded30 Jan 2026

Bids

1 Bid30 Jan 2026

#	Company	Amount	Status
1	Anand Rathi Insurance Brokers Limited ₹33.0 LAWARDED	₹33.0 L	AWARDED

Tender Value

₹25.0 L

EMD Value

₹50,000

Closing Date

7 Feb 2026, 11:00 pmClosed

Tender Inviting Authority

Office Inviting Bids

Centre for Smart Governance

Contact Person

Vijaylakshmi

Office Number

Work Description

TENDER FOR PROVIDING GROUP MEDICAL INSURANCE TO EMPLOYEES OF CENTRE FOR SMART GOVERNANCE

Tender Information

Tender ID

CSG/2025-26/SE0025

Reference Number

CSG/2025-26/SE0025

Tender Type

Open

Form of Contract

Two Tender Document System(Two Cover)

Location

Centre for Smart Governance office Bengaluru

Source Website

Subscribe to view

Documents Required

1 document required · 1 mandatory

Technical Bid

RequiredBidders should submit all the technical documents as per tender document.

Eligibility Criteria

Bidders shall not be under a declaration of ineligibility for corrupt and fraudulent practices issued by Government of Karnataka

It shall be the responsibility of the Bidder to ensure credit of Tender Processing Fee and EMD into the respective receiving bank accounts of e-Procurement on or before the last date and time of bid submission.

EMD Payments through e-Payment mode shall be made as one single transaction and payments made in part are liable for rejection.

1.Bidder with Least rate L1 (for the total), will be considered as successful bidder.

2.The tentative number of lives to be insured is provided under Section 6, Sub section II.

3.The number of lives to be insured is subject to vary due to new joinees and resignations. Hence, premium amount will be calculated on pro-rata basis.

Technical Criteria

Capabilities of Vendor

Bidders should submit all the technical documents as per tender document.

Others -- Bidders should submit all the technical documents as per tender document.

Fee & Financial Details

Tender Fee Amount

₹630

EMD Fee Amount

₹50,000

Important Dates

Last Activity

30 Jan 2026

Published

30 Jan 2026

Bid Opening

9 Feb 2026

Download Ends

3 Feb 2026

Pre-Bid Meeting

3 Feb 2026

BOQ Preview

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Policy No SBIG Branch Name SBIG Branch Code SBIG Region SBI Bank Circle Insured Name Product LOB Claim LOB Policy Start Date Policy End Date TPA Name Sum Insured Employee Proposer Name Member ID Loan Account Owner Account No Employee Code Patient Name Gender Date of Birth Relationship Type of Treatment Event Type Claim Type Diagnosis Claimed Amount Claim No Loss date Notification Date Event Type Cause of Loss Claim Owner Claim Processing Location Claim Status Total Reserve Paid Total YTD Paid Date Closed Date Loss Location Loss State Branch Name IMD Code IMD Name Channel SubChannel_1 SubChannel_2 SSM Code SSM Name Litigation Flag Co-ins Month Rejection Reason Documents Required UTR No UTR Date

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4101220200000103-02 Jayanagar 00118 South 2 NA Abhilash Kumar D S SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Abhilash Kumar D S 4021571547 510101006872845 314 Abhilash Kumar D S M Self Allopathy Cashless INFECTIOUS DISEASES (BACTERIAL / VIRAL / Others) 38764 90765916 12-13-24 12-14-24 Cashless Fever Of Unknown Origin Pune Health Hub Pune Health Hub Pending 28885 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Dec-24 0

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4101220200000103-02 Jayanagar 00118 South 2 NA Abhishek H A SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Abhishek H A 4021571558 64199544152 513 Harshitha L F Sunday, February 07, 1999 Spouse Allopathy Reimbursement CAESAREAN SECTION 58686 90509922 05-16-24 06-07-24 Reimbursement Encounter for cesarean delivery without indication Pune Health Hub Pune Health Hub Paid 0 45941 Thursday, June 13, 2024 Channarayapatna Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Jun-24 06-13-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Arpita M Tarikeri SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Arpita M Tarikeri 4021571592 42930100013255 411 Arpita M Tarikeri F Self Reimbursement INFECTIOUS DISEASES (BACTERIAL / VIRAL / Others) 22717 90767875 11-10-24 12-16-24 Reimbursement Fever Of Unknown Origin Pune Health Hub Pune Health Hub Paid 0 22285 Thursday, December 26, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Dec-24 0 SBIN124358477273 12-26-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Arpita M Tarikeri SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Arpita M Tarikeri 4021571592 42930100013255 411 Arpita M Tarikeri F Self Reimbursement MATERNITY RELATED DISORDERS 12100 90761487 11-25-24 12-11-24 Reimbursement Medical Abortion Pune Health Hub Pune Health Hub Paid 0 12100 Wednesday, December 18, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Dec-24 0 SBIN324351122475 12-18-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Ashok Kumar H S SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Ashok Kumar H S 4021571602 02610310000030 320 Ashok Kumar H S M Self Allopathy Cashless DISORDERS OF THE RESPIRATORY SYSTEM 58980 90784872 12-28-24 12-29-24 Cashless Unspecified acute lower respiratory infection Pune Health Hub Pune Health Hub Pending 53380 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Dec-24 0

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4101220200000103-02 Jayanagar 00118 South 2 NA Ashok Kumar H S SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Ashok Kumar H S 4021571602 50200026252901 320 Ashok Kumar H S M Self Allopathy Cashless INFECTIOUS DISEASES (BACTERIAL / VIRAL / Others) 60000 90787601 12-30-24 12-31-24 Cashless Fever Of Unknown Origin Pune Health Hub Pune Health Hub Pending 48000 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Dec-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Baby Of Priyank Group Health Insurance - GMC Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Praveen Kumar S J 4021650693 220 Baby Of Priyank F Sunday, February 11, 2024 Daughter Reimbursement Reimbursement Dehydration 29849 90415222 02-14-24 03-19-24 Reimbursement Dehydration Pune Health Hub Pune Health Hub Paid 0 24029 Sunday, March 24, 2024 Bangalore Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Mar-24 248809963 03-21-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Bhagyalaxmi R P Group Health Insurance - GMC Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Prashanth R J 4021571939 60 Bhagyalaxmi R P F Wednesday, September 09, 1987 Spouse Reimbursement Reimbursement Endometriosis in cutaneous scar 176399 90392465 02-14-24 02-29-24 Reimbursement Endometriosis in cutaneous scar Pune Health Hub Pune Health Hub Paid 0 171299 Sunday, March 03, 2024 Bangalore Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Mar-24 SBIN324061627757 03-01-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Brunda M SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Brunda M 4021571645 917020048866069 81 Brunda M F Wednesday, August 05, 1998 Self Allopathy Cashless INJURIES / FRACTURES / DISLOCATIONS 74272 90733623 11-19-24 11-20-24 Cashless Superficial Injury of head Pune Health Hub Pune Health Hub Paid 0 73572 Monday, December 23, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Nov-24 0 SBIN524337939957 12-23-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Chaithra Arun Patil Group Health Insurance - GMC Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Arun Patil 4021571597 163 Chaithra Arun Patil F Tuesday, March 07, 1995 Spouse Reimbursement Reimbursement Encounter for cesarean delivery without indication 55548 90423297 03-13-24 03-26-24 Reimbursement Encounter for cesarean delivery without indication Pune Health Hub Pune Health Hub Paid 0 49903 Wednesday, April 03, 2024 Bangalore Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Apr-24 68010157 04-01-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Dayyala Bhaskar Reddy SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Dayyala Bhaskar Reddy 4021571674 40975266033 368 A Keerthika F Monday, August 02, 1993 Spouse Reimbursement INFECTIOUS DISEASES (BACTERIAL / VIRAL / Others) 16052 90647936 08-28-24 09-18-24 Reimbursement Dengue fever [classical dengue] Pune Health Hub Pune Health Hub Paid 0 15802 Saturday, November 09, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Sep-24 Kindly provide investigation report supporting the diagnosis Blood Test Reports,Kindly provide investigation report supporting the diagnosis: Urine Routine/Urine Culture report,Please provide copy of Cancelled cheque (with Pre-Printed name of Proposer/Policyholder/ employee) OR copy of the first page of Bank Passbook OR copy of Recent Month’s Bank Account Statement, for transferring amount -(Dayyala Bhaskar Reddy)(NEFT is standard document to be submitted as part of claim documents checklist; it does not imply admissibility of the claim). ,Kindly provide investigation report supporting the diagnosis Blood Test Reports,Kindly provide investigation report supporting the diagnosis: Urine Routine/Urine Culture report,Please provide copy of Cancelled cheque (with Pre-Printed name of Proposer/Policyholder/ employee) OR copy of the first page of Bank Passbook OR copy of Recent Month’s Bank Account Statement, for transferring amount -(Dayyala Bhaskar Reddy)(NEFT is standard document to be submitted as part of claim documents checklist; it does not imply admissibility of the claim). ,Reason for discrepancy noted in -While processing your claim, we need some additional information; In this regard, request you to please provide: 1) Please provide us clinical clarification - why pathology reports are verified by Treating doctor/ Lab incharge only, instead of MD Pathologist 551013867 11-09-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Janavi B SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Janavi B 4021571731 8146125304 68 Pragna C F Sunday, May 23, 2021 Daughter Allopathy Cashless DISORDERS OF THE RESPIRATORY SYSTEM 28283 90735036 11-21-24 11-21-24 Cashless Acute pharyngitis, unspecified Pune Health Hub Pune Health Hub Paid 0 23271 Tuesday, December 10, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Nov-24 SBIN424344227232 12-10-24

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4101220200000103-02 Jayanagar 00118 South 2 NA K G Rajeshwar SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 K G Rajeshwar 4021571738 054115605003 2 K G Rajeshwar M Friday, May 19, 1967 Self Allopathy Cashless DISORDERS OF THE GASTROINTESTINAL SYSTEM 178063 90509530 06-07-24 06-06-24 Cashless Other acute appendicitis Pune Health Hub Pune Health Hub Paid 0 174052 Wednesday, June 19, 2024 Bangalore Rural Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 June-24 SBIN324170457636 06-19-24

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4101220200000103-02 Jayanagar 00118 South 2 NA K S Shruthi SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 K S Shruthi 4021571745 32837748935 426 K S Shruthi F Wednesday, September 19, 1990 Self Allopathy Cashless NORMAL DELIVERY 42501 90513848 06-09-24 06-10-24 Cashless Single spontaneous delivery Pune Health Hub Pune Health Hub Paid 0 42500 Tuesday, June 25, 2024 Mysore Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Jun-24 06-25-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Kalpana SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Kalpana 4021571749 15530200002458 406 Kalpana F Saturday, May 15, 1999 Self Allopathy Cashless DISORDERS OF BLOOD & BLOOD FORMING ORGANS, IMMUNE MECHANISM 37648 90521227 06-16-24 06-17-24 Cashless Anemia, unspecified Pune Health Hub Pune Health Hub Paid 0 33783 Thursday, July 11, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 June-24 SBIN324192362834 07-11-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Lakshmi Mounika Group Health Insurance - GMC Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Venkat Earthni 4021572166 273 Lakshmi Mounika F Monday, November 23, 1998 Spouse Cashless Cashless Enlarged lymph nodes, unspecified 82174 90396163 03-04-24 03-02-24 Cashless Enlarged lymph nodes, unspecified Pune Health Hub Pune Health Hub Paid 0 78495 Sunday, April 14, 2024 Bangalore Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Apr-24 SBIN224103516359 04-10-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Lavanya SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Lavanya 4021571784 60336181396 293 Shivakumar M Saturday, June 01, 1991 Spouse Allopathy Cashless DISORDERS OF THE GENITOURINARY SYSTEM 16314 90531115 06-23-24 06-24-24 Cashless Calculus of ureter Pune Health Hub Pune Health Hub Paid 0 14618 Wednesday, July 10, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 June-24 SBIN224191383460 07-10-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Mogili Bhargava SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Mogili Bhargava 4021571834 IN449612900 Mogili Rishitha F Friday, December 11, 2020 Daughter Cashless Cashless SKIN DISORDERS 201458 90395844 03-06-24 03-02-24 Epidermal cyst Epidermal cyst Pune Health Hub Pune Health Hub Closed 0 03-05-24 Bangalore Rural Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Feb-24 DEFINITIONS: The following words or terms shall have the meaning ascribed to them wherever they appear in this Policy, and references to the singular or to the masculine shall include references to the plural and to the feminine wherever the context so permits: Condition Precedent: Condition Precedent means a policy term or condition upon which the Insurer's liability under the policy is conditional upon.

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4101220200000103-02 Jayanagar 00118 South 2 NA Mohammed Touseef SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Mohammed Touseef 4021571840 262 Misbah Kouser F Saturday, June 01, 1991 Spouse Reimbursement INFECTIOUS DISEASES (BACTERIAL / VIRAL / Others) 69599 90576713 07-11-24 07-29-24 Reimbursement Fever Of Unknown Origin Pune Health Hub Pune Health Hub Paid 0 50000 Friday, August 23, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 July-24 SBIN224234357587 08-23-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Naveen Kumar K L Group Health Insurance - GMC Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Naveen Kumar K L 4021571866 408 Naveen Kumar K L M Saturday, January 23, 1982 Self Cashless Cashless Calculus of kidney 118150 90430434 03-31-24 04-01-24 Cashless Calculus of kidney Pune Health Hub Pune Health Hub Paid 0 112429 Friday, April 19, 2024 Bangalore Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Apr-24 SBIN224109210478 04-16-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Naveen Kumar K L SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Naveen Kumar K L 4021571866 915010045371886 408 Naveen Kumar K L M Saturday, January 23, 1982 Self Allopathy Reimbursement DISORDERS OF THE GENITOURINARY SYSTEM 1975 90497088 03-31-24 05-28-24 Reimbursement Calculus of kidney Pune Health Hub Pune Health Hub Paid 0 1975 Saturday, June 08, 2024 Bangalore Rural Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 May-24 SBIN424159292802 06-08-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Pavan A S SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Pavan A S 4021571907 829397299 466 Pavan A S M Self Allopathy Cashless DISORDERS OF THE MUSCULOSKELTAL SYSTEM 57429 90763243 12-13-24 12-12-24 Cashless Ganglion, right wrist Pune Health Hub Pune Health Hub Pending 51571 Bangalore Rural Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Dec-24 0

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4101220200000103-02 Jayanagar 00118 South 2 NA Pavithra Nayak R Group Health Insurance - GMC Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Pradeep B N 4021571925 434 Pavithra Nayak R F Sunday, April 11, 1999 Spouse Reimbursement Reimbursement Encounter for cesarean delivery without indication 42873 90405804 02-16-24 03-11-24 Reimbursement Encounter for cesarean delivery without indication Pune Health Hub Pune Health Hub Paid 0 40959 Sunday, March 17, 2024 Bangalore Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Mar-24 195295817 03-15-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Pragna C Group Health Insurance - GMC Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Janavi B 4021571731 68 Pragna C F Sunday, May 23, 2021 Daughter Cashless Cashless Diaorrhoea & gastroenteritis of presumed infectious origin 18733 90462357 04-28-24 04-29-24 Cashless Diaorrhoea & gastroenteritis of presumed infectious origin Pune Health Hub Pune Health Hub Paid 0 16465 Saturday, May 11, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Apr-24 SBIN424131173160 05-11-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Prathesha C Group Health Insurance - GMC Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Prathesha C 4021571942 165 Prathesha C M Tuesday, May 02, 1989 Self Cashless Cashless Fever Of Unknown Origin 22805 90428633 03-30-24 03-30-24 Cashless Fever Of Unknown Origin Pune Health Hub Pune Health Hub Paid 0 20525 Tuesday, April 23, 2024 Bangalore Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Apr-24 315698021 04-19-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Punith Kumar K SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Punith Kumar K 4021571962 30799650161 328 Aishwarya M B F Spouse Allopathy Cashless MATERNITY RELATED DISORDERS 45481 90756775 12-07-24 12-08-24 Cashless Incomplete spontaneous abortion without complication Pune Health Hub Pune Health Hub Pending 42512 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Dec-24 Please submit break-up bill for the hospital main/final bill

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4101220200000103-02 Jayanagar 00118 South 2 NA Ramesha L B SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Ramesha L B 4021571997 50200027533901 121 Ranjini B S F Friday, June 01, 1990 Spouse Allopathy Cashless CAESAREAN SECTION 110501 90674088 10-05-24 10-05-24 Cashless Encounter for cesarean delivery without indication Pune Health Hub Pune Health Hub Paid 0 75000 Tuesday, October 15, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Oct-24 0 SBIN424284586031 10-15-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Sania Rahmath SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Sania Rahmath 4021572025 50200038736740 Sania Rahmath F Monday, July 07, 1997 Self Cashless Cashless CAESAREAN SECTION 56250 90486112 05-18-24 05-18-24 Encounter for cesarean delivery without indication Encounter for cesarean delivery without indication Pune Health Hub Pune Health Hub Paid 0 56250 Wednesday, June 19, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 May-24 SBIN324170457636 06-19-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Sania Rahmath SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Sania Rahmath 4021572025 64061378394 412 Sania Rahmath F Monday, July 07, 1997 Self Reimbursement CAESAREAN SECTION 5700 90535810 05-18-24 06-28-24 Reimbursement Encounter for cesarean delivery without indication Pune Health Hub Pune Health Hub Paid 0 5000 Friday, July 12, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 June-24 284480352 07-12-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Sania Rahmath SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Sania Rahmath 4022807093 64061378394 412 Sidra Fathima F Saturday, May 18, 2024 Daughter Reimbursement NEONATAL DISORDERS 10566 90529778 05-18-24 06-24-24 Reimbursement Preterm newborn, gestational age 35 completed weeks Pune Health Hub Pune Health Hub Paid 0 10266 Friday, July 12, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 June-24 284480352 07-12-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Santosh Bakkappa SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Santosh Bakkappa 4021572040 31919026313 119 Megha Santosh Bakkappa F Saturday, December 25, 2010 Daughter Allopathy Cashless INFECTIOUS DISEASES (BACTERIAL / VIRAL / Others) 21515 90649889 09-17-24 09-19-24 Cashless Dengue fever [classical dengue] Pune Health Hub Pune Health Hub Paid 0 21015 Tuesday, October 15, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Sep-24 289691347 10-15-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Sriharikrishna J SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Sriharikrishna J 4021572102 74370200000198 50 Sriharikrishna J M Monday, March 24, 1986 Self Allopathy Cashless INFECTIOUS DISEASES (BACTERIAL / VIRAL / Others) 51819 90642885 09-12-24 09-13-24 Cashless Dengue fever [classical dengue] Pune Health Hub Pune Health Hub Paid 0 42832 Tuesday, October 15, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Sept-24 FINAL APPROVAL. PLEASE DONT COLLECT HOSPITAL DISCOUNT FROM THE PATIENT. ROOM RENT CAPPING APPLICABLE AS PER POLICY T & C. SBIN124274971301 10-15-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Sripriya H S SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Sripriya H S 4021572113 05142790000103 4 Shreyas T M Thursday, June 10, 2010 Son Allopathy Cashless NEUROLOGICAL & CEREBROVASCULAR DISORDERS 68707 90569993 07-22-24 07-23-24 Cashless Other seizures Pune Health Hub Pune Health Hub Paid 0 58315 Thursday, August 08, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 July-24 SBIN524219793901 08-08-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Sripriya H S SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Sripriya H S 4021572113 37686213890 4 Shreyas T M Thursday, June 10, 2010 Son Reimbursement NEUROLOGICAL & CEREBROVASCULAR DISORDERS 8913 90609767 07-22-24 08-22-24 Reimbursement Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, with status epilepticus Pune Health Hub Pune Health Hub Paid 0 5191 Friday, September 06, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Aug-24 0 393669030 09-06-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Sripriya H S SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Sripriya H S 4021572113 37686213890 4 Shreyas T M Thursday, June 10, 2010 Son Allopathy Reimbursement NEUROLOGICAL & CEREBROVASCULAR DISORDERS 600 90646328 07-22-24 09-17-24 Reimbursement Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, with status epilepticus Pune Health Hub Pune Health Hub Paid 0 600 Tuesday, September 24, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Sep-24 claim for partial amount claim is payable. 525512808 09-24-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Swetha N Group Health Insurance - GMC Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Swetha N 4021572136 237 Swetha N F Tuesday, May 25, 1993 Self Reimbursement Reimbursement Encounter for cesarean delivery without indication 118117 90433076 03-07-24 04-03-24 Reimbursement Encounter for cesarean delivery without indication Pune Health Hub Pune Health Hub Paid 0 75000 Wednesday, April 10, 2024 Bangalore Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Apr-24 433928690 04-05-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Tanuja M Group Health Insurance - GMC Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Ashok Kumar H S 4021571603 320 Tanuja M F Tuesday, December 11, 2001 Spouse Cashless Cashless Encounter for cesarean delivery without indication 97655 90434808 04-02-24 04-04-24 Cashless Encounter for cesarean delivery without indication Pune Health Hub Pune Health Hub Paid 0 69999 Tuesday, May 14, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Apr-24 SBIN124134665073 05-14-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Tanuja M Group Health Insurance - GMC Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Ashok Kumar H S 4021571603 320 Tanuja M F Tuesday, December 11, 2001 Spouse Cashless Cashless Supervision of young primigravida, third trimester 8217 90407060 03-12-24 03-12-24 Cashless Supervision of young primigravida, third trimester Pune Health Hub Pune Health Hub Paid 0 5001 Sunday, March 24, 2024 Bangalore Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Mar-24 SBIN224082365540 03-21-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Vani P M SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Vani P M 4021572156 64016152100 363 K S Shekar M Spouse Reimbursement CARDIAC DISORDERS 17215 90768666 11-01-24 12-17-24 Reimbursement Atherosclerotic heart disease of native coronary artery without angina pectoris Pune Health Hub Pune Health Hub Paid 0 15382 Thursday, December 26, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Dec-24 0 573660503 12-26-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Vani P M SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Vani P M 4021572156 64016152100 363 K S Shekar M Monday, February 10, 1975 Spouse Reimbursement INFECTIOUS DISEASES (BACTERIAL / VIRAL / Others) 417578 90735930 11-01-24 11-22-24 Reimbursement Fever Of Unknown Origin Pune Health Hub Pune Health Hub Paid 0 105820 Saturday, December 14, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Nov-24 Detailed discharge summary with reason for hospitalization, significant findings and procedures and treatment provided during hospital stay ,Detailed discharge summary with reason for hospitalization, significant findings and procedures and treatment provided during hospital stay ,Please provide the original Physical documents please provide settlement letter with hospital signed and stamp,Please provide the original Physical documents please provide settlement letter with hospital signed and stamp 124773092 12-14-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Vinay S SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Vinay S 4024537208 02310110038451 233 Baby Of Prathyusha M F Daughter Reimbursement NEONATAL DISORDERS 21050 90760567 11-25-24 12-11-24 Reimbursement Neonatal jaundice due to excessive haemolysis Pune Health Hub Pune Health Hub Paid 0 18464 Thursday, December 26, 2024 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Dec-24 Please provide copy of Cancelled cheque (with Pre-Printed name of Proposer/Policyholder/ employee) OR copy of the first page of Bank Passbook OR copy of Recent Month’s Bank Account Statement, for transferring amount - provide NEFT details with pre-printed proposer name " Vinay S" (NEFT is standard document to be submitted as part of claim documents checklist; it does not imply admissibility of the claim) SBIN124358468414 12-26-24

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4101220200000103-02 Jayanagar 00118 South 2 NA Yogish B SBIGen_Group Health Insurance Policy Health Health 02-11-24 02-10-25 SBI General Insurance Company Limited 500000 Yogish B 4021572197 20174263632 74 Namratha N F Monday, August 03, 1998 Spouse Reimbursement INFECTIOUS DISEASES (BACTERIAL / VIRAL / Others) 1400 90587872 07-06-24 08-06-24 Reimbursement Fever Of Unknown Origin Pune Health Hub Pune Health Hub Closed 0 08-26-24 Bengaluru Karnataka Jayanagar 61174 SBI General Insurance Direct Code SME NA FLS - SME 11026 RAJENDRA PRASAD S NO 100 Aug-24 Hospitalization outside policy period for the beneficiary, hence this claim is not payable | DEFINITIONS: The following words or terms shall have the meaning ascribed to them wherever they appear in this Policy, and references to the singular or to the masculine shall include eferences to the plural and to the feminine wherever the context so permits: Maternity expenses: Maternity expenses shall include— a. medical treatment expenses traceable to childbirth ( including complicated deliveries and caesarean sections incurred during hospitalization). b. expenses towards lawful medical termination of pregnancy during the policy period.

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Applied filters: Policy No is 4101220200000103-02

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4101220200000103-01 Jayanagar 00118 South 2 NA AALIYA Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37264509CESGH AFZAL AHAMED D A M Sunday, January 06, 1985 Spouse HOSPITALIZATION CASHLESS Rt Knee Acl Tear 316937 100623065963-01 07-20-23 07-19-23 Rt Knee Acl Tear Rt Knee Acl Tear Pune Health Hub Pune Health Hub Paid 0 196726 Monday, July 31, 2023 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Jul-23 SBIN523213568898 08-01-23

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4101220200000103-01 Jayanagar 00118 South 2 NA AALIYA Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37264509CESGH AFZAL AHAMED D A M Sunday, January 06, 1985 Spouse HOSPITALIZATION REIMBURSEMENT Rt Knee Acl Tear 37263 100623065963-02 07-20-23 09-28-23 Rt Knee Acl Tear Rt Knee Acl Tear Pune Health Hub Pune Health Hub Paid 0 34841 Tuesday, October 17, 2023 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Oct-23 430653817 10-17-23

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4101220200000103-01 Jayanagar 00118 South 2 NA ABHISHEK Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE 137 ABHISHEK F Wednesday, October 13, 1993 Spouse Pregnancy CASHLESS Pregnancy 52800 100623178216-01 02-02-24 02-06-24 Pregnancy Pregnancy Pune Health Hub Pune Health Hub Paid 0 49104 Tuesday, February 13, 2024 Mandya KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 feb-24 SBIN424044148588 02-13-24

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4101220200000103-01 Jayanagar 00118 South 2 NA AMRUTHA C P Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37117370CESGE AMRUTHA C P F Thursday, December 03, 1998 Self HOSPITALIZATION CASHLESS Pregnancy 52000 100623154181-01 12-20-23 12-22-23 Pregnancy Pregnancy Pune Health Hub Pune Health Hub Paid 0 28412 Tuesday, January 30, 2024 RAMANAGRA KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Jan-24 SBIN224030484588 01-29-24

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4101220200000103-01 Jayanagar 00118 South 2 NA ARUN PATIL Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37117281CESGW CHAITHRA ARUN PATIL F Tuesday, March 07, 1995 Spouse HOSPITALIZATION REIMBURSEMENT O063 Unspecified Abortion Incomplete With Other And Unspecified Complications 30136 200623100965-01 09-10-23 09-20-23 O063 Unspecified Abortion Incomplete With Other And Unspecified Complications Threatened Abortion Pune Health Hub Pune Health Hub Closed 0 09-29-23 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Sep-23 THE REPORTED CLAIM OF MRS. CHAITHRA ARUN PATIL IS FOR TREATMENT OF PRIMIGRAVIDA WITH 11 WEEKS OF GESTATION WITH THREATENED ABORTION FOR WHICH CONSERVATIVE MANAGEMENT WAS DONE. WE HAVE CAREFULLY PURSUED THE CLAIM DOCUMENTS AND IT IS CLEARLY EVIDENT FROM THE DOCUMENTS SUBMITTED THAT THE CLAIM IS FOR PRE NATAL AND POST NATAL EXPENSES . AS PER POLICY TERMS AND CONDITIONS MATERNITY EXPENSES INCLUDE MEDICAL TREATMENT EXPENSES TRACEABLE TO CHILDBIRTH INCLUDING COMPLICATED DELIVERIES AND CAESAREAN SECTIONS INCURRED DURING HOSPITALIZATION AND EXPENSES TOWARDS LAWFUL MEDICAL TERMINATION OF PREGNANCY DURING THE POLICY PERIOD ONLY. THIS CLAIM FALLS BEYOND PURVIEW OF POLICY COVERAGE AND HENCE NOT PAYABLE.

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4101220200000103-01 Jayanagar 00118 South 2 NA CHANDRASHEKAR H M Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37117267CESGW ASHVINI H L F Saturday, November 26, 1994 Spouse HOSPITALIZATION REIMBURSEMENT Emergency Caesarean Section Lscs 58193 200623161306-01 12-11-23 01-04-24 Emergency Caesarean Section Lscs Caesarean Section Pune Health Hub Pune Health Hub Paid 0 45344 Wednesday, January 10, 2024 Bellary KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Jan-24 425797112 01-11-24

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4101220200000103-01 Jayanagar 00118 South 2 NA GANESH PRABHU P A Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE 527 GANESH PRABHU P A M Tuesday, March 03, 1992 Self Balanitis CASHLESS Balanitis 57000 100623180368-01 01-26-24 02-09-24 Balanitis Balanitis Pune Health Hub Pune Health Hub Paid 0 45720 Monday, February 12, 2024 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 feb-24 SBIN324043007335 02-12-24

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4101220200000103-01 Jayanagar 00118 South 2 NA GANESH PRABHU P A Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE 527 GANESH PRABHU P A M Tuesday, March 03, 1992 Self SURGICAL CASHLESS SURGICAL 46125 100623173689-01 01-25-24 01-27-24 SURGICAL SURGICAL Pune Health Hub Pune Health Hub Closed 0 02-07-24 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 feb-24 Others

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4101220200000103-01 Jayanagar 00118 South 2 NA GURUPADAPPA PATTANASHETTI Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE 235 GURUPADAPPA PATTANASHETTI F Saturday, October 19, 1991 Spouse G3p1l0a1 With 38+3 Weeks Of Pregnancy With El Lscs CASHLESS G3p1l0a1 With 38+3 Weeks Of Pregnancy With El Lscs 115765 100623175809-01 02-01-24 02-02-24 G3p1l0a1 With 38+3 Weeks Of Pregnancy With El Lscs G3p1l0a1 With 38+3 Weeks Of Pregnancy With El Lscs Pune Health Hub Pune Health Hub Paid 0 75000 Friday, February 09, 2024 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 feb-24 SBIN224043360698 02-12-24

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4101220200000103-01 Jayanagar 00118 South 2 NA GURUPADAPPA PATTANASHETTI Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 GURUPADAPPA PATTANASHETTI 235 GURUPADAPPA PATTANASHETTI M Thursday, February 01, 2024 Son Term Agac REIMBURSEMENT Term ,Agac 23408 200623188379-01 02-01-24 02-22-24 Term Agac Newborn Health Examination Pune Health Hub Pune Health Hub Closed 0 03-09-24 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Mar-24 The reported claim of BABY OF VIJAYALAXMI PATTANASHETTI is for single live term appropriate for gestational age baby boy for which conservative management was done. As per submitted documents it is evident that baby is normal with no complications. As per policy terms and conditions expenses related stay in a hospital without undertaking any active regular treatment by the medical practitioner which ordinarily cannot be given without hospitalization are excluded from policy coverage. As per policy terms and conditions expenses related to any admission primarily tor diagnostics and evaluation purposes are excluded from policy coverage. This claim for hospitalization falls beyond purview of policy coverage and hence not payable.

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4101220200000103-01 Jayanagar 00118 South 2 NA JANAVI B Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE 68 JANAVI B M Wednesday, May 31, 1989 Spouse Bilatred Ll Varicose Veins CASHLESS Bilatred Ll Varicose Veins 146931 100623182488-01 02-02-24 02-12-24 Bilatred Ll Varicose Veins Bilatred Ll Varicose Veins Pune Health Hub Pune Health Hub Paid 0 127304 Wednesday, February 14, 2024 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 feb-24 SBIN424045946294 02-14-24

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4101220200000103-01 Jayanagar 00118 South 2 NA JANAVI B Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE 68 JANAVI B M Wednesday, May 31, 1989 Spouse PREAUTH CASHLESS PREAUTH 145630 100623174426-01 02-01-24 01-30-24 PREAUTH PREAUTH Pune Health Hub Pune Health Hub Closed 0 02-10-24 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 feb-24 Others

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4101220200000103-01 Jayanagar 00118 South 2 NA LAVANYA Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37175777CESGE LAVANYA F Monday, June 02, 1997 Self HOSPITALIZATION REIMBURSEMENT K291 Other Acute Gastritis 33431 200623112433-01 10-02-23 10-10-23 K291 Other Acute Gastritis K291 Other Acute Gastritis Pune Health Hub Pune Health Hub Paid 0 26983 Friday, November 03, 2023 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Nov-23 SBIN423308932010 11-03-23

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4101220200000103-01 Jayanagar 00118 South 2 NA MAHENDRA KUMAR SHRIVAS Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE 397 MAHENDRA KUMAR SHRIVAS M Monday, June 22, 1987 Self SURGERY REIMBURSEMENT SURGERY 50000 200623170280-01 12-22-23 01-22-24 SURGERY SURGERY Pune Health Hub Pune Health Hub Closed 0 02-28-24 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 feb-24 Others

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4101220200000103-01 Jayanagar 00118 South 2 NA MONISHA N Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37409205CESGE MONISHA N F Friday, September 10, 1999 Self HOSPITALIZATION CASHLESS Acid Peptic Dieasae Bppv Urticardia 20613 100623080923-01 08-14-23 08-16-23 Acid Peptic Dieasae Bppv Urticardia Acid Peptic Dieasae Bppv Urticardia Pune Health Hub Pune Health Hub Paid 0 20613 Tuesday, August 22, 2023 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Aug-23 SBIN323234402002 08-22-23

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4101220200000103-01 Jayanagar 00118 South 2 NA NAGAMEGHA KUNTOJI Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN39087981CESGE NAGAMEGHA KUNTOJI F Wednesday, July 07, 1999 Self HOSPITALIZATION CASHLESS Pregnancy 45000 100623162449-01 01-05-24 01-06-24 Pregnancy Pregnancy Pune Health Hub Pune Health Hub Paid 0 45000 Thursday, January 18, 2024 Hubli KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Jan-24 SBIN424019043818 01-19-24

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4101220200000103-01 Jayanagar 00118 South 2 NA NAVEEN KUMAR K L Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE 408 NAVEEN KUMAR K L F Thursday, December 07, 2023 Daughter Term Aga Iugr Female REIMBURSEMENT Term Aga Iugr Female 17165 200623162023-01 12-07-23 01-05-24 Term Aga Iugr Female Term Aga Iugr Lbw Female Lscs Pune Health Hub Pune Health Hub Paid 0 11000 Tuesday, February 06, 2024 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 feb-24 SBIN224038627080 02-07-24

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4101220200000103-01 Jayanagar 00118 South 2 NA NAVEEN KUMAR K L Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE 408 NAVEEN KUMAR K L M Saturday, January 23, 1982 Self Acs With Acute Awmi REIMBURSEMENT Acs With Acute Awmi 10233 100623158742-02 12-29-23 02-09-24 Acs With Acute Awmi Acs With Acute Awmi Pune Health Hub Pune Health Hub Paid 0 10233 Monday, February 26, 2024 Davangere KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 feb-24 SBIN524058959039 02-26-24

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4101220200000103-01 Jayanagar 00118 South 2 NA NAVEEN KUMAR K L Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE 408 NAVEEN KUMAR K L M Saturday, January 23, 1982 Self Acs With Acute Awmi REIMBURSEMENT Acs With Acute Awmi 5734 100623158742-03 12-29-23 02-23-24 Acs With Acute Awmi Acs With Acute Awmi Pune Health Hub Pune Health Hub Paid 0 5734 Wednesday, February 28, 2024 Davangere KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 feb-24 SBIN424060631868 02-28-24

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4101220200000103-01 Jayanagar 00118 South 2 NA NAVEEN KUMAR K L Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN39058000CESGE NAVEEN KUMAR K L M Saturday, January 23, 1982 Self HOSPITALIZATION CASHLESS Acs With Acute Awmi 339754 100623158742-01 12-29-23 01-02-24 Acs With Acute Awmi Acs With Acute Awmi Pune Health Hub Pune Health Hub Paid 0 313521 Tuesday, January 23, 2024 Davangere KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Jan-24 227365637 01-24-24

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4101220200000103-01 Jayanagar 00118 South 2 NA NAVEEN KUMAR K L Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN39058000CESGW POONAM M F Tuesday, June 25, 1991 Spouse HOSPITALIZATION CASHLESS surgical management 73000 100623144978-01 12-07-23 12-08-23 surgical management surgical management Pune Health Hub Pune Health Hub Closed 0 12-29-23 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Dec-23 INTIMATION CLOSED

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4101220200000103-01 Jayanagar 00118 South 2 NA NAVEEN KUMAR K L Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN39058000CESGW POONAM M F Tuesday, June 25, 1991 Spouse HOSPITALIZATION REIMBURSEMENT Emergency Caesarean Section Lscs 124091 200623162104-01 12-07-23 01-05-24 Emergency Caesarean Section Lscs Emergency Caesarean Section Lscs Pune Health Hub Pune Health Hub Paid 0 75000 Wednesday, January 10, 2024 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Jan-24 SBIN124011889642 01-11-24

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4101220200000103-01 Jayanagar 00118 South 2 NA NAVEEN KUMAR K L Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 NAVEEN KUMAR K L 408 NAVEEN KUMAR K L M Saturday, January 23, 1982 Self Acs With Acute Awmi REIMBURSEMENT Acs With Acute Awmi 15194 100623158742-04 12-29-23 03-04-24 Acs With Acute Awmi Acs With Acute Awmi Pune Health Hub Pune Health Hub Paid 0 2300 Thursday, March 07, 2024 Davangere KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Mar-24 SBIN324070137876 03-07-24

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4101220200000103-01 Jayanagar 00118 South 2 NA PAVAN A S Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN39079561CESGE PAVAN A S M Thursday, July 31, 1997 Self HOSPITALIZATION CASHLESS Febrile Thrombocytopenia 25919 100623065979-01 07-18-23 07-19-23 Febrile Thrombocytopenia Febrile Thrombocytopenia Pune Health Hub Pune Health Hub Paid 0 24623 Wednesday, August 02, 2023 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Aug-23 SBIN323214704703 08-02-23

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4101220200000103-01 Jayanagar 00118 South 2 NA RAKSHITHA K B Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN39087960CESGE RAKSHITHA K B F Monday, September 14, 1998 Self HOSPITALIZATION REIMBURSEMENT Primi 75317 200623105465-01 09-27-23 09-28-23 MATERNITY / DELIVERY MATERNITY / DELIVERY Pune Health Hub Pune Health Hub Paid 0 45073 Tuesday, October 31, 2023 Harihara KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Oct-23 SBIN123305288134 11-01-23

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4101220200000103-01 Jayanagar 00118 South 2 NA RAMESH D JADHAV Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37264512CESGW SHOBHA F Wednesday, June 10, 1992 Spouse HOSPITALIZATION REIMBURSEMENT O821 Delivery By Emergency Caesarean Section 45160 200623046381-01 06-13-23 06-15-23 MATERNITY / DELIVERY MATERNITY / DELIVERY Pune Health Hub Pune Health Hub Paid 0 24163 Monday, July 17, 2023 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Jul-23 262972990 07-17-23

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4101220200000103-01 Jayanagar 00118 South 2 NA RAMPRASAD B H Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37117355CESGW ARCHANA NIDIMAMIDI F Sunday, March 28, 1982 Spouse HOSPITALIZATION REIMBURSEMENT R078 Other Chest Pain 519768 200623091639-01 08-11-23 09-04-23 R078 Other Chest Pain R078 Other Chest Pain Pune Health Hub Pune Health Hub Paid 0 54384 Wednesday, September 20, 2023 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Sep-23 SBIN423264428307 09-21-23

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4101220200000103-01 Jayanagar 00118 South 2 NA SANIA RAHMATH Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN39058004CESGD IQRA FATHIMA F Wednesday, October 28, 2020 Daughter HOSPITALIZATION REIMBURSEMENT Fever 22677 200623167040-01 11-13-23 01-16-24 Fever Fever Pune Health Hub Pune Health Hub Paid 0 12873 Monday, January 22, 2024 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Jan-24 404780055 01-23-24

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4101220200000103-01 Jayanagar 00118 South 2 NA SANIA RAHMATH Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN39058004CESGD IQRA FATHIMA F Wednesday, October 28, 2020 Daughter HOSPITALIZATION REIMBURSEMENT Others 80000 200623132140-01 11-15-23 11-16-23 Others Others Pune Health Hub Pune Health Hub Closed 0 12-29-23 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Dec-23 INTIMATION CLOSED

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4101220200000103-01 Jayanagar 00118 South 2 NA SANIA RAHMATH Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN39058004CESGE SANIA RAHMATH F Monday, July 07, 1997 Self HOSPITALIZATION CASHLESS Perianal Abscess 48145 100623074281-01 08-01-23 08-03-23 Perianal Abscess Perianal Abscess Pune Health Hub Pune Health Hub Paid 0 37804 Thursday, August 17, 2023 Udupi KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Aug-23 SBIN423229324380 08-17-23

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4101220200000103-01 Jayanagar 00118 South 2 NA SANTHOSH P Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37117228CESGS MOKSHITH S M Friday, September 27, 2019 Son HOSPITALIZATION CASHLESS Lrti With Dehydration 42697 100623159146-01 12-31-23 01-03-24 Lrti With Dehydration Lrti With Dehydration Pune Health Hub Pune Health Hub Paid 0 32092 Friday, January 19, 2024 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Jan-24 SBIN524022326479 01-22-24

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4101220200000103-01 Jayanagar 00118 South 2 NA SIDDARAM Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN39079546CESGW MANJITA F Monday, September 04, 1995 Spouse HOSPITALIZATION CASHLESS Primigravida With 23+2 Weeks Of Gestation With Threatened Preterm Labor 50000 100623024118-01 03-18-23 05-09-23 Primigravida With 23+2 Weeks Of Gestation With Threatened Preterm Labor Primigravida With 23+2 Weeks Of Gestation With Threatened Preterm Labor Pune Health Hub Pune Health Hub Closed 0 05-31-23 0 KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 May-24 INTIMATION CLOSED

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4101220200000103-01 Jayanagar 00118 South 2 NA SIDDARAM Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN39079546CESGW MANJITA F Monday, September 04, 1995 Spouse HOSPITALIZATION CASHLESS Primigravida With 37 Weeks 6 Days Of Gestation With Lscs 94134 100623055178-01 06-27-23 07-01-23 Primigravida With 37 Weeks 6 Days Of Gestation With Lscs Primigravida With 37 Weeks 6 Days Of Gestation With Lscs Pune Health Hub Pune Health Hub Paid 0 75000 Tuesday, July 04, 2023 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Jul-23 SBIN123186081774 07-04-23

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4101220200000103-01 Jayanagar 00118 South 2 NA SIDDARAM Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN39079546CESGW MANJITA F Monday, September 04, 1995 Spouse HOSPITALIZATION REIMBURSEMENT external bleeding 50000 200622216734-01 03-18-23 03-20-23 external bleeding external bleeding Pune Health Hub Pune Health Hub Closed 0 05-04-23 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 May-24 INTIMATION CLOSED

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4101220200000103-01 Jayanagar 00118 South 2 NA SRIHARIKRISHNA J Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37117230CESGS BABY OF AYSHWARYA R M Sunday, October 08, 2023 Son HOSPITALIZATION REIMBURSEMENT P832 Hydrops Fetalis Not Due To Haemolytic Disease 301854 200623122816-01 10-08-23 10-28-23 P832 Hydrops Fetalis Not Due To Haemolytic Disease P832 Hydrops Fetalis Not Due To Haemolytic Disease Pune Health Hub Pune Health Hub Paid 0 241419 Tuesday, January 09, 2024 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Jan-24 392758205 01-10-24

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4101220200000103-01 Jayanagar 00118 South 2 NA SRIHARIKRISHNA J Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37117230CESGW AYSHWARYA.R F Tuesday, June 27, 1995 Spouse HOSPITALIZATION REIMBURSEMENT Emergency Lscs 98646 200623117708-01 10-08-23 10-18-23 Emergency Lscs Emergency Lscs Pune Health Hub Pune Health Hub Paid 0 50000 Friday, November 03, 2023 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Nov-23 92991411 11-03-23

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4101220200000103-01 Jayanagar 00118 South 2 NA SUDHAMATI M H Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37264527CESGE SUDHAMATI M H F Thursday, January 01, 1998 Self HOSPITALIZATION CASHLESS ADMISSION 75000 100623075060-01 08-02-23 08-04-23 ADMISSION ADMISSION Pune Health Hub Pune Health Hub Closed 0 08-16-23 BIDAR KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Aug-23 INTIMATION CLOSED

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4101220200000103-01 Jayanagar 00118 South 2 NA SUSHMA L K Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN39163064CESGE SUSHMA L K F Saturday, February 04, 1989 Self HOSPITALIZATION REIMBURSEMENT Pregnancy 116451 200623028352-01 04-30-23 05-17-23 Pregnancy Pregnancy Pune Health Hub Pune Health Hub Paid 0 75000 Saturday, May 20, 2023 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 May-24 177010414 05-22-23

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4101220200000103-01 Jayanagar 00118 South 2 NA SWETHA N Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37117347CESGE SWETHA N F Tuesday, May 25, 1993 Self HOSPITALIZATION CASHLESS Details Enclosed 215500 100623103956-01 09-21-23 09-23-23 Details Enclosed Details Enclosed Pune Health Hub Pune Health Hub Closed 0 09-23-23 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Sep-23 PRE AUTHORIZATION DENIED

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4101220200000103-01 Jayanagar 00118 South 2 NA USHA D R Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37117333CESGE USHA D R F Friday, October 21, 1994 Self HOSPITALIZATION CASHLESS G2 P0l0 A1 With Ftp With For Safe Confinsment 90000 100623009780-01 04-13-23 04-14-23 G2 P0l0 A1 With Ftp With For Safe Confinsment G2 P0l0 A1 With Ftp With For Safe Confinsment Pune Health Hub Pune Health Hub Paid 0 75000 Wednesday, April 19, 2023 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Apr-23 SBIN423109519826 04-19-23

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4101220200000103-01 Jayanagar 00118 South 2 NA VENKAT EARTHNI Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37117381CESGW LAKSHMI MOUNIKA F Monday, November 23, 1998 Spouse HOSPITALIZATION CASHLESS Rt Clavicle Necrotic Lymphadenopathy 140651 100623137049-01 11-29-23 11-27-23 Rt Clavicle Necrotic Lymphadenopathy Rt Clavicle Necrotic Lymphadenopathy Pune Health Hub Pune Health Hub Closed 0 12-04-23 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Dec-23 PRE AUTHORIZATION DENIED

•

4101220200000103-01 Jayanagar 00118 South 2 NA VENKAT EARTHNI Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37117381CESGW LAKSHMI MOUNIKA F Monday, November 23, 1998 Spouse HOSPITALIZATION REIMBURSEMENT HOSPITALIZATION 30000 200623035245-01 05-26-23 05-27-23 HOSPITALIZATION HOSPITALIZATION Pune Health Hub Pune Health Hub Closed 0 06-29-23 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Jun-23 INTIMATION CLOSED

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4101220200000103-01 Jayanagar 00118 South 2 NA YOGISH B Group Health Insurance - GMC Health Health 02-11-23 02-10-24 PARAMOUNT HEALTH SERVICES & INSURANCE TPA PVT. LTD 500000 CENTRE FOR SMART GOVERNANCE SBPUN37117240CESGE YOGISH B M Monday, March 19, 1990 Self HOSPITALIZATION CASHLESS Multiple Lipomatosis 75127 100623120098-01 10-22-23 10-23-23 Multiple Lipomatosis Multiple Lipomatosis Pune Health Hub Pune Health Hub Paid 0 53865 Friday, November 17, 2023 Bangalore KARNATAKA Jayanagar 61174 SBI General Insurance Direct Code SME NA Direct 22480 Manya Dubey NO 100 Nov-23 SBIN123324982962 11-20-23

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Applied filters: Policy No is 4101220200000103-01

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Sl.No Emp No Employee NAME Dependent name GENDER D.O.B Age RELATIONSHIP RELATIONSHIP Group

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1 0002 K.G Rajeshwar K.G Rajeshwar Male 05-19-67 58 Self Self 56-60

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2 0002 K.G Rajeshwar M G Suman kumari female 06-06-76 49 Spouse Spouse 46-55

•

3 0002 K.G Rajeshwar K R Gayathri Female 09-09-03 22 Child Kid1 0-35

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4 0004 Sripriya H S Sripriya H S Female 04-06-79 46 Self Self 46-55

•

5 0004 Sripriya H S Shreyas T Male 06-10-10 15 Child Kid1 0-35

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6 0006 K J Thrilok K J Thrilok Male 01-31-78 48 Self Self 46-55

•

7 0006 K J Thrilok Shobha S R Female 10-01-82 43 Spouse Spouse 36-45

•

8 0006 K J Thrilok Dhruvadarshan T Male 08-27-10 15 Child Kid1 0-35

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9 0006 K J Thrilok Vivaan T Male 05-19-15 10 Child Kid2 0-35

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10 0013 Parvathi S Gavimath Parvathi S Gavimath Female 07-22-77 48 Self Self 46-55

•

11 0013 Parvathi S Gavimath Santosh Sharanayya Gavimath Male 03-15-77 49 Spouse Spouse 46-55

•

12 0013 Parvathi S Gavimath Sanjana Santosh Gavimath Female 10-28-05 20 Child Kid1 0-35

•

13 0021 Kavya H N Kavya H N Female 06-30-91 34 Self Self 0-35

•

14 0021 Kavya H N Madhu M C Male 04-01-87 39 Spouse Spouse 36-45

•

15 0021 Kavya H N Paavani Makanur Female 07-13-20 5 Child Kid1 0-35

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16 0029 Akshatha Mahadev Mundaganur Akshatha Mahadev Mundaganur Female 03-16-97 29 Self Self 0-35

•

17 0029 Akshatha Mahadev Mundaganur Ananda Paramananda Halli Male 08-07-97 28 Spouse Spouse 0-35

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18 0041 Santhosh P Santhosh P Male 12-10-86 39 Self Self 36-45

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19 0041 Santhosh P Pavana D S female 05-21-89 36 Spouse Spouse 36-45

•

20 0041 Santhosh P Mokshith S Male 09-27-19 6 Child Kid1 0-35

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21 0047 Seema N A Seema N A Female 12-14-96 29 Self Self 0-35

•

22 0053 Shrikant H Shrikant H Male 01-02-93 33 Self Self 0-35

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23 0055 Rakshith Gowda D P Rakshith Gowda D P Male 04-13-97 28 Self Self 0-35

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24 0058 Nagabhushan M Hosamani Nagabhushan M Hosamani Male 04-02-74 51 Self Self 46-55

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25 0061 Divyashree R N Divyashree R N Female 12-17-96 29 Self Self 0-35

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26 0064 Sanjay Gangadkar Sanjay Gangadkar Male 10-20-95 30 Self Self 0-35

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27 0068 Janavi B Janavi B Female 08-19-94 31 Self Self 0-35

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28 0068 Janavi B Chethan H Male 05-31-89 36 Spouse Spouse 36-45

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29 0068 Janavi B Pragna C Female 05-23-21 4 Child Kid1 0-35

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30 0077 Indushree Indushree Female 05-05-98 27 Self Self 0-35

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31 0084 Basavaraja G H Basavaraja G H Male 03-25-80 46 Self Self 46-55

•

32 0084 Basavaraja G H Padmavathi S Female 10-12-86 39 Spouse Spouse 36-45

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33 0084 Basavaraja G H Vihaan B H Male 07-26-17 8 Child Kid1 0-35

•

34 0084 Basavaraja G H Shreshta B H Female 09-11-19 6 Child Kid2 0-35

•

35 0089 Dhanushree S Dhanushree S Female 11-14-95 30 Self Self 0-35

•

36 0089 Dhanushree S Arun Kumar H V Male 04-21-95 30 Spouse Spouse 0-35

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37 0093 Kumarswamy H R Kumarswamy H R Male 05-20-78 47 Self Self 46-55

•

38 0093 Kumarswamy H R Anu M Female 08-01-86 39 Spouse Spouse 36-45

•

39 0093 Kumarswamy H R Guhan K H Male 12-28-11 14 Child Kid1 0-35

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40 0095 Vijaya Bhaskar N Vijaya Bhaskar N Male 04-18-79 46 Self Self 46-55

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41 0095 Vijaya Bhaskar N Shilpa Female 09-24-80 45 Spouse Spouse 36-45

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42 0100 Chethan K Chethan K Male 06-24-84 41 Self Self 36-45

•

43 0100 Chethan K Vandhana P Female 05-04-92 33 Spouse Spouse 0-35

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44 0100 Chethan K Gaurav C Male 11-08-16 9 Child Kid1 0-35

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45 0100 Chethan K Bhargav C Male 10-13-21 4 Child Kid2 0-35

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46 0104 Ramya G A Ramya G A Female 09-04-89 36 Self Self 36-45

•

47 0104 Ramya G A Raveesh H Male 07-21-88 37 Spouse Spouse 36-45

•

48 0111 Mithun Patil Mithun Patil Male 06-02-79 46 Self Self 46-55

•

49 0111 Mithun Patil Swetha Patil Female 08-02-85 40 Spouse Spouse 36-45

•

50 0111 Mithun Patil Arjun Patil Male 05-29-14 11 Child Kid1 0-35

•

51 0113 Raghunath K S Raghunath K S Male 05-20-68 57 Self Self 56-60

•

52 0113 Raghunath K S Uma B N Female 12-19-72 53 Spouse Spouse 46-55

•

53 0113 Raghunath K S Surabhi R Female 06-27-05 20 Child Kid1 0-35

•

54 0116 Praveen S Patil Praveen S Patil Male 10-30-98 27 Self Self 0-35

•

55 0119 Santosh Bakkappa Santosh Bakkappa Male 01-22-75 51 Self Self 46-55

•

56 0119 Santosh Bakkappa Shailaja Female 03-21-82 44 Spouse Spouse 36-45

•

57 0119 Santosh Bakkappa Riya Santosh Bakkappa Female 09-15-09 16 Child Kid1 0-35

•

58 0119 Santosh Bakkappa Megha Santosh Bakkappa Female 12-25-10 15 Child Kid2 0-35

•

59 0121 Ramesha L B Ramesha L B Male 03-01-87 39 Self Self 36-45

•

60 0121 Ramesha L B Ranjini B S Female 06-01-90 35 Spouse Spouse 0-35

•

61 0121 Ramesha L B Baby of Ranjini B S Female 10-05-24 1 Child Kid1 0-35

•

62 0130 Suchitra V Suchitra V Female 08-15-94 31 Self Self 0-35

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63 0137 Abhishek Abhishek Male 01-03-92 34 Self Self 0-35

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64 0137 Abhishek Priya Darshini Female 10-13-93 32 Spouse Spouse 0-35

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65 0137 Abhishek Adya Abhishek Female 08-02-21 4 Child Kid1 0-35

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66 0137 Abhishek Tanvi Abhishek Female 02-02-24 2 Child Kid2 0-35

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67 0138 Chandrashekar H M Chandrashekar H M Male 07-06-88 37 Self Self 36-45

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68 0138 Chandrashekar H M Ashvini H L Female 11-26-94 31 Spouse Spouse 0-35

•

69 0138 Chandrashekar H M Baby of Ashvini H L Female 12-11-23 2 Child Kid1 0-35

•

70 0139 Vijay Kumar K Vijay Kumar K Male 11-24-73 52 Self Self 46-55

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71 0139 Vijay Kumar K Shashikala M Female 01-23-77 49 Spouse Spouse 46-55

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72 0139 Vijay Kumar K Harsha V Male 12-16-05 20 Child Kid1 0-35

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73 0142 Dheemanth Urs. R Dheemanth Urs. R Male 05-11-91 34 Self Self 0-35

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74 0142 Dheemanth Urs. R Sandhya R Female 06-30-93 32 Spouse Spouse 0-35

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75 0142 Dheemanth Urs. R Baby of Sandhya R Male 01-09-25 1 Child Kid1 0-35

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76 0154 Kusuma B Kusuma B Female 11-10-97 28 Self Self 0-35

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77 0155 Prajvitha.U.P Prajvitha.U.P Female 02-27-94 32 Self Self 0-35

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78 0158 Saurabh Bhattacharya Saurabh Bhattacharya Male 12-03-78 47 Self Self 46-55

•

79 0158 Saurabh Bhattacharya Shuchi Bhattacharya Female 05-23-81 44 Spouse Spouse 36-45

•

80 0158 Saurabh Bhattacharya Sharang Bhattacharya Male 12-23-06 19 Child Kid1 0-35

•

81 0158 Saurabh Bhattacharya Sauvarn Bhattacharya Male 10-07-14 11 Child Kid2 0-35

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82 0159 Veeresh Meti Veeresh Meti Male 05-03-94 31 Self Self 0-35

•

83 0163 Arun Patil Arun Patil Male 06-25-87 38 Self Self 36-45

•

84 0163 Arun Patil Chaithra Arun Patil Female 03-07-95 31 Spouse Spouse 0-35

•

85 0163 Arun Patil Aaghnya A Patil Female 03-14-24 2 Child Kid1 0-35

•

86 0165 PRATHESHA C PRATHESHA C Male 05-02-89 36 Self Self 36-45

•

87 0165 PRATHESHA C Yarramaneni Jyoshna Female 07-11-00 25 Spouse Spouse 0-35

•

88 0170 Vinod Kumar V S Vinod Kumar V S Male 05-30-81 44 Self Self 36-45

•

89 0171 Bhargavi C S Bhargavi C S Female 05-23-89 36 Self Self 36-45

•

90 0171 Bhargavi C S Chandan B E Male 06-18-89 36 Spouse Spouse 36-45

•

91 0174 Venkata Mounasri T Venkata Mounasri T Female 07-23-87 38 Self Self 36-45

•

92 0174 Venkata Mounasri T Prasanna Kumar CVR Male 07-08-81 44 Spouse Spouse 36-45

•

93 0174 Venkata Mounasri T Pratham Raj P Male 09-28-11 14 Child Kid1 0-35

•

94 0177 Sandhya T Sandhya T Female 06-24-97 28 Self Self 0-35

•

95 0182 Hanumantha Reddy Hanumantha Reddy Male 06-14-92 33 Self Self 0-35

•

96 0182 Hanumantha Reddy Bandi Anantha Lakshmi Female 06-20-93 32 Spouse Spouse 0-35

•

97 0182 Hanumantha Reddy Bandi Rushi Sai Reddy Male 10-16-23 2 Child Kid1 0-35

•

98 0182 Hanumantha Reddy Baby of Bandi Anantha Lakshmi Male 06-20-25 3 months Child Kid2 0-35

•

99 0184 Gowtham K Gowtham K Male 09-08-95 30 Self Self 0-35

•

100 0187 Shubham Jain Shubham Jain Male 01-09-97 29 Self Self 0-35

•

101 0188 Shashank Gowda M K Shashank Gowda M K Male 08-23-91 34 Self Self 0-35

•

102 0188 Shashank Gowda M K Keerthana Shankar Female 10-02-91 34 Spouse Spouse 0-35

•

103 0192 Annaray B Annaray B Male 06-02-86 39 Self Self 36-45

•

104 0192 Annaray B Mahalakshmi Female 12-09-94 31 Spouse Spouse 0-35

•

105 0192 Annaray B Tejit Male 04-30-18 7 Child Kid1 0-35

•

106 0192 Annaray B Thrilok Male 07-18-21 4 Child Kid2 0-35

•

107 0203 Sudeep Kumar K Sudeep Kumar K Male 12-09-94 31 Self Self 0-35

•

108 0204 Arjun Arjun Male 07-04-97 28 Self Self 0-35

•

109 0205 Pavana H R Pavana H R Male 05-10-97 28 Self Self 0-35

•

110 0206 Sadiq A Mulla Sadiq A Mulla Male 01-04-93 33 Self Self 0-35

•

111 0206 Sadiq A Mulla Neelofar Kandagal Female 08-20-96 29 Spouse Spouse 0-35

•

112 0208 Atrey kulkarni Atrey kulkarni Male 07-16-86 39 Self Self 36-45

•

113 0209 Bindushri V Bindushri V Female 04-27-97 28 Self Self 0-35

•

114 0210 Vineeth Vineeth Male 06-11-97 28 Self Self 0-35

•

115 0211 Yuktha M Yuktha M Female 06-28-99 26 Self Self 0-35

•

116 0212 Meghana M C Meghana M C Female 05-01-99 26 self self 0-35

•

117 0214 Tejashree K Tejashree K Female 08-20-99 26 Self Self 0-35

•

118 0216 Kavya G D Kavya G D Female 07-18-94 31 Self Self 0-35

•

119 0219 Vijayalaxmi desai Vijayalaxmi desai Female 08-09-96 29 Self Self 0-35

•

120 0221 Manjunath C K Manjunath C K Male 05-30-87 38 Self Self 36-45

•

121 0221 Manjunath C K Bhavyashree SN Female 03-14-90 36 Spouse Spouse 36-45

•

122 0221 Manjunath C K Sourabhi manjunath Female 09-20-21 4 Child Kid1 0-35

•

123 0221 Manjunath C K Baby of Bhavyashree SN Female 07-04-24 1 Child Kid2 0-35

•

124 0223 Naveen Kumar R Naveen Kumar R Male 10-16-75 50 Self Self 46-55

•

125 0223 Naveen Kumar R Poornima R Female 07-15-80 45 Spouse Spouse 36-45

•

126 0223 Naveen Kumar R Samarth N Kumar Male 02-21-10 16 Child Kid1 0-35

•

127 0225 Sivith M.S Sivith M.S Male 08-09-92 33 Self Self 0-35

•

128 0226 Prakruthi S Prakruthi S Female 08-19-96 29 Self Self 0-35

•

129 0226 Prakruthi S Chandan J C Male 09-23-94 31 Spouse Spouse 0-35

•

130 0228 Raksha R Pai Raksha R Pai Female 05-15-99 26 Self Self 0-35

•

131 0228 Raksha R Pai Ananth Kamath K Male 02-21-98 28 Spouse Spouse 0-35

•

132 0229 Akshatha H V Akshatha H V Female 12-04-98 27 Self Self 0-35

•

133 0230 Divya V Divya V Female 11-30-98 27 Self Self 0-35

•

134 0231 Chethan G Chethan G Male 10-07-98 27 Self Self 0-35

•

135 0233 Vinay. S Vinay. S Male 09-13-91 34 Self Self 0-35

•

136 0233 Vinay. S Prathyusha. M Female 07-23-96 29 Spouse Spouse 0-35

•

137 0233 Vinay. S Baby of Prathyusha. M Female 11-25-24 1 Child Kid1 0-35

•

138 0235 Gurupadappa Pattanashetti Gurupadappa Pattanashetti Male 07-28-88 37 Self Self 36-45

•

139 0235 Gurupadappa Pattanashetti Vijayalaxmi Pattanashetti Female 10-19-91 34 Spouse Spouse 0-35

•

140 0235 Gurupadappa Pattanashetti Prashul Pattanashetti Male 02-01-24 2 Child Kid1 0-35

•

141 0237 Swetha N Swetha N Female 05-25-93 32 Self Self 0-35

•

142 0237 Swetha N Harsha B Male 02-15-84 42 Spouse Spouse 36-45

•

143 0237 Swetha N Shivankh Harsha Male 03-07-24 2 Child Kid1 0-35

•

144 0238 Navya Shree B M Navya Shree B M Female 06-09-91 34 Self Self 0-35

•

145 0238 Navya Shree B M Rajeev J N Male 08-26-89 36 Spouse Spouse 36-45

•

146 0238 Navya Shree B M Abhyudaya Datta J R Male 02-25-19 7 Child Kid1 0-35

•

147 0239 Aniket Naik Aniket Naik Male 03-04-90 36 Self Self 36-45

•

148 0239 Aniket Naik Pranoti Nachane female 02-11-93 33 Spouse Spouse 0-35

•

149 0241 Shalini K S Shalini K S Female 11-17-84 41 Self Self 36-45

•

150 0241 Shalini K S Hanumantha.N Male 05-05-70 55 Spouse Spouse 46-55

•

151 0241 Shalini K S Dhatri.H Female 10-14-10 15 Child Kid1 0-35

•

152 0242 Devika B V Devika B V female 08-29-85 40 Self Self 36-45

•

153 0243 Shashwini Sridhar Shashwini Sridhar Female 09-19-91 34 Self Self 0-35

•

154 0245 Ramprasad B H Ramprasad B H Male 12-27-77 48 Self Self 46-55

•

155 0245 Ramprasad B H Archana Nidimamidi Female 03-28-82 44 Spouse Spouse 36-45

•

156 0245 Ramprasad B H Sanjana B R Female 12-04-04 21 Child Kid1 0-35

•

157 0245 Ramprasad B H Sarayu B R Female 04-04-09 16 Child Kid2 0-35

•

158 0246 Ayesha Jamadar Ayesha Jamadar Female 10-16-87 38 Self Self 36-45

•

159 0247 Duragappa Duragappa Male 06-01-88 37 Self Self 36-45

•

160 0247 Duragappa Lakshmi N Female 01-01-95 31 Spouse Spouse 0-35

•

161 0247 Duragappa Baby of Lakshmi N Male 03-03-25 1 Child Kid1 0-35

•

162 0248 Sushma L K Sushma L K Female 02-04-89 37 Self Self 36-45

•

163 0248 Sushma L K Jagadish ME Male 11-28-86 39 Spouse Spouse 36-45

•

164 0248 Sushma L K Shourvik Gowda Male 04-06-21 4 Child Kid1 0-35

•

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•

424 0553 Shobharani H R Vismaya M Female 07-02-02 23 Child Kid1 0-35

•

425 0553 Shobharani H R Vinaya M Female 03-29-06 20 Child Kid2 0-35

•

426 0555 Bharatesh Patil Bharatesh Patil Male 12-10-97 28 Self Self 0-35

•

427 0556 Varun M N Varun M N Male 04-06-97 28 Self Self 0-35

•

428 0557 Munish Sharma Munish Sharma Male 02-06-71 55 Self Self 46-55

•

429 0557 Munish Sharma Archana Sharma Female 12-08-72 53 Spouse Spouse 46-55

•

430 0557 Munish Sharma Shreya Sharma Female 07-23-05 20 Child Kid1 0-35

•

431 0558 Ruthramoorthy P R Ruthramoorthy P R Male 09-09-94 31 Self Self 0-35

•

432 0558 Ruthramoorthy P R Priyanka S Male 06-30-99 26 Spouse Spouse 0-35

•

433 0559 Pavan Kumar Deshpande Pavan Kumar Deshpande Male 04-18-90 35 Self Self 0-35

•

434 0559 Pavan Kumar Deshpande Trupti Joshi Female 01-21-90 36 Spouse Spouse 36-45

•

435 0559 Pavan Kumar Deshpande Vihaan Deshpande Male 08-07-20 5 Child Kid1 0-35

•

436 0561 Vijay Kumar S Vijay Kumar S Male 07-17-01 24 Self Self 0-35

•

437 0563 Chandana J Chandana J Female 02-14-02 24 Self Self 0-35

•

438 0564 Piku Maity Piku Maity Male 05-01-99 26 Self Self 0-35

•

439 0565 Manikanta G M Manikanta G M Male 04-19-97 28 Self Self 0-35

•

440 0566 Shaik Tajuddin Shaik Tajuddin Male 09-20-86 39 Self Self 36-45

•

441 0566 Shaik Tajuddin Pathan Naziya Female 01-12-94 32 Spouse Spouse 0-35

•

442 0566 Shaik Tajuddin Zaara Falak Female 02-18-15 11 Child Kid1 0-35

•

443 0566 Shaik Tajuddin Shaik Zayan Male 06-11-18 7 Child Kid2 0-35

•

444 0572 Vaishnavi Dhore Vaishnavi Dhore Female 02-01-95 31 Self Self 0-35

•

445 0573 Arvind Eshwar M C Arvind Eshwar M C Male 23-Aug-01 24 Self Self 0-35

•

446 0574 Poornima S Poornima S Female 19-May-86 39 Self Self 36-45

•

447 0574 Poornima S Dinesh S Male 21-Sep-75 50 Spouse Spouse 46-55

•

448 0575 Soumya P Soumya P Female 17-Jul-99 26 Self Self 0-35

•

449 0576 Madhusoodhanan P Madhusoodhanan P Male 19-May-96 29 Self Self 0-35

•

450 0577 U Karthik U Karthik Male 10-Jul-02 23 Self Self 0-35

•

451 0578 Rajendra Prasad H S Rajendra Prasad H S Male 22-Mar-02 24 Self Self 0-35

•

452 0579 Manu G M Manu G M Male 18-Nov-01 24 Self Self 0-35

•

453 0580 Keerthan Chandra M Keerthan Chandra M Male 9-Oct-02 23 Self Self 0-35

•

454 0581 N P Pratik N P Pratik Male 13-Aug-02 23 Self Self 0-35

•

455 0582 Rajat Raghavendra Hegde Rajat Raghavendra Hegde Male 24-Dec-02 23 Self Self 0-35

•

456 0583 Bibi Haleema N Bibi Haleema N Female 7-Jan-02 24 Self Self 0-35

•

457 0584 Yash Veer Yash Veer Male 25-May-99 26 Self Self 0-35

•

458 0585 Anurag Gadhave Anurag Gadhave Male 5-Dec-91 34 Self Self 0-35

•

459 0586 Shrihari Ravi Nadar Shrihari Ravi Nadar Male 27-Oct-00 25 Self Self 0-35

•

460 0587 Muneer Wadageri Muneer Wadageri Male 07-25-89 36 Self Self 36-45

•

461 0587 Muneer Wadageri Ajreen Muneer Wadageri Female 14-Nov-97 28 Spouse Spouse 0-35

•

462 0587 Muneer Wadageri Anaiza Muneer Wadageri Female 7-May-23 2 Child Kid1 0-35

•

463 0588 Subhashree Ragte Subhashree Ragte Female 23-Oct-93 32 Self Self 0-35

•

464 0588 Subhashree Ragte Anuj Malleshappa Male 23-May-92 33 Spouse Spouse 0-35

•

465 0589 Nischitha N Nischitha N Female 22-Jun-00 25 Self Self 0-35

•

466 0590 Sourabh Madiwal Sourabh Madiwal Male 29-Jul-97 28 Self Self 0-35

•

467 0591 Manjunath Reddy Manjunath Reddy Male 10-Jun-96 29 Self Self 0-35

•

468 0592 Sharan S Sharan S Male 30-Aug-01 24 Self Self 0-35

•

469 0593 Srinidhi S Kashyap Srinidhi S Kashyap Male 17-Feb-95 31 Self Self 0-35

•

470 0593 Srinidhi S Kashyap Bindu Raj N Female 15-Aug-97 28 Spouse Spouse 0-35

•

471 0593 Srinidhi S Kashyap Baby of Bindu Raj N Male 18-Sep-25 0 Child Kid1 0-35

•

472 0595 Rakshith K S Rakshith K S Male 21-Jul-99 26 Self Self 0-35

•

473 0596 M Gowtham M Gowtham Male 4-Aug-03 22 Self Self 0-35

•

474 0597 Kunduru Keshava Kunduru Keshava Male 29-Aug-99 26 Self Self 0-35

•

475 0598 Saveesh P M Saveesh P M Male 11-15-89 36 Self Self 36-45

•

476 0598 Saveesh P M Shilpa A S Female 06-22-92 33 Spouse Spouse 0-35

•

477 0599 Jagadesh. G Jagadesh. G Male 09-12-97 28 Self Self 0-35

•

478 0600 Rajashri M Bashetti Rajashri M Bashetti Female 07-20-91 34 Self Self 0-35

•

479 0601 Madhu Bhaskar Katakamsetti Madhu Bhaskar Katakamsetti Male 09-24-93 32 Self Self 0-35

•

480 0601 Madhu Bhaskar Katakamsetti Narla Lakshmi Mounica Female 11-18-94 31 Spouse Spouse 0-35

•

481 0601 Madhu Bhaskar Katakamsetti Katakamsetti Bhavica Female 02-07-24 2 Child Kid1 0-35

•

482 0602 Santhosh R Patil Santhosh R Patil Male 01-04-74 52 Self Self 46-55

•

483 0602 Santhosh R Patil Shoba A C Female 08-30-74 51 Spouse Spouse 46-55

•

484 0602 Santhosh R Patil Shreya S Patil Female 02-24-06 20 Child Kid1 0-35

•

485 0603 Naveen Kumar D Naveen Kumar D Male 05-20-76 49 Self Self 46-55

•

486 0603 Naveen Kumar D Vasantha Kumari M M Female 07-21-80 45 Spouse Spouse 36-45

•

487 0603 Naveen Kumar D Vikas N Male 01-08-09 17 Child Kid1 0-35

•

488 0604 Kavyashree D Kavyashree D Female 03-24-00 26 Self Self 0-35

•

489 0605 Shasivardhan B Shasivardhan B Male 10-14-01 24 Self Self 0-35

•

490 0606 Shivakumar Gudala Shivakumar Gudala Male 06-26-00 25 Self Self 0-35

•

491 0607 Hanumantha T P Hanumantha T P Male 11-21-99 26 Self Self 0-35

•

492 0608 Deepak Kumawat Deepak Kumawat Male 11-26-01 24 Self Self 0-35

•

493 0609 Vijayalakshmi R A Vijayalakshmi R A Female 06-19-98 27 Self Self 0-35

•

494 0610 Keerthana V Naik Keerthana V Naik Female 07-07-02 23 Self Self 0-35

•

495 0611 Kanaka J Kanaka J Female 10-16-03 22 Self Self 0-35

•

496 0612 Kartik D Narayanpur Kartik D Narayanpur Male 05-16-01 24 Self Self 0-35

•

497 0613 Durgesh Shetty Durgesh Shetty Male 09-28-03 22 Self Self 0-35

•

498 0614 Suman Chaithalya S M Suman Chaithalya S M Female 12-03-03 22 Self Self 0-35

•

499 0615 Preethi Preethi Female 02-05-04 22 Self Self 0-35

•

500 0616 Manikya H Hansabhavi Manikya H Hansabhavi Female 04-20-00 25 Self Self 0-35

•

501 0617 B S Nivedhan B S Nivedhan Male 02-23-03 23 Self Self 0-35

•

502 0618 Santosh C Kumbar Santosh C Kumbar Male 09-29-01 24 Self Self 0-35

•

503 0619 Rahul Rahul Male 08-15-03 22 Self Self 0-35

•

504 0620 Venkatesh Kumar V Venkatesh Kumar V Male 09-19-03 22 Self Self 0-35

•

505 0621 Harshadeep Donapati Harshadeep Donapati Male 06-04-03 22 Self Self 0-35

•

506 0622 Ankit Parwani Ankit Parwani Male 10-28-96 29 Self Self 0-35

•

507 0623 Prajit Banerjee Prajit Banerjee Male 05-26-99 26 Self Self 0-35

•

508 0624 Abhijeet Kumar Sharma Abhijeet Kumar Sharma Male 08-10-97 28 Self Self 0-35

•

509 0625 Akanksha Akanksha Female 03-10-03 23 Self Self 0-35

•

510 0626 K R Mahaadevan K R Mahaadevan Male 08-04-02 23 Self Self 0-35

•

511 0627 R Satish Kumar R Satish Kumar Male 03-29-72 54 Self Self 46-55

•

512 0627 R Satish Kumar S Lakshmi Female 04-01-77 49 Spouse Spouse 46-55

•

513 0627 R Satish Kumar S Shreyas Male 01-09-01 25 Child Kid1 0-35

•

514 0628 Sahana K R Sahana K R Male 12-08-03 22 Self Self 0-35

•

515 0629 Shankaraling Kalaburagi Shankaraling Kalaburagi Male 07-20-00 25 Self Self 0-35

•

516 0630 Baban Kumar Singh Baban Kumar Singh Male 01-15-89 37 Self Self 36-45

•

517 0630 Baban Kumar Singh Shwetha Kumari Female 01-05-91 35 Spouse Spouse 0-35

•

518 0630 Baban Kumar Singh Anshika Singh Female 04-11-18 7 Child Kid1 0-35

•

519 0630 Baban Kumar Singh Shreyansh Kumar Male 07-20-19 6 Child Kid2 0-35

•

520 0631 Harish R Harish R Male 10-01-02 23 Self Self 0-35

•

521 0632 Swathi B M Swathi B M Female 03-10-02 24 Self Self 0-35

•

522 0633 Divya Srinivas Divya Srinivas Female 08-19-87 38 Self Self 36-45

•

523 0634 Diwakar B L Diwakar B L Male 10-11-86 39 Self Self 36-45

•

524 0634 Diwakar B L Deepanjali L Female 10-23-88 37 Spouse Spouse 36-45

•

525 0634 Diwakar B L Devansh D Male 04-02-22 3 Child Kid1 0-35

•

526 0635 Suthesh M Suthesh M Male 04-30-99 26 Self Self 0-35

•

527 0636 Vasu D G Vasu D G Male 05-31-84 41 Self Self 36-45

•

528 0636 Vasu D G Ashwini R Female 04-08-89 36 Spouse Spouse 36-45

•

529 0636 Vasu D G Hemanya V Female 12-20-13 12 Daughter Kid1 0-35

•

530 0636 Vasu D G Jnanavi V Female 09-23-19 6 Daughter Kid2 0-35

•

531 0637 Rishabh Tripathi Rishabh Tripathi Male 09-13-04 21 Self Self 0-35

•

532 0638 Manjunatha Swamy M N Manjunatha Swamy M N Male 02-09-95 31 Self Self 0-35

•

533 0639 Rakshitha N Rakshitha N Female 07-18-02 23 Self Self 0-35

•

534 0640 Rakesh G M Rakesh G M Male 11-24-00 25 Self Self 0-35

•

535 0641 Raksha Bhat Raksha Bhat Female 05-31-01 25 Self Self 0-35

•

536 0642 Rakesh Kumar Reddy Malaka Rakesh Kumar Reddy Malaka Male 10-27-00 25 Self Self 0-35

•

537 0643 Manthan Goudar Manthan Goudar Male 03-08-01 25 Self Self 0-35

•

538 0644 Bharath Raj B A Bharath Raj B A Male 05-15-98 27 Self Self 0-35

•

Insurance Name Policy No Master Policy No Member Inception date Policy Start date Policy End date Company Name Proposer Name Policy Type Product type Product Name Sum Insured Cumulative Bonus Proposer Name Employee Name Proposer SBIG Member ID Patient Name Patient SBIG Member ID Gender DOB Age Relationship Employee code Balance Suminsured MAID Address Insured City Insured District Insured State Pincode Providername Provider PANNo Provideraddress Providerplace Providerstate Provider Pincode Provider Mobile No Provider Email Rohini Code PROVIDERTYPE Provider Discount Admission Type Date of Admission Date of Discharge Service Type Claim No Claim Type Requesttype External Status Type of treatment ICD 10 Code Primary Diagnosis Group Class Of Accommodation Corporate Buffer Utilization Claimamount Incurred Amount Disallowed made towards co pay Disallowed made towards deductibles Disallowed owing to sub limits imposed Disallowed towards Non Medical Items Disallowed towards Proportionate deductions Dis Allowence Reason Latest Transaction Payment Transaction ID UTR Payment Transaction Date Claimcreateddatetime Fhp Disease

•

SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Deepak Kumar Singh GM1251355600 Anika Singh GM1251355601 F 12-Feb-2023 2 Daughter 267 445922 4021571676 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Sumathi Nursing & Maternity Home AASFS8564P #426/12, 2nd Cross, Mathikere Layout, Behind Canara Bank-Bengaluru Urban Bengaluru Karnataka 560054 7026596685 [email protected] 8900080186941 Network Emergency 18-Mar-2025 12:00:00 21-Mar-2025 12:00:00 IPD 90891756 Cashless Cashless Claim Paid Allopathy J22.0 DISORDERS OF THE RESPIRATORY SYSTEM Single private room 0 28924 26724 0 0 2200 0 NMEs:-500.00,processing fee:-600.00,DOCUMENTATION FEE:-600.00,REGISTRATION FEE:-500.00 31-Mar-2025 02:00:44 359851928 31-Mar-2025 02:00:33 19-Mar-2025 05:13:10 Unspecified acute lower respiratory infection

•

SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Harshitha C GM1251351300 Harshitha C GM1251351300 F 10-Apr-1994 30 Self 98 448852 4021571719 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 MOTHERHOOD HOSPITAL(A UNIT OF RHEA HEALTHCARE PRIVATE LIMITED) AADCR9846F #17/12-4/19, 30th Main Road Banagirinagara Banashankari 3rd Stage-Bengaluru Urban bengaluru Karnataka 560085 9606089896 [email protected] 8900080397187 Network Planned 20-Mar-2025 12:00:00 23-Mar-2025 12:00:00 IPD 90900768 Reimbursement Reimbursement Claim Paid Allopathy O82.0 CAESAREAN SECTION Single private room 0 105433 20066 0 85367 0 MAINTAINANCE CHARGES:-1000.00,DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES:-3200.00,ALCOHOL SWABES:-2.00,URINE CONTAINER:-55.00,FACE MASK:-140.00,APRON:-154.00,GOWN:-230.00,BED SHEET - DISPOSABLE:-300.00,ADHESIVE BANDAGE:-324.00,FLEXI MASK:-331.00,URINE BAG:-360.00,GAUZE:-780.00,BED UNDER PAD CHARGES:-2160.00,ANY KIT WITH NO DETAILS MENTIONED (DELIVERY KIT, ORTHOKIT, RECOVERY KIT, ETC):-3080.00,EXAMINATION GLOVES:-3251.00 23-Apr-2025 12:00:20 SBIN125092515940 23-Apr-2025 12:00:12 26-Mar-2025 11:50:25 Encounter for cesarean delivery without indication

•

SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 21-Mar-2025 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Harshitha C GM1251351300 Baby of Harshitha C GM1251351302 M 21-Mar-2025 1 Son 98 448852 4025763272 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 MOTHERHOOD HOSPITAL(A UNIT OF RHEA HEALTHCARE PRIVATE LIMITED) AADCR9846F #17/12-4/19, 30th Main Road Banagirinagara Banashankari 3rd Stage-Bengaluru Urban bengaluru Karnataka 560085 9606089896 [email protected] 8900080397187 Network Planned 21-Mar-2025 12:00:00 24-Mar-2025 12:00:00 IPD 90907360 Reimbursement Reimbursement Claim Paid Allopathy P08.1 NEONATAL DISORDERS Single private room 0 34925 30717 0 4208 0 GOGGLE:-19.00,DIAPER OF ANY TYPE:-450.00,WET WIPES:-199.00,ADMISSION/REGISTRATION CHARGES:-1800.00,MEDICAL RECORDS:-1100.00,FOOD CHARGES (OTHER THAN PATIENT's DIET PROVIDED BY HOSPITAL):-640.00 05-Apr-2025 02:00:24 SBIN325094380980 05-Apr-2025 02:00:19 31-Mar-2025 10:23:51 Other heavy for gestational age newborn

•

SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Venkat Earthni GM1251356100 Lakshmi Mounika GM1251356102 F 23-Nov-1998 26 Spouse 273 415592 4021572166 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Manipal Hospital - Hebbal AACCC2943F Kirloskar Business Park, Bellary Road,Vinayakanagar-Bengaluru Urban bengaluru Karnataka 560024 9902249308 [email protected] 8900080184299 Network Planned 02-Apr-2025 12:00:00 03-Apr-2025 12:00:00 IPD 90908339 Cashless Cashless Claim Paid Allopathy A18.2 INFECTIOUS DISEASES (BACTERIAL / VIRAL / Others) General/Economy ward 0 83257 71288 0 0 9987 0 ADMISSION CHG:-700.00,MISCELLANEOUS CHARGES:-1470.00,Room Rent / Nursing Excess of Tariff rates - not to be collected from the patient: 1100.00:-1100.00,URINE ROUTINE CONTAINER:-12.00,OT TABLE SHEET:-600.00,BED BATH TOWEL:-600.00,NEBULIZER MASK:-626.00,NMEs:-500.00,ECG ELECTRODES:-220.00,GLOVES:-649.00,Room Rent / Nursing Excess of Tariff rates - not to be collected from the patient: 510.00:-510.00,Room Rent / Nursing Excess of Tariff rates - not to be collected from the patient: 3000.000:-3000.000 19-Apr-2025 02:00:22 SBIN125107432125 19-Apr-2025 02:00:16 31-Mar-2025 05:00:41 Tuberculous peripheral lymphadenopathy

•

SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 21-Mar-2025 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Harshitha C GM1251351300 Baby of Harshitha C GM1251351302 M 21-Mar-2025 1 Son 98 448852 4025763272 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 MOTHERHOOD HOSPITAL(A UNIT OF RHEA HEALTHCARE PRIVATE LIMITED) AADCR9846F #17/12-4/19, 30th Main Road Banagirinagara Banashankari 3rd Stage-Bengaluru Urban bengaluru Karnataka 560085 9606089896 [email protected] 8900080397187 Network Planned 21-Mar-2025 12:00:00 24-Mar-2025 12:00:00 IPD 90908348 Reimbursement Post Hospitalisation Claim Paid Allopathy P59.9 NEONATAL DISORDERS General/Economy ward 0 1130 280 0 850 0 NO BILLS FOUND:-850.00 04-Apr-2025 02:00:07 SBIN125093924407 04-Apr-2025 02:00:06 31-Mar-2025 05:08:57 Neonatal jaundice, unspecified

•

SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Ramprasad B H GM1251373200 Sarayu B R GM1251373202 F 04-Apr-2009 15 Daughter 245 465440 4021572000 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Atreum Hospitals Private Limited AAQCA0059G 916 D , 80 feet road, Ideal homes town ship Rajarajeshwari nagar-Bengaluru Urban bengaluru Karnataka 560098 9513704021 [email protected] 8900080413832 Network Planned 21-Apr-2025 12:00:00 23-Apr-2025 12:00:00 IPD 90947232 Reimbursement Reimbursement Claim Paid Allopathy K29.00 DISORDERS OF THE GASTROINTESTINAL SYSTEM General/Economy ward 0 37409 34560 0 2849 0 return:-849.00,DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES:-1000.00,initial assement chg:-1000.00 06-May-2025 02:00:11 118462055 06-May-2025 02:00:09 29-Apr-2025 09:57:30 Acute gastritis without bleeding

•

SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Naveen Kumar K L GM1251371400 Poonam M GM1251371403 F 25-Jun-1991 33 Spouse 408 273648 4021571869 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Manipal Hospital - Hebbal AACCC2943F Kirloskar Business Park, Bellary Road,Vinayakanagar-Bengaluru Urban bengaluru Karnataka 560024 9902249308 [email protected] 8900080184299 Network Planned 30-Apr-2025 12:00:00 01-May-2025 12:00:00 IPD 90947959 Cashless Cashless Claim Paid Allopathy K80.00 DISORDERS OF THE GASTROINTESTINAL SYSTEM Semi private room 0 219089 207538 0 0 10691 0 Room Rent / Nursing Excess of Tariff rates - not to be collected from the patient: 1160.00:-1160.00,Room Rent / Nursing Excess of Tariff rates - not to be collected from the patient: 3300.000:-3300.000,NMEs:-500.00,URINE CONTAINER:-12.00,CAPS:-24.00,APRON:-60.00,GAUZE:-60.00,MASK:-103.00,EXAMINATION GLOVES:-177.00,HANDRUB:-204.00,OXYGEN MASK:-331.00,GOWN:-650.00,BLANKET/WARMER BLANKET:-1720.00,ADMISSION/REGISTRATION CHARGES:-810.00,DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES:-630.00,MEDICAL RECORDS:-950.00 28-May-2025 03:00:29 SBIN525146923101 28-May-2025 03:00:19 29-Apr-2025 02:49:39 Calculus of gallbladder with acute cholecystitis without obstruction

•

SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Naveen Kattimani GM1251371500 Lata Naveen Kattimani GM1251371502 F 27-Nov-1997 27 Spouse 416 439316 4021571865 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 MANE MULTISPECIALITY HOSPITAL Near Railway Station, BAGALKOT- BAGALKOTE Karnataka 587101 [email protected] Non-Network Planned 17-Apr-2025 12:00:00 21-Apr-2025 12:00:00 IPD 90961292 Reimbursement Reimbursement Claim Paid Allopathy O82.0 CAESAREAN SECTION General/Economy ward 0 71257 60684 0 8573 0 Feeding Tube:-70.00,BED UNDER PAD CHARGES:-40.00,CAPS:-20.00,CLEAN SHEET:-200.00,DIAPER OF ANY TYPE:-129.00,FACE MASK:-40.00,GLOVES:-560.00,URINE BAG:-200.00,Baby Bills:-7164.00,ADMISSION/REGISTRATION CHARGES:-150.00 27-May-2025 01:01:16 306220613 27-May-2025 01:01:02 09-May-2025 12:00:43 Encounter for cesarean delivery without indication

•

SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 16-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Pradeep B N GM1251362100 Advith P GM1251362102 M 16-Feb-2024 0 Son 434 473704 4021760163 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 RAGHAVENDRA PEOPLETREE HOSPITALS AADCT8883C NO.13/4,T.DASARAHALLI,TUMAKUR MAIN ROAD,BANGALORE-560057-Bengaluru Urban bengaluru Karnataka 560057 9900511146 [email protected] 8900080361010 Network Emergency 02-Jun-2025 12:00:00 04-Jun-2025 12:00:00 IPD 90996127 Cashless Cashless Claim Paid Allopathy D50.9 DISORDERS OF BLOOD & BLOOD FORMING ORGANS, IMMUNE MECHANISM Deluxe room 0 27796 26296 0 0 1500 0 ADMISSION/REGISTRATION CHARGES:-500.00,DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES:-500.00,NMEs:-500.00 26-Jun-2025 08:00:24 SBIN425170075668 26-Jun-2025 08:00:20 03-Jun-2025 01:14:19 Iron deficiency anemia, unspecified

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Prakruthi S GM1251353900 Chandan J C GM1251353901 M 23-Sep-1994 30 Spouse 226 374415 4021571929 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Sparsh Hospital AAICS6819E NO. 8, Ideal Homes HBCS Layout, Rajarajeshwari Nagar, Bengaluru-Bengaluru Urban bengaluru Karnataka 560098 9880129005 [email protected] 8900080449114 Network Planned 09-Jun-2025 12:00:00 11-Jun-2025 12:00:00 IPD 90996791 Cashless Cashless Claim Paid Allopathy K40.90 DISORDERS OF THE GASTROINTESTINAL SYSTEM Semi private room 0 128594 125585 0 0 2440 0 UNDERPAD:-960.00,ADMISSION CHARGES/Documentation / Processing Fee:-1480.00 28-Jun-2025 03:00:57 SBINR12025062690176162 28-Jun-2025 03:00:42 03-Jun-2025 05:07:57 Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 15-Jun-2025 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Manjesh Kumar K GM1251370500 Baby Of Shalini GM1251370503 M 15-Jun-2025 1 Son 257 -100000 4026337958 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Natus Women And Children Hospital AAHCN6532G Mysore road No.79/118, Beside Metro station(Nayandahalli), Bangaluru- Sangli Maharashtra 560039 8050283376 [email protected] 8900080515970 Network Emergency 15-Jun-2025 12:00:00 28-Jun-2025 12:00:00 IPD 91016259 Cashless Cashless Claim Paid Allopathy Q39.2 CONGENITAL DISORDERS Deluxe room 100000 681613 600000 0 0 6037 0 INSURANCE PROCESSING FEE:-1000.00,DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES:-1500.00,NMEs:-1000.00,APRON:-45.00,CAPS:-42.00,DIAPER OF ANY TYPE:-1290.00,ECG ELECTRODES:-100.00,EXAMINATION GLOVES:-225.00,FACE MASK:-60.00,GOWN:-350.00,SPLINT:-150.00,THERMOMETER:-275.00 13-Jul-2025 02:00:41 SBINR12025071191797026 13-Jul-2025 02:00:36 17-Jun-2025 10:39:56 Congenital tracheo-esophageal fistula without atresia

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Raghunath K S GM1251373900 Surabhi R GM1251373901 F 27-Jun-2005 19 Daughter 113 426554 4021571971 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 FORTIS HEALTH MANAGEMENT LIMITED AABCF2101R 23, 80 FEET ROAD GURUKRUPA LAYOUT 2ND STAGE NAGARABHAVI BANGALORE - 560072-Bengaluru Urban bengaluru Karnataka 560072 7760968343 [email protected] 8900080354753 Network Emergency 20-Jun-2025 12:00:00 23-Jun-2025 12:00:00 IPD 91022884 Cashless Cashless Claim Paid Allopathy R50.0 INFECTIOUS DISEASES (BACTERIAL / VIRAL / Others) Semi private room 0 78195 73446 0 0 4749 0 TPA PROCESSING CHG:-1040.00,ADMISSION CHG:-420.00,DOCUMENTATION CHG:-630.00,PATIENT LINEN CHG:-480.00,NUTRITION PLANNING CHARGES - DIETICIAN CHARGES- DIET CHARGES:-310.00,NMEs:-1000.00,GLOVES:-620.00,THERMOMETER:-249.00 11-Jul-2025 08:01:08 SBINR12025070891420002 11-Jul-2025 08:00:53 21-Jun-2025 11:26:51 Fever Of Unknown Origin

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Hanumantha Reddy GM1251352500 Bandi Anantha Lakshmi GM1251352501 F 20-Jun-1993 31 Spouse 182 447392 4021571716 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Aditya Nursing Home Patel Nagar, Main Road, Opp M.G. Automobiles- BALLARI Karnataka 583101 8392-261173 / 9845652580 Non-Network Planned 20-Jun-2025 12:00:00 23-Jun-2025 12:00:00 IPD 91036759 Reimbursement Reimbursement Claim Paid Allopathy O82.0 CAESAREAN SECTION General/Economy ward 0 54805 52608 0 2197 0 EASY FIX:-47.00,BAND AIDS, BANDAGES, STERILE INJECTIONS, NEEDLES, SYRINGES:-298.00,BETADINE / HYDROGEN PEROXIDE/SPIRIT/ DISINFECTANTS ETC:-296.00,COTTON:-100.00,DIAPER OF ANY TYPE:-151.00,GLOVES:-600.00,URINE BAG:-405.00,ADMISSION/REGISTRATION CHARGES:-300.00 11-Jul-2025 08:01:12 137730760 11-Jul-2025 08:00:57 01-Jul-2025 11:14:31 Encounter for cesarean delivery without indication

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 01-Mar-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Ruthramoorthy P R GM1251366900 Ruthramoorthy P R GM1251366900 M 09-Sep-1994 30 Self 558 441240 4022098393 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Aveksha Hospitals Private Limited AAWCA1116A Singapur Road, M.S.Palya Post-Bengaluru Urban bengaluru Karnataka 560097 9900072001 [email protected] 8900080190177 Network Emergency 07-Jul-2025 12:00:00 11-Jul-2025 12:00:00 IPD 91045732 Cashless Cashless Claim Paid Allopathy N39.0 DISORDERS OF THE GENITOURINARY SYSTEM Semi private room 0 69694 58760 0 0 5807 0 linen charges:-110.00,initial assessment:-440.00,infection preventive:-800.00,dietary charge's:-2000.00,NUTRITION PLANNING CHARGES - DIETICIAN CHARGES- DIET CHARGES:-300.00,nebulizer mask:-572.00,NMEs:-1000.00,EXAMINATION GLOVES:-280.00,URINE BAG:-55.00,Admission fee:-250.00 30-Jul-2025 02:00:26 SBIN425209267446 30-Jul-2025 02:00:20 07-Jul-2025 12:54:37 Urinary tract infection, site not specified

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 21-Mar-2025 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Harshitha C GM1251351300 Baby of Harshitha C GM1251351302 M 21-Mar-2025 1 Son 98 448852 4025763272 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 MOTHERHOOD HOSPITAL(A UNIT OF RHEA HEALTHCARE PRIVATE LIMITED) AADCR9846F #17/12-4/19, 30th Main Road Banagirinagara Banashankari 3rd Stage-Bengaluru Urban bengaluru Karnataka 560085 9606089896 [email protected] 8900080397187 Network Planned 21-Mar-2025 12:00:00 24-Mar-2025 12:00:00 IPD 91067427 Reimbursement Post Hospitalisation Claim Paid Allopathy P08.1 NEONATAL DISORDERS General/Economy ward 0 4735 85 0 4650 0 Bill exceeding post hospitalization days:-500.00,Bill exceeding post hospitalization days:-750.00,Bill exceeding post hospitalization days:-500.00,Bill exceeding post hospitalization days:-289.00,Bill exceeding post hospitalization days:-71.00,nebulizer set:-572.00,BAND AIDS, BANDAGES, STERILE INJECTIONS, NEEDLES, SYRINGES:-11.00,oriental insuraance co ltd:-970.00,NO BILLS FOUND:-987.00 26-Jul-2025 02:00:39 SBIN125205781029 26-Jul-2025 02:00:32 21-Jul-2025 10:16:20 Other heavy for gestational age newborn

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Shobharani H R GM1251373600 Vinaya M GM1251373602 F 29-Mar-2006 18 Daughter 553 471129 4021572076 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Sparsh Hospital AAICS6819E NO. 8, Ideal Homes HBCS Layout, Rajarajeshwari Nagar, Bengaluru-Bengaluru Urban bengaluru Karnataka 560098 9880129005 [email protected] 8900080449114 Network Emergency 01-Aug-2025 12:00:00 03-Aug-2025 12:00:00 IPD 91089006 Cashless Cashless Claim Paid Allopathy A09.0 INFECTIOUS DISEASES (BACTERIAL / VIRAL / Others) Semi private room 0 31301 28871 0 0 2430 0 ADMISSION CHARGES:1480.00, DIETICIAN CHARGES:510.00, REGISTRATION CHARGES:70.00, EXAMINATION GLOVES:108.00, TEGADERM:262.00 12-Aug-2025 02:00:23 SBIN425221885587 12-Aug-2025 02:00:14 02-Aug-2025 01:27:39 Diaorrhoea & gastroenteritis of presumed infectious origin

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Arpita M Tarikeri GM1251361000 Arpita M Tarikeri GM1251361000 F 17-May-1993 31 Self 411 425000 4021571592 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Bhagwan Mahaveer Jain Hospital AAATB0895L #17, Millers Road, Vasanthnagar-Bengaluru Urban bengaluru Karnataka 560052 9880166935 [email protected] 8900080187450 Network Emergency 04-Aug-2025 12:00:00 07-Aug-2025 12:00:00 IPD 91092418 Cashless Cashless Claim Paid Allopathy O34.30 MATERNITY RELATED DISORDERS Single private room 0 51368 41312 0 0 6348 0 NUTRITION PLANNING CHARGES - DIETICIAN CHARGES- DIET CHARGES:-300.00,BED UNDER PAD CHARGES:-80.00,ECG ELECTRODES:-103.00,THERMOMETER:-206.00,APRON:-210.00,BED PAN:-295.00,LEGGINGS:-342.00,OXYGEN MASK:-361.00,WET WIPES:-375.00,UROMETER, URINE JUG:-550.00,NEBULISATION KIT:-626.00,ANY KIT WITH NO DETAILS MENTIONED (DELIVERY KIT, ORTHOKIT, RECOVERY KIT, ETC):-1180.00,ADMISSION/REGISTRATION CHARGES:-500.00,DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES:-720.00,TPA CHARGES:-500.00 26-Aug-2025 02:01:17 SBINR12025082296313606 26-Aug-2025 02:01:01 05-Aug-2025 09:06:16 Maternal care for cervical incompetence, unspecified trimester

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2025 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Abhishek GM1251351700 Tanvi Abhishek GM1251351702 F 02-Feb-2024 1 Daughter 137 467442 4025354208 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Manipal Hospitals - Mysore AACCC2943F #85-86, Bangalore-Mysore Ring Road Junction, Bannimantap A-Layout, Siddiqui Nagar-Mysuru Mysuru Karnataka 570015 9880450157 [email protected],[email protected],[email protected] 8900080191587 Network Emergency 05-Sep-2025 12:00:00 07-Sep-2025 12:00:00 IPD 91144860 Cashless Cashless Claim Paid Allopathy J22.0 DISORDERS OF THE RESPIRATORY SYSTEM Semi private room 0 37205 32558 0 0 4375 0 EXAMINATION GLOVES:-499.00,MASK:-626.00,ADMISSION CHG:-1150.00,DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES:-1260.00,MEDICAL RECORDS:-840.00 24-Sep-2025 08:01:21 SBIN425266259573 24-Sep-2025 08:01:04 07-Sep-2025 12:12:23 Unspecified acute lower respiratory infection

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Punith Kumar K GM1251358800 Benoy Krishna P GM1251358801 M 31-Jul-2023 1 Son 328 462942 4021571961 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Unity Lifline Hospital AABCU0879M #193, 80 Feet Road, 2nd Block 2nd Stage,Nagarbhavi-Bengaluru Urban bengaluru Karnataka 560072 9880020142 [email protected] 8900080188358 Network Emergency 08-Sep-2025 12:00:00 09-Sep-2025 12:00:00 IPD 91147262 Cashless Cashless Claim Paid Allopathy S01.81XA INJURIES / FRACTURES / DISLOCATIONS Single private room 0 39708 37058 0 0 2650 0 NMEs:-1000.00,OTHER CHARGE:-150.00,TPA CHARGES:-1000.00,ADMISSION/REGISTRATION CHARGES:-500.00 28-Sep-2025 06:00:33 486321091 28-Sep-2025 06:00:26 08-Sep-2025 07:19:15 Laceration without foreign body of other part of head, initial encounter

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Srinivasan Doraiswamy GM1251357200 Ranjani Mahendar GM1251357202 F 08-Aug-1991 33 Spouse 297 451306 4021572109 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Sparsh Hospital AAICS6819E NO. 8, Ideal Homes HBCS Layout, Rajarajeshwari Nagar, Bengaluru-Bengaluru Urban bengaluru Karnataka 560098 9880129005 [email protected] 8900080449114 Network Emergency 19-Sep-2025 12:00:00 21-Sep-2025 12:00:00 IPD 91166726 Cashless Cashless Claim Paid Allopathy O80.0 NORMAL DELIVERY Single private room 0 90178 38836 0 35404 4395 0 Documentation / Processing Fee:-1690.00,ADMISSION CHARGES (ADAD00022A) || IPB:-2100.00,daiper:-125.00,BED UNDER PAD CHARGES:-480.00 01-Oct-2025 05:01:19 SBIN525273361324 01-Oct-2025 05:01:05 19-Sep-2025 01:50:00 Single spontaneous delivery

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Akshatha Mahadev Mundaganur GM1251350300 Akshatha Mahadev Mundaganur GM1251350300 F 16-Mar-1997 27 Self 29 463482 4021571565 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Sparsh Children Hospital 0 near new bus stand, teradala road, basavanagar 4th cross rabkavi- BAGALKOTE Karnataka 587314 7411405094 Non-Network Planned 07-Sep-2025 12:00:00 09-Sep-2025 12:00:00 IPD 91170157 Reimbursement Reimbursement Claim Paid Allopathy O80.0 NORMAL DELIVERY Single private room 0 42020 36518 0 5502 0 Bill dates are outside policy period:-3834.00,BAND AIDS, BANDAGES, STERILE INJECTIONS, NEEDLES, SYRINGES:-47.00,BED UNDER PAD CHARGES:-381.00,GAUZE:-130.00,Suction set/IV SET/Stopcock/Pm line:-646.00,Vasofix:-464.00 29-Sep-2025 04:00:30 335700030 29-Sep-2025 04:00:26 22-Sep-2025 12:19:33 Single spontaneous delivery

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 01-Mar-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Pavan Kumar Deshpande GM1251367000 Pavan Kumar Deshpande GM1251367000 M 18-Apr-1990 34 Self 559 434572 4022098390 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 JOSHIS ANDROLOGY & UROLOGY CENTRE AAPFJ3207R No. 776, 1st & 2nd Floor, Sri Krishna Complex, Opp. Ganesha Temple, 'A' Block, Sahakar Nagar, Bangalore-Bengaluru Urban bengaluru Karnataka 560092 8197371247 [email protected] 8900080491830 Network Planned 19-Sep-2025 12:00:00 20-Sep-2025 12:00:00 IPD 91185678 Reimbursement Reimbursement Claim Paid Allopathy N47.6 DISORDERS OF THE GENITOURINARY SYSTEM General/Economy ward 0 72128 65428 0 200 0 ADMISSION/REGISTRATION CHARGES:-200.00 08-Oct-2025 05:01:16 SBIN525277504715 08-Oct-2025 05:01:06 30-Sep-2025 05:00:19 Balanoposthitis

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Srinivasan Doraiswamy GM1251357200 Ranjani Mahendar GM1251357202 F 08-Aug-1991 33 Spouse 297 451306 4021572109 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Sparsh Hospital AAICS6819E NO. 8, Ideal Homes HBCS Layout, Rajarajeshwari Nagar, Bengaluru-Bengaluru Urban bengaluru Karnataka 560098 9880129005 [email protected] 8900080449114 Network Emergency 03-Oct-2025 12:00:00 06-Oct-2025 12:00:00 IPD 91189369 Cashless Cashless Claim Paid Allopathy O16.5 MATERNITY RELATED DISORDERS Single private room 0 45480 9858 0 25902 4060 0 TEGADERM:-270.00,Documentation / Processing Fee, ADMISSION CHARGES:-3790.00 18-Oct-2025 05:00:50 SBIN325290208177 18-Oct-2025 05:00:41 03-Oct-2025 01:19:56 Unspecified maternal hypertension, complicating the puerperium

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 18-Sep-2025 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Srinidhi S Kashyap GM1251368000 Baby Of Bindu Raj N GM1251368002 M 18-Sep-2025 1 Son 593 446479 4027921164 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Sri Dharmasthala Manjunatheshwara College Of Ayurveda And Hospital, Hassan 0 P.B.No. 164, B.M Road, Thanniruhalla, Hassan- Hassan Karnataka 573201 08172-256460, 61 [email protected] Non-Network Planned 18-Sep-2025 12:00:00 23-Sep-2025 12:00:00 IPD 91272055 Reimbursement Reimbursement Claim Paid Allopathy P59.9 NEONATAL DISORDERS ICU 0 9215 4850 0 4365 0 radiant warmer:-2730.00,return:-26.00,soap:-55.00,HAND HOLDER:-4.00,According to policy Terms & Conditions, Room Rent means the amount charged by a Hospital towards Room and Nursing expenses shall include the room charges. Hence, Nursing Charges deducted.:-1250.00,Reasonable and Customary charges means the charges for services or supplies, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the illness / injury involved.:-300.00 12-Jan-2026 02:00:26 SBIN226009418295 12-Jan-2026 02:00:22 26-Nov-2025 10:38:38 Neonatal jaundice, unspecified

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2025 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Srinidhi S Kashyap GM1251368000 Bindu Raj N GM1251368001 F 15-Aug-1997 27 Spouse 593 446479 4025354205 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Sri Dharmasthala Manjunatheshwara College Of Ayurveda And Hospital, Hassan 0 P.B.No. 164, B.M Road, Thanniruhalla, Hassan- Hassan Karnataka 573201 08172-256460, 61 [email protected] Non-Network Planned 15-Sep-2025 12:00:00 23-Sep-2025 12:00:00 IPD 91272135 Reimbursement Reimbursement Claim Paid Allopathy O82.0 CAESAREAN SECTION Single private room 0 52358 48671 0 3687 0 BAND AIDS, BANDAGES, STERILE INJECTIONS, NEEDLES, SYRINGES:-924.00,IV Cannula:-621.00,MASK:-114.00,Suction set/IV SET/Stopcock/Pm line:-563.00,Investigation Reports Not Submitted; Pathology (HPE,Biopsy) NRQty: 1.00:-1465.00 12-Jan-2026 02:00:26 SBIN226009418295 12-Jan-2026 02:00:22 26-Nov-2025 11:11:08 Encounter for cesarean delivery without indication

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Arpita M Tarikeri GM1251361000 Arpita M Tarikeri GM1251361000 F 17-May-1993 31 Self 411 425000 4021571592 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Bhagwan Mahaveer Jain Hospital AAATB0895L #17, Millers Road, Vasanthnagar-Bengaluru Urban bengaluru Karnataka 560052 9880166935 [email protected] 8900080187450 Network Emergency 26-Nov-2025 12:00:00 29-Nov-2025 12:00:00 IPD 91274352 Cashless Cashless Claim Paid Allopathy O26.00 MATERNITY RELATED DISORDERS Semi private room 0 39767 8688 0 23075 4820 0 NMEs:-1000.00,ADMISSION/REGISTRATION CHARGES:-500.00,DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES:-720.00,FOOD CHARGES (OTHER THAN PATIENT's DIET PROVIDED BY HOSPITAL):-2100.00,TPA CHARGES:-500.00 13-Dec-2025 02:01:31 SBINR12025121008885063 13-Dec-2025 02:01:23 27-Nov-2025 02:04:02 Excessive weight gain in pregnancy, unspecified trimester

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Vani P M GM1251371100 Pooja Shekar GM1251371101 F 16-Dec-2006 18 Daughter 363 484036 4021572155 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Bharath Health Care Centre And Piles,Fistula,Fissures Hospital Vidyaranyapura main road,doddabommasandra,beside vishal medical store - bengaluru Karnataka 560097 9945194600 Non-Network Planned 28-Nov-2025 12:00:00 29-Nov-2025 12:00:00 IPD 91296394 Reimbursement Reimbursement Claim Paid Allopathy K64.9 DISORDERS OF THE GASTROINTESTINAL SYSTEM General/Economy ward 0 26594 15964 0 10630 0 Under Reasonable & Customary Clause; Consultation / Visit NRQty: 0.10Under Reasonable & Customary Clause; Consultation / Visit NRQty: 0.10:-1520.00,BAND AIDS, BANDAGES, STERILE INJECTIONS, NEEDLES, SYRINGES:-9.00,MICROPORE/ SURGICAL TAPE:-100.00,NO BILLS FOUND:-9001.00 27-Dec-2025 02:00:15 509550326 27-Dec-2025 02:00:13 12-Dec-2025 10:31:51 Unspecified hemorrhoids

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2024 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Arpita M Tarikeri GM1251361000 Arpita M Tarikeri GM1251361000 F 17-May-1993 31 Self 411 425000 4021571592 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Bhagwan Mahaveer Jain Hospital AAATB0895L #17, Millers Road, Vasanthnagar-Bengaluru Urban bengaluru Karnataka 560052 9880166935 [email protected] 8900080187450 Network Emergency 21-Dec-2025 12:00:00 25-Dec-2025 12:00:00 IPD 91310559 Cashless Cashless Claim Paid Allopathy O82.0 CAESAREAN SECTION Single private room 0 130980 25000 0 91888 8410 0 cross matching:-400.00,NMEs:-1000.00,CARRY BAGS:-45.00,ECG ELECTRODES:-97.00,OXYGEN MASK:-338.00,easy bath towel:-375.00,BED UNDER PAD CHARGES:-450.00,TEGADERM:-540.00,UROMETER, URINE JUG:-550.00,DIAPER OF ANY TYPE:-561.00,Vasofix:-984.00,ADMISSION/REGISTRATION CHARGES:-500.00,DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES:-720.00,TPA CHARGES:-500.00,diet charges.:-1350.00 15-Jan-2026 02:00:11 SBIN126014248481 15-Jan-2026 02:00:08 22-Dec-2025 11:25:31 Encounter for cesarean delivery without indication

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2025 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Abhilash Kumar D S GM1251370800 Baby Of Shashikala H GM1251370803 F 13-Feb-2025 0 Daughter 314 425000 4025569685 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Sidvin Hospital AAOCS4947H #1031, 20th Main Road, 5th Block, Rajajinagar-Bengaluru Urban bengaluru Karnataka 560010 9900017607 [email protected] 8900080183254 Network Planned 11-Feb-2025 12:00:00 14-Feb-2025 12:00:00 IPD 90878088 Reimbursement Reimbursement Claim Repudiated Allopathy Z00.129 Others Single private room 0 18477 0 0 1545 0 ADMISSION/REGISTRATION CHARGES:-500.00,other member bill:-777.00,DIAPER OF ANY TYPE:-268.00 15-Mar-2025 03:41:54 10-Mar-2025 10:03:58 Encounter for routine child health examination without abnormal findings

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2025 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Abhishek GM1251351700 Tanvi Abhishek GM1251351702 F 02-Feb-2024 1 Daughter 137 467442 4025354208 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Manipal Hospitals - Mysore AACCC2943F #85-86, Bangalore-Mysore Ring Road Junction, Bannimantap A-Layout, Siddiqui Nagar-Mysuru Mysuru Karnataka 570015 9880450157 [email protected],[email protected],[email protected] 8900080191587 Network Planned 05-Sep-2025 12:00:00 07-Sep-2025 12:00:00 IPD 91158723 Reimbursement Post Hospitalisation Claim Repudiated Allopathy J22.0 DISORDERS OF THE RESPIRATORY SYSTEM Single private room 0 419 0 0 0 0 19-Nov-2025 12:06:12 15-Sep-2025 01:24:28 Unspecified acute lower respiratory infection

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 22-Dec-2025 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Arpita M Tarikeri GM1251361000 Baby Son Of Arpita M Tarikeri GM1251361002 M 22-Dec-2025 1 Son 411 425000 4028447798 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Bhagwan Mahaveer Jain Hospital AAATB0895L #17, Millers Road, Vasanthnagar-Bengaluru Urban bengaluru Karnataka 560052 9880166935 [email protected] 8900080187450 Network Emergency 22-Dec-2025 12:00:00 02-Jan-2026 12:00:00 IPD 91318514 Cashless Cashless Claim Repudiated Allopathy Q79.8 CONGENITAL DISORDERS Single private room 0 200000 0 0 30000 0 Estimated Approval:-30000.00 26-Dec-2025 06:43:07 26-Dec-2025 06:10:03 Other congenital malformations of musculoskeletal system

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 22-Dec-2025 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Arpita M Tarikeri GM1251361000 Baby Daughter Of Arpita M Tarikeri GM1251361003 F 22-Dec-2025 1 Daughter 411 425000 4028447797 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Bhagwan Mahaveer Jain Hospital AAATB0895L #17, Millers Road, Vasanthnagar-Bengaluru Urban bengaluru Karnataka 560052 9880166935 [email protected] 8900080187450 Network Emergency 22-Dec-2025 12:00:00 01-Jan-2026 12:00:00 IPD 91319195 Cashless Cashless Claim Repudiated Allopathy Q79.8 CONGENITAL DISORDERS Single private room 0 200000 0 0 30000 0 Estimated Approval:-30000.00 27-Dec-2025 02:35:39 27-Dec-2025 01:57:32 Other congenital malformations of musculoskeletal system

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2025 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Poornima S GM1251372300 Poornima S GM1251372300 F 19-May-1986 38 Self 574 425000 4025354195 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Northwest hospital 61, 20th Main Road, 1st Block, Rajajinagar, Bengaluru- bengaluru Karnataka 560010 Non-Network Planned 04-Jan-2026 12:00:00 07-Jan-2026 12:00:00 IPD 91363032 Reimbursement Reimbursement Awaiting Pending Activities Allopathy O82.0 CAESAREAN SECTION General/Economy ward 0 121167 96933 37817 8350 0 ADMISSION/REGISTRATION CHARGES:-550.00,Duty Doctor Charges:-2100.00,As per policy Terms & Conditions, Room Rent means the amount charged by a Hospital towards Room and Nursing expenses shall include the room charges. Hence, Nursing Charges are deducted.:-5700.00 28-Jan-2026 11:32:25 27-Jan-2026 03:40:45 Encounter for cesarean delivery without indication

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SBI General Insurance Company Limited 41010250200000120-00 41010250200000120-00 11-Feb-2025 12:00:00 11-Feb-2025 12:00:00 10-Feb-2026 12:00:00 CENTRE FOR SMART GOVERNANCE Floater Group SBIGen_Group Health Insurance Policy 500000 0 Poornima S GM1251372300 Poornima S GM1251372300 F 19-May-1986 38 Self 574 425000 4025354195 CENTRE FOR SMART GOVERNANCE, 2ND FLOOR, BMTC BUS-STOP, YESHWANTHPUR, BANGALORE Bangalore Bengaluru Karnataka 560022 Northwest hospital 61, 20th Main Road, 1st Block, Rajajinagar, Bengaluru- bengaluru Karnataka 560010 Non-Network Planned 04-Jan-2026 12:00:00 07-Jan-2026 12:00:00 IPD 91364017 Reimbursement Post Hospitalisation Pending claim adjudication Allopathy O24.410 MATERNITY RELATED DISORDERS Single private room 0 56430 45144 1130 5300 0 NO BILLS FOUND:-1100.00,Bill exceeding Pre hospitalization days:-4200.00 28-Jan-2026 11:09:19 28-Jan-2026 11:03:10 Gestational diabetes mellitus in pregnancy, diet controlled

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Company

Anand Rathi Insurance Brokers Limited

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