EMEDLIFE INSURANCE BROKING SERVICES LIMITED

GROUP MEDICLAIM POLICY

Proposer Details:
Name of the Client AJ PACKAGING LIMITED
Policy Period 16-SEP-2021 to 15-SEP-2022
Current Insurer Bharti Axa General insurance company limited
TPA Health India
Policy Inception Details for 2020 - 2021:
Number of Employees : 43
Number of Dependents : 106
Total Number of Lives : 149
Family Size: 1+3 (Self+spouse+4 childrens)
Premium paid at inception(Excluding GST) 615,003
Premium paid till date(Excluding GST) 615,003
Claim Ratio 48.78%
Claim MIS Dated 13-Sep-21
Claimed Amount 3,000,000
365 days claims out go 3,033,241
Annualized claims ratio 49.18%
Policy Details for Renewal 2021 - 2022
Number of Employees: 50
Number of Dependents : 119
Total Number of Lives : 169
SL.NO FEATURES TERMS AND CONDITIONS

1 FAMILY DEFINITION (1+3) Self + Spouse + 4 Dependent Children

2 SUM INSURED Family Floater Sum Insured of INR 300,000

3 AGE BRACKET 0-80 Years

4 1ST, 2ND AND 4TH YEAR WAITING PERIOD Waived for all
5 1ST 30 DAYS WAITING PERIOD Waived for all
6 PRE-EXISTING DISEASE WAITING PERIOD Waived for all
7 MATERNITY BENEFITS - LIMITS AND COVERAGES Not Covered
8 NEW BORN BABY COVERAGE FROM DAY 1 NO

2% of SI for Normal Hospitalisation and 4% of SI for ICU Hospitalisation.

9 ROOM RENT OR ROOM TYPE RESTRICTION
Opting for a room of higher category than the eligible category will result in higher cost for all
hospitalization services , which must be borne by the claimant

10 PRE AND POST HOSPITALIZATION COVERAGE 30 days pre-hospitalization and 60 days post-hospitalization respectively.
11 DOMICILIARY HOSPITALIZATION COVER Not Covered
12 CONGENITAL INTERNAL DISEASE Covered for all
13 CORPORATE BUFFER Not Covered
14 DAY CARE PROCEDURES Covered
15 CLAIMS INTIMATION No Claims intimation required for reimbursement claims & Day Care procedure claims
16 RE-IMBURSEMENT CLAIMS REPORTING / SUBMITTING PERIOD Claim reporting /submission period within 30 days from the Date of Discharge
17 LIMIT ON ANY ONE DISEASE OR AILMENT No capping; Cataract Limit restricted to INR 15,000 per eye
LIMIT ON SURGEON CHARGES, ANESTHETIC CHARGES, STENT
18 CHARGES, ETC. No Capping

19 CO-PAY CLAUSE No Copay

20 HOSPITALIZATION / INJURY ARISING OUT TERRORISM Covered

21 PREMIUM CALCULATION Pro rata Basis

22 EMERGENCY AMBULANCE CHARGES Covered upto INR 3000 per hospitalisation
 EMEDLIFE INSURANCE BROKING SERVICES LIMITED
GROUP MEDICLAIM POLICY
Proposer Details:
Name of the Client AJ PACKAGING LIMITED
Policy Period 16-SEP-2021 to 15-SEP-2022
Current Insurer Bharti Axa General insurance company limited
TPA Health India
Policy Inception Details for 2020 - 2021:
Number of Employees : 43
Number of Dependents : 106
Total Number of Lives : 149
Family Size: 1+3 (Self+spouse+4 children)
Premium paid at inception(Excluding GST) 615,003
Premium paid till date(Excluding GST) 615,003
Claim Ratio 48.78%
Claim MIS Dated 13-Sep-21
Claimed Amount 300,000
365 days claims out go 302,486
Annualized claims ratio 49.18%
Policy Details for Renewal 2021 - 2022
Number of Employees: 50
Number of Dependents : 119
Total Number of Lives : 169
SL.NO FEATURES TERMS AND CONDITIONS MAGMA HDI

1 FAMILY DEFINITION (1+3) Self + Spouse + 4 Dependent Children YES

2 SUM INSURED Family Floater Sum Insured of INR 300,000 YES

3 AGE BRACKET 0-80 Years YES

4 1ST, 2ND AND 4TH YEAR WAITING PERIOD Waived for all YES

5 1ST 30 DAYS WAITING PERIOD Waived for all YES

6 PRE-EXISTING DISEASE WAITING PERIOD Waived for all YES

7 MATERNITY BENEFITS - LIMITS AND COVERAGES Not Covered YES

8 NEW BORN BABY COVERAGE FROM DAY 1 NO YES

2% of SI for Normal Hospitalisation and 4% of SI for ICU Hospitalisation. YES

9 ROOM RENT OR ROOM TYPE RESTRICTION
Opting for a room of higher category than the eligible category will result in higher cost for all
YES
hospitalization services , which must be borne by the claimant

10 PRE AND POST HOSPITALIZATION COVERAGE 30 days pre-hospitalization and 60 days post-hospitalization respectively. YES

11 DOMICILIARY HOSPITALIZATION COVER Not Covered YES

12 CONGENITAL INTERNAL DISEASE Covered for all YES

13 CORPORATE BUFFER Not Covered YES

14 DAY CARE PROCEDURES Covered YES

15 CLAIMS INTIMATION No Claims intimation required for reimbursement claims & Day Care procedure claims YES

16 RE-IMBURSEMENT CLAIMS REPORTING / SUBMITTING PERIOD Claim reporting /submission period within 30 days from the Date of Discharge YES

17 LIMIT ON ANY ONE DISEASE OR AILMENT No capping; Cataract Limit restricted to INR 15,000 per eye YES

LIMIT ON SURGEON CHARGES, ANESTHETIC CHARGES, STENT

18 No Capping YES
CHARGES, ETC.

19 CO-PAY CLAUSE No Copay YES

20 HOSPITALIZATION / INJURY ARISING OUT TERRORISM Covered YES

21 PREMIUM CALCULATION Pro rata Basis YES

22 EMERGENCY AMBULANCE CHARGES Covered upto INR 3000 per hospitalisation YES

PREMIUM EXCL GST 500,000

PREMIUM PAYABLE GST @ 18% 90,000
PREMIUM INCL GST 590,000