Quote Slip for Group Mediclaim Insurance Po

Insured Name : Permeshwar fashions impex pvt ltd

Address : Phase 2, GIDC, Vapi, Gujarat 396191
Business Profile of the client :
Existing Insurer : Fresh
Existing TPA :
Policy Period :
Premium Paid (Exclusive of Service Tax) :
Incurred Claims (Paid + O/s) : INR 0
Projected annualized claims outgo incl
:
IBNR #DIV/0!
Claims ratio :
Total no. of Employees at inception : 120
Total no. of Dependants at inception : 0
Total no. of lives at inception : 120
Total No. of Employees at the expiry :
Total No. of Dependants at the expiry :
Total no. of lives at expiry : 0

Scope of Coverage: : Expiring

:
Family Definition : Self
Family Size : 1
Age Limit : 60
Type of Cover : GMC
Sum Insured Per family / employee : 1LAC
Domiciliary Hospitalisation :
Pre existing disease exclusion :
First 30 days waiting period :
1 / 2/ 4 year exclusion :
Maternity Benefit : NO
Maternity 9 months waiting period : NOT APPLICABLE
Pre-Post Natal Expenses on IPD : NOT APPLICABLE
Pre-Post Natal Expenses on OPD : NOT APPLICABLE
New Born Baby Coverage : NOT APPLICABLE
Corporate Buffer - Annual Amount :
Pre & Post Hospitalisation Expenses
:
(30-60 Days respectively)
Daily Room Rent Restriction :
Internal Congenital Ailments cover :
Emergency Ambulance Charges :
Sub Limit for various Ailments /
:
Treatments
Sub Limit for Cataract :
Standard Sub-limits as per Insurance
:
company Policy
Co-Payment :
Terrorism Cover :
Day Care Procedures :
Dental Treatment :
Cashless Facility :
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

pvt ltd
396191

To
Including Endorsement Premium
Claims as on

Policy run days

new insurer
new insurer
 Quote Slip for Group Personal Accident Poli

Insured Name :

:
Address
Type of Policy :
Status of Employment :
Existing Insurer :
Policy Period :
Premium Paid (Exclusive of Service Tax) :
Claim detail :
Total no. of lives at inception :
Total no. of lives at expiry :
Sum Insured Per Employee :
Total Sum Insured :
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

To

new insurer

new insurer 0