Quote Slip for Group Mediclaim Insurance Po
Insured Name
Address
Business Profile of the client
Existing Insurer
Existing TPA
Policy Period
Premium Paid (Exclusive of Service Tax)
Incurred Claims (Paid + O/s)
Projected annualized claims outgo incl
IBNR
Claims ratio
Total no. of Employees at inception
Total no. of Dependants at inception
Total no. of lives at inception
Total No. of Employees at the expiry
Total No. of Dependants at the expiry
Total no. of lives at expiry
Scope of Coverage:
Family Definition
Family Size
Age Limit
Type of Cover
Sum Insured Per family / employee
Domiciliary Hospitalisation
Pre existing disease exclusion
First 30 days waiting period
1 / 2/ 4 year exclusion
Maternity Benefit
Maternity 9 months waiting period
Pre-Post Natal Expenses on IPD
Pre-Post Natal Expenses on OPD
New Born Baby Coverage
Corporate Buffer - Annual Amount
: M/s Gems
Tower AW and Jwellery
1010, BHARAT Export Promotion
DIMOND BOURSE,Council
BANDR O
: 400051
:
: ADITYA BIRLA HEALTH INSURANCE CO LTD
: FAMILY HEALTH PLAN INSURANCE TPA
: 21/2/2019
: INR 1,621,095
: INR 0
:
#DIV/0!
:
: 255
: 646
: 901
:
:
: 0
: Expiring
:
SELF+ ANY 3 ( SPOUSE+ 2 DEPENDENT
: CHILDREN + PARENT OR PARENTS
INLAW)
: 1+3
:
: GMC
: 1LAC, 2LAC, 3 LAC, 5LAC
: APPLICABLE
:
: WAIVED OFF
: WAIVED OFF
: NOT APPLICABLE
:
:
:
: YES
:
Pre & Post Hospitalisation Expenses
: YES
(30-60 Days respectively)
Daily Room Rent Restriction : 1% OF SI, (2% FOR ICU)
Internal Congenital Ailments cover :
Emergency Ambulance Charges : COVERED UPTO Rs.2500 PER CASE
Sub Limit for various Ailments /
:
Treatments
Sub Limit for Cataract :
Standard Sub-limits as per Insurance
:
company Policy
Co-Payment : 25% OF COPAY ON ALL APRENTAL CLAIMS

Terrorism Cover :
527 DAYCARE PROCEDURES ARE
Day Care Procedures :
COVERED
Dental Treatment :
Cashless Facility : COVERED
GIPSA PPN Clause Applicable :
Addition-Deletion on pro-rata basis from
Date of Joining and Date of Leaving
:
respectively subject to CD Balance with
the Insurance company
Mid-term Addition of Dependents :
Mid-term revision of Sum Insured due to
:
promotion
Claim Intimation :
Claim Submission :
Special condition :

Insurance Co. :
Net Premium :
GST 18% :
Gross Premium :
m Insurance Policy

t Promotion
MOND BOURSE,Council
BANDRAOf India
KURLA COMPLEX, MUMBAI-

RANCE CO LTD
ANCE TPA
To 20/2/2020
Including Endorsement Premium
Claims as on

Policy run days

new insurer
new insurer
 Quote Slip for Group Personal Accident Poli

Insured Name : M/s Gems and Jwellery Export Promotion Council O

Tower AW 1010, BHARAT DIMOND BOURSE, BANDR
:
Address 400051
Type of Policy : Group personal accident
Status of Employment :
Existing Insurer : ADITYA BIRLA HEALTH INSURANCE CO LTD
Policy Period : 21/2/2019
Premium Paid (Exclusive of Service Tax) : 10,583
Claim detail :
Total no. of lives at inception : 255
Total no. of lives at expiry :
Sum Insured Per Employee : 1LAC, 2 LAC
Total Sum Insured : INR 47,900,000
Existing rate per mile :

Scope of Coverage: : Expiring

Age limit :
Accidental Death (AD) :
Permanent Total Disability (PTD) :
Permanent Partial Disability (PPD) :
Temporary Total Disability (TTD) /
:
Weekly Benefit (WB)
Medical Expenses :
Education Benefit :
Funeral Expenses & repatriation of
:
Remains
Terrorism Cover :
Territory Limit :
Operative Time :
Addition-Deletion on Pro-rata basis :

Insurance Co. :
Net Premium :
GST 18% :
Gross Premium :
al Accident Policy

t Promotion Council Of India

MOND BOURSE, BANDRA KURLA COMPLEX, MUMBAI-

RANCE CO LTD
To 20/2/2020

new insurer

new insurer 0