QUOTE FOR GROUP HEALTH INSURANCE POLICY

BASIC DETAILS
Name of Corporate A AND K GLOBAL HEALTH INDIA PVT LTD Location Gurgaon
Industry Others Intermediary Emedlife Insurance Broker
Sales Vertical Group Sales Relationship Manager Kriti Jain
POLICY DETAILS
Self + Spouse+ 2 Kids + 2 Dependent Parent/
Floater/Non-Floater Floater Family definition
Inlaws
Policy inception date 30-09-2017 Date of expiry 29-09-2018
Type of policy Market Rollover No. of Dependents 55
No. of Employees 20 Total Lives 75
Quote date 29-09-2017 TPA Medi Assist

PREMIUM PAYABLE
Gross Premium 3,50,000
GST @18% 63,000
Premium payable 4,13,000

COVERAGE DESCRIPTION
Employee, spouse, 2 dependent children upto 25 years and 2 dependent parents or parent in laws. Cross selection of parent &
Family definition
parent in-law is not allowed
Sum insured Sum insured Rs.-------300000----------Per Family as per demography attached herewith
Parents SI restriction No SI restriction for parents
Age band 1 day - 80 years
PED Cover Pre-existing diseases covered
30 days waiting period Not applicable
2 yrs waiting period Not applicable

Room rent Room rent restricted to 2% of SI for normal room and 4% of SI for ICU. All other charges in accordance with room rent limit.

Disease sublimits No disease sublimits applicable

Maternity Maternity limit Rs.50000/- for normal delivery & Rs.75000/- for C-Section.
9 month waiting period for
Not applicable
maternity
Pre-post natal cover Pre-post natal covered upto Rs.5000/- within maternity limit
Baby day 1 Baby covered from day 1
Co-pay No co-pay applicable
Parental co-pay No co-pay applicable on parenteral claims

Corporate buffer of Rs. 5,00,000/- Available up to the family floater sum insured per family. CORPORATE BUFFER WILL NOT BE
Corporate buffer
AVAILABLE FOR MATERNITY CLAIMS

Ambulance Road ambulance charges are covered upto Rs. 1,000/- per incident in case of emergency.
Day care 527 Day care procedures are covered
Pre-post hosptalization Pre & Post – hospitalization Medical Expenses are covered upto 30 days & 60 days respectively

OPD Cover upto Rs.5000 for 6 executives health check up only. To be claim only on re-imbursement basis and only once in a policy year

Internal congenital disease Covered

External congenital diseases Covered in case of life threatening conditions

Lasik surgery Covered if correction index is +/- 7.5D

Cyberknife treatment/ Stem

Cell Transplantation/Robotic Covered with 50% Co-pay
Surgery

Oral
Chemotherapy/Hormone
therapy for Cancer
Well Baby expenses
Claim Intimation
Claim submission
Special Condition
Is payable under comprehensive corporate floater of Rs. 3,00,000/-.
Covered upto Rs. 5000/- within maternity limit.
Within 7 days from date of admission
Reimbursement claim should be submitted within 30 days from date of discharge.
NA

DISCLAIMER - WHEREEVER APPLICABLE

1. No Individual (Employee or Dependant) can be covered more than once in a policy.
2. Any change in demography/Sum Insured will warrant a revision in Quote/ Rates.
3. Data for new joinees - Employees and dependant’s data to reach by pre-decided mutually agreed timeline or 30 days.
4. In case of New Joinees names of all dependants to be submitted one time only along with the name of the employee.
5. Addition/ Deletion to be done on Prorate basis effective from date of joining/relieving subject to balance being available in CD account.
6. In case of deletions, there will be no refund for the members who have claimed.
7. Maximum age of entry in policy is 80 years for parents and 65 Yrs for Self and Spouse
8. Maximum age of entry for dependent children is 25 years.
9. No change of Sum insured allowed after commencement of the policy.
10. No addition of new slabs for Sum Insured allowed after commencement of the policy.

11. Midterm addition allowed only in case of New Born baby and Spouse (on account of marriage).Mid term addition of parents not allowed except for new joinees.

12. Natural additions for any existing employee must done within 30 days of marriage (for spouse) and date of birth (for child).
13. Additional premium to be collected for every new addition in the policy.
14. All insurable members in the group to be insured under GMC policy and there shall be no selection of members.
15. Members already employed but not declared by the employer at the time of providing the quote shall not be covered subsequently after commencement of the
policy.
16. We shall provide Per member Premium for addition and deletion in the policy.
17. The basis of selecting the sum insured for the members shall be communicated to the insurance company prior to inception of policy. No individual member shall
be allowed to choose his/her sum insured deviating from the basis provided.
18. The cover shall cease automatically for any member leaving the organization insured under our GMC policy.
19. Quote is valid for 15 days only.

Demography
Sum Insured 0-25 26-35 36-45 46-55 56-65 66-70 71-75 76-80 Above 80
50,000 0 0 0 0 0 0 0 0 0
75,000 0 0 0 0 0 0 0 0 0
1,00,000 0 0 0 0 0 0 0 0 0
1,50,000 0 0 0 0 0 0 0 0 0
2,00,000 0 0 0 0 0 0 0 0 0
2,50,000 0 0 0 0 0 0 0 0 0
3,00,000 13 20 8 10 13 8 2 1 0
3,50,000 0 0 0 0 0 0 0 0 0
4,00,000 0 0 0 0 0 0 0 0 0
4,50,000 0 0 0 0 0 0 0 0 0
5,00,000 0 0 0 0 0 0 0 0 0
5,50,000 0 0 0 0 0 0 0 0 0
6,00,000 0 0 0 0 0 0 0 0 0
7,00,000 0 0 0 0 0 0 0 0 0
8,00,000 0 0 0 0 0 0 0 0 0
9,00,000 0 0 0 0 0 0 0 0 0
10,00,000 0 0 0 0 0 0 0 0 0
Total 13 20 8 10 13 8 2 1 0

Endorsement rates (Excluding GST)

Sum Insured 0-25 26-35 36-45 46-55 56-65 66-70 71-75 76-80 Above 80
50,000 1218 1365 1723 2594 3940 6022 8542 10731 11717
75,000 1410 1580 1995 3003 4562 6972 9889 12425 13565
1,00,000 1548 1736 2192 3299 5010 7657 10861 13646 14899
1,50,000 1738 1949 2460 3703 5624 8596 12193 15319 16726
2,00,000 1867 2093 2642 3977 6040 9232 13094 16451 17962
2,50,000 1960 2197 2774 4175 6342 9693 13749 17273 18860
3,00,000 2029 2274 2871 4322 6564 10033 14231 17880 19521
3,50,000 2291 2568 3242 4880 7412 11328 16068 20188 22042
4,00,000 2495 2796 3530 5314 8071 12336 17497 21983 24002
4,50,000 2612 2928 3697 5565 8452 12919 18324 23022 25136
5,00,000 2736 3067 3872 5828 8852 13530 19191 24111 26325
5,50,000 2856 3202 4043 6085 9242 14126 20036 25173 27484
6,00,000 2982 3343 4221 6353 9650 14749 20920 26283 28696
7,00,000 3206 3593 4537 6829 10372 15852 22485 28250 30844
8,00,000 3409 3821 4824 7261 11028 16856 23908 30038 32796
9,00,000 3632 4071 5140 7736 11750 17959 25474 32004 34943
10,00,000 3774 4230 5341 8039 12210 18662 26470 33256 36310
*Rates for only those sum insured option which are opted in quote will be applicable. These rates may vary with any change in demography, sum insured and coverages.