24/05/2023

PARAMOUNT HEALTH SERVICES & INSURANCE TPA PRIVATE LIMITED

CORPORATE PREMIUM DETAILS

Corporate Name HALONIX TECHNOLOGIES PVT. LTD.
Insurance Company The New India Assura nce Compa ny Ltd.
Broker/Agent Name Unison Ins. Broking Services Pvt. Lt d.
Policy Number 324000/34/22/04/00000029 Policy From 04/06/2022
Policy Period
Policy Run Days 355 Policy upto 03/06/2023
Inception Lives 2,114 Inception Premium 79,87,062
Lives A dded 607 Additional Premium 4,98,095
Lives Delet ed 551 Deletion Premi um 40,205
Present Lives Covered 2,170 Current Total Premium 84,44,952
Premium Type INSTALLMENT PREMIUM

CORPORATE PREMIUM VS CLAIMS RATIO

Earned Premi um 82,13,583 Premium Per Life (Per Capita Premium) 3,892
Incurred Amt IPD 85,81,365 Incurred Amt OPD 0
Claim Frequency IPD 7% A verag e Claim Size ‐ IPD 45,629
Claim Frequency OPD 0% Averag e Clai m Size ‐ OPD 0
Clai m Ratio (A ct ual) ‐ IPD 102% Claim Ratio (Pro‐rata) ‐ IPD 104%
Claim Ratio (Actual) ‐ OPD +IPD 102% Claim Ratio (Pro‐rata) ‐ OPD+IPD 104%
CORPORATE FLOAT SUM INSURED ALLOTTED 20,00,000
CORPORATE FLOAT SUM INSURED UTILISED 3,93,409
BALANCE AMOUNT OF CORPORATE FLOAT SUM INSURED 16,06,591

CLAIMS REPORTED SUMMARY

Type of Clai ms Cashless Reimbursement OPD
Total No. of Cl aims Total Amt of Claims
Claims Status No. of Cl ai ms Amt of Claims No. of Cl ai ms Amt of Claims No of Cl ai ms Amt of Claims
Paid 123 64,87,781 49 13,60,361 0 0 172 78,48,142
Declined 0 18,407 6 2,61,386 0 0 6 2,79,793
Outstanding 8 5,94,030 4 1,39,193 0 0 12 7,33,223
Reported 131 71,00,218 59 17,60,940 0 0 190 88,61,158

CLAIMS PAID SUMMARY

Cashless Reimbursement OPD
Claims Status Total No. of Cl aims Total Amt of Claims
No. of Cl ai ms Amt of Claims No. of Cl ai ms Amt of Claims No of Cl ai ms Amt of Claims
Paid Main 123 63,73,109 49 13,59,821 0 0 172 77,32,930
Paid Pre Post 15 1,14,672 1 540 0 0 16 1,15,212
Total 123 64,87,781 49 13,60,361 0 0 172 78,48,142

CLAIMS DECLINED SUMMARY

Cashless Reimbursement OPD
Claims Status Total No. of Cl aims Total Amt of Claims
No. of Cl ai ms Amt of Claims No. of Cl ai ms Amt of Claims No of Cl ai ms Amt of Claims
Rejected Main 0 0 6 2,61,386 0 0 6 2,61,386
Rejected Pre Post 2 18,407 0 0 0 0 2 18,407
Deficient, Closed M a in 0 0 0 0 0 0 0 0
Deficient, Closed Pre P ost 0 0 0 0 0 0 0 0
Total 0 18,407 6 2,61,386 0 0 6 2,79,793

CASHLESS DENIAL SUMMARY

Ca shl ess Request D eni ed 13 8,36,956 0 0 0 0 13 8,36,956
Ca shl ess Request Closed 1 28,800 0 0 0 0 1 28,800
Total 14 8,65,756 0 0 0 0 14 8,65,756

CLAIMS OUTSTANDING SUMMARY

Cashless Reimbursement OPD
Claims Status Total No. of Cl aims Total Amt of Claims
No. of Cl ai ms Amt of Claims No. of Cl ai ms Amt of Claims No of Cl ai ms Amt of Claims
Processed 3 1,79,876 0 0 0 0 3 1,79,876
Under Deficiency 0 0 1 7,659 0 0 1 7,659
Under Process 1 50,000 3 1,31,534 0 0 4 1,81,534
Bills Not Received 4 2,93,129 0 0 0 0 4 2,93,129
Pre P ost 3 71,025 0 0 0 0 3 71,025
Total 8 5,94,030 4 1,39,193 0 0 12 7,33,223
 GUIDELINES FOR CORPORATE OVERVIEW
Earned Premi um Net Premium/P olicy Period x Policy Run Da ys
Premi um Per Life (Per Capita premi um) Net Premi um/ No. of Lives as on report dat e
Claim Frequency No. of R eport ed Cla ims/ No. of Lives as on report dat e
Averag e Claim Size Amt of Clai ms Paid ( OPD /IP D) / No. of Claims Paid
Claim Ratio ( A ct ual ) Amt of Incurred Claims (OPD/IPD)/ Net Premi um
Claim Ratio (Pro‐rata) Amt of Incurred Claims (OPD/IPD) / Earned P remi um

GUIDELINES FOR CORPORATE SUMMARY

"Declined" claims in "Claims Report ed Summa ry" includes Rej ect ed and Closed defici ent claims.
"Defi ci ent , Cl osed" claims in "Clai ms Decli ned Summa ry" i ncl udes clai ms closed due to deficient documents not received within stipulated time peri od.
"Ca shl ess Request s D eni ed" and "Cashl ess R equests Cl osed" are not incl uded under "Reported Claims".
"Ca shl ess Requests Closed" under "Cashl ess Denial Summary" incl udes cashl ess request s issued but not utili sed by the member.
"Processed" in "Claim Outstanding Summary" incl udes Claims processed and awaiting confirmati on or approval from insura nce compa ny and aw aiting payout f rom
insurance company.
"Under Defi ciency" claims in "Claims Outstanding Summa ry" includes deficient claims and claims awaiting for confirmation from insurance company, corporate, broker.
"Under Process" claims in "Claims Outsta nding Summary" incl udes under process with PHS, under investigation and pending for PHS interdepart mental confi rmation.
"Bill Not Received" in "Claims Out standing Summa ry"i ncl udes ca shl ess claims for whi ch hospit al bill is not recei ved.
Total of "Claims Paid Summary", "Claims Declined Summa ry" and "Claims Outstanding Summary" respecti vel y does not include the number of Pre‐ post claims, how ever
amount of pre‐ post claims is i ncl uded in total.