Name : Bhupesh Pathak

Age : 33yrs
Gender : Male
Relation : Self
EmpCode : 51306412

SLA for issue of Pre authorization for Cashless : is 4 hours.

For Cashless Related issues, please contact the following contact numbers.
Chennai: 9381390555 / Bangalore: 9742879895 / Hyderabad: 9394645003 / Mumbai: 9322424061 /
Noida: 9313771788 / Kolkata: 9330154828
In case of no response within 4 hours,The escalation points are:
1st Escalation : Prabhavathi - 9242088822 / 2nd Escalation : Srinivas - 9343555374

This card is only for identification purpose and is not an authorisation to proceed with the treatment or
a guarantee for payment.
Subject to the terms and conditions of the underlying insurance policy, this non transferable
identification card valid at selected all network hospitals will enable you to avail Cashless
hospitalisation only on the basis of pre-authorisation issued by Medi Assist.
1. In Case preauthorisation is not issued,the policy holder / beneficiary will be required to make
payments to hospital and submit the claim to Medi Assist for a possible reimbursement. -All
preauthorisation and/or settlement of claims is subject to the terms and conditions of the relevant
policy with HCL Technologies Ltd.
2. This soft copy of Medi Assist Identity card is valid for identification when printed and presented
with a valid proof of identity at any Medi Assist Network Hospital:such as IDCard of the Employee
only issued by the employer / Passport / Driver's Licence / Ration Card / Voter IDCard / PAN Card
should be presented at the Hospital
3. All non admissible expenses incurred have to be paid directly to the hospital by the employee. For
illustrative list please visit your intranet.
4. This card is valid only for hospitalization in India.
5. Copy of this eCard signed by patient or a family member covered under the policy should be sent
to Mediassist along with the filled & signed Pre-Authorization form.

ADDRESS:
MEDI ASSIST INDIA PVT.LTD
3rd Floor,No.49 shilpa Vidya,Sarakki Industrial Layout,1st Main Road,
J P Nagar 3rd Stage, Bangalore - 560 078.
Ph:(080)26584811,Fax:(080)26584812. For Network Hospitals-www.mediassistindia.com
Name : Richa Pathak
Age : 25yrs
Gender : Female
Relation : Spouse
EmpCode : 51306412

SLA for issue of Pre authorization for Cashless : is 4 hours.

For Cashless Related issues, please contact the following contact numbers.
Chennai: 9381390555 / Bangalore: 9742879895 / Hyderabad: 9394645003 / Mumbai: 9322424061 /
Noida: 9313771788 / Kolkata: 9330154828
In case of no response within 4 hours,The escalation points are:
1st Escalation : Prabhavathi - 9242088822 / 2nd Escalation : Srinivas - 9343555374

This card is only for identification purpose and is not an authorisation to proceed with the treatment
or a guarantee for payment.
Subject to the terms and conditions of the underlying insurance policy, this non transferable
identification card valid at selected all network hospitals will enable you to avail Cashless
hospitalisation only on the basis of pre-authorisation issued by Medi Assist.

1. In Case preauthorisation is not issued,the policy holder / beneficiary will be required to make
payments to hospital and submit the claim to Medi Assist for a possible reimbursement. -All
preauthorisation and/or settlement of claims is subject to the terms and conditions of the relevant
policy with HCL Technologies Ltd.
2. This soft copy of Medi Assist Identity card is valid for identification when printed and presented
with a valid proof of identity at any Medi Assist Network Hospital:such as IDCard of the Employee
only issued by the employer / Passport / Driver's Licence / Ration Card / Voter IDCard / PAN Card
should be presented at the Hospital
3. All non admissible expenses incurred have to be paid directly to the hospital by the employee. For
illustrative list please visit your intranet.
4. This card is valid only for hospitalization in India.
5. Copy of this eCard signed by patient or a family member covered under the policy should be sent
to Mediassist along with the filled & signed Pre-Authorization form.
ADDRESS:
MEDI ASSIST INDIA PVT.LTD
3rd Floor,No.49 shilpa Vidya,Sarakki Industrial Layout,1st Main Road,
J P Nagar 3rd Stage, Bangalore - 560 078.
Ph:(080)26584811,Fax:(080)26584812. For Network Hospitals-www.mediassistindia.com
Name : Vibhu Pathak
Age : 1yrs
Gender : Male
Relation : Son
EmpCode : 51306412

SLA for issue of Pre authorization for Cashless : is 4 hours.

For Cashless Related issues, please contact the following contact numbers.
Chennai: 9381390555 / Bangalore: 9742879895 / Hyderabad: 9394645003 / Mumbai: 9322424061 /
Noida: 9313771788 / Kolkata: 9330154828
In case of no response within 4 hours,The escalation points are:
1st Escalation : Prabhavathi - 9242088822 / 2nd Escalation : Srinivas - 9343555374

This card is only for identification purpose and is not an authorisation to proceed with the treatment
or a guarantee for payment.
Subject to the terms and conditions of the underlying insurance policy, this non transferable
identification card valid at selected all network hospitals will enable you to avail Cashless
hospitalisation only on the basis of pre-authorisation issued by Medi Assist.

1. In Case preauthorisation is not issued,the policy holder / beneficiary will be required to make
payments to hospital and submit the claim to Medi Assist for a possible reimbursement. -All
preauthorisation and/or settlement of claims is subject to the terms and conditions of the relevant
policy with HCL Technologies Ltd.
2. This soft copy of Medi Assist Identity card is valid for identification when printed and presented
with a valid proof of identity at any Medi Assist Network Hospital:such as IDCard of the Employee
only issued by the employer / Passport / Driver's Licence / Ration Card / Voter IDCard / PAN Card
should be presented at the Hospital
3. All non admissible expenses incurred have to be paid directly to the hospital by the employee. For
illustrative list please visit your intranet.
4. This card is valid only for hospitalization in India.
5. Copy of this eCard signed by patient or a family member covered under the policy should be sent
to Mediassist along with the filled & signed Pre-Authorization form.
ADDRESS:
MEDI ASSIST INDIA PVT.LTD
3rd Floor,No.49 shilpa Vidya,Sarakki Industrial Layout,1st Main Road,
J P Nagar 3rd Stage, Bangalore - 560 078.
Ph:(080)26584811,Fax:(080)26584812. For Network Hospitals-www.mediassistindia.com
Name : R P PATHAK
Age : 67yrs
Gender : Female
Relation : Mother
EmpCode : 51306412

SLA for issue of Pre authorization for Cashless : is 4 hours.

For Cashless Related issues, please contact the following contact numbers.
Chennai: 9381390555 / Bangalore: 9742879895 / Hyderabad: 9394645003 / Mumbai: 9322424061 /
Noida: 9313771788 / Kolkata: 9330154828
In case of no response within 4 hours,The escalation points are:
1st Escalation : Prabhavathi - 9242088822 / 2nd Escalation : Srinivas - 9343555374

This card is only for identification purpose and is not an authorisation to proceed with the treatment
or a guarantee for payment.
Subject to the terms and conditions of the underlying insurance policy, this non transferable
identification card valid at selected all network hospitals will enable you to avail Cashless
hospitalisation only on the basis of pre-authorisation issued by Medi Assist.

1. In Case preauthorisation is not issued,the policy holder / beneficiary will be required to make
payments to hospital and submit the claim to Medi Assist for a possible reimbursement. -All
preauthorisation and/or settlement of claims is subject to the terms and conditions of the relevant
policy with HCL Technologies Ltd.
2. This soft copy of Medi Assist Identity card is valid for identification when printed and presented
with a valid proof of identity at any Medi Assist Network Hospital:such as IDCard of the Employee
only issued by the employer / Passport / Driver's Licence / Ration Card / Voter IDCard / PAN Card
should be presented at the Hospital
3. All non admissible expenses incurred have to be paid directly to the hospital by the employee. For
illustrative list please visit your intranet.
4. This card is valid only for hospitalization in India.
5. Copy of this eCard signed by patient or a family member covered under the policy should be sent
to Mediassist along with the filled & signed Pre-Authorization form.
ADDRESS:
MEDI ASSIST INDIA PVT.LTD
3rd Floor,No.49 shilpa Vidya,Sarakki Industrial Layout,1st Main Road,
J P Nagar 3rd Stage, Bangalore - 560 078.
Ph:(080)26584811,Fax:(080)26584812. For Network Hospitals-www.mediassistindia.com