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Extra Care Star Package Hospital Cash Critical Illness

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https://general.bajajallianz.com/Corp/health-insurance/health-insurance.jsp
Silver Health Health Ensure Personal Guard HCS Individual HCS Floater
 COMPREHENSIVE CARE PLAN 18-25 years
Fire & Allied Pe
Date: 29-Mar-21
Insured Name Mr. X
Sum Insured 30000000
Occupation Self Employed Policy Period 2 years Co-Applicant Yes
NO
SECTION Premium
Selection Name Sum Insured Age Occupation
Cover A (MANDATORY) Amount

Critical illness Cover & Accident Protection

Applicant 15000000 18-25 years Self Employed 89100
Cover

Co-Applicant
Critical illness Cover & Accident Protection
(If Opted to be Insured under 15000000 18-25 years Self Employed 89100
Cover
the Policy)

Cover B (OPTIONAL) Optional Cover Opted YES

Premium
Cover Sum Insured
Amount
Fire & Allied Perils Cover: Building 30000000 35100
Fire & Allied Perils Cover
Fire & Allied Perils Cover: Contents 7500000 8775
Burglary & Robbery Cover: Contents 7500000 32775
Burglary & Robbery Cover
Burglary & Robbery Cover: Jewellery 1500000 9855
Net Premium 264,705
Service Tax & Education Cess 12.36% 32,718
Final Premium 297,423
 Surgical Protection Plan
DOB Add-on Covers Date: 29-Mar-21

Surgical Critical Hospital Personal Good

Age Cash Daily Loading
Sr No Name Relation DD MM YYYY (as on Gender Benefit Plan Illness Accident Health Premium
today) Cover - SI - 1lack Allowance - SI - 5lack % Discount
- Rs 1500/-

1 Self 1 Jan 1949 72 Male 1 Plan 2 - SI 1.5lack Yes Yes Yes Yes 27,078
2 Spouse 0 Plan 1 - SI 1lack 0
3 Child1 0 Plan 1 - SI 1lack 0
4 Child2 0 Plan 1 - SI 1lack 0
5 Child3 0 Plan 1 - SI 1lack 0
6 Child4 0 Plan 1 - SI 1lack 0
7 Parent1 0 Plan 1 - SI 1lack 0
8 Parent2 0 Plan 1 - SI 1lack 0
Premium 27,078
Family Discount 0
Good Health Discount 1,354
No Discount 0
Net Premium 25,724
Total Loading 0
Net Premium Incl Loading 25,724
Service Tax 14.00% 3,601
Gross Premium 29,325
 Individual Health Guard

PLEASE ENTER DATA IN YELLOW CELLS ONLY Date: 29-Mar-2021

DOB
Coverage Sum Insured Premium
Relation DD MM YYYY Age Band Additioal Loading
Option (Rs) (Rs)

Self Yes 150,000 1 Jan 1969 46-55 Yrs None 5,028

Spouse No 150,000 1 Jan 1970 46-55 Yrs None 0

Child1 No 150,000 1 Jan 1990 Age Exceeded None #N/A

Child2 Yes 150,000 1 Jan 1990 Age Exceeded None #N/A

Child3 Yes 150,000 1 Jan 1990 31-40 Yrs None 2,532

Deductible Amount
Parent1 Yes 150,000 1 Jan 1950 Age Exceeded None #N/A

Parent2 Yes 150,000 1 Jan 1956 61-65 Yrs None 8,849

Other1 Yes 150,000 1 Jan 1982 31-40 Yrs None 2,532

Other2 Yes 150,000 1 Jan 1986 31-40 Yrs None 2,532

Base Premium #N/A

Eligible for Family Discount #N/A
Voluntary Deductible 250,000
Co-Payment Waiver for Non-Network Hospital 10%
Net Premium #N/A
Service Tax 14.00% #N/A
Final Premium #N/A
 PLEASE ENTER DATA IN YELLOW CELLS ONLY Date: 29-Mar-2021
DOB
Sr No Name Relation Age Age Band
DD MMM YYYY
1 Self 1 Jan 1952 69 Age Exceeded
2 Spouse 1 Jan 1995 26 26-40 Yrs
3 Child 1 1 Jan 2007 14 0-25 Yrs
4 Child 2 1 Jan 1991 30 Age Exceeded
5 Child 3 1 Jan 1991 30 Age Exceeded
6 Child 4 1 Jan 1991 30 Age Exceeded
#N/A
Sum Insured 300,000
No of Member Covered 1

Base Premium (Self) #N/A

Co-Payment Waiver for Non-Network Hospital 10%
Voluntary Deductible 10,000
Service Tax 14.00% #N/A
Final Premium #N/A
 Extra Care

PLEASE ENTER DATA IN YELLOW CELLS ONLY Date: 29-Mar-2021

Plan Plan A - 1000000/300000
Coverage DOB
Sr No Relation Age Age Band
Option DD MMM YYYY

1 Self Yes 1 Jan 1949 72 Age Exceeded

2 Spouse No

3 Child1 No

4 Child2 No

5 Child3 No

No of Member Covered 1 Member

Base Premium #N/A

Service Tax 14.00% #N/A
Final Premium #N/A
 Star Package Policy

PLEASE ENTER DATA IN YELLOW CELLS ONLY Date : 29-Mar-21

Policy Term 1 Yr Select Members No of Section Covered 4
DOB 2 Jan 2003 Age : 18 Self ✘ Spouse ✘ Child ✘ No of Child 1
Section Coverage
Section Section Name Relation Option Sum Insured Premium
Opted Option
0
Self No A
1 Hospital Cash No Spouse Yes Up to 25 Yrs 500
Child1 Yes
0
Self No A
Health Guard No Spouse No 90 Days - 25 150,000
Child1 No
Add-on Coverages
Sr No Coverage Coverage Opted
1 Accommodation to Relative Rs 500/- per day for 10 Days No
2 Organ Transplant expences of Donor upto Rs 100000/- No
2
Accidental Emergency, Reconstruction Surgery (in case of Accident), Physiotherapy,
3 No
Medical evacuation upto Rs 50000/-
4 Burial, Cremation Expenses Rs 25000/- No
Medical Expenses for accidental hospitalization SI under healthguard would double for
5 No
accidental hospitalization and related surgeries
Co-Payment Waiver for Non-Network Hospital 0.0%
Voluntary Deductible 0
0
Self No A
3 Critical Illness No Spouse Yes 6-25 Yrs 100,000
Child1 Yes
1
4 Personal Accident Yes NA Yes A 200,000 375
1
5 Education Grant Yes NA Yes A 200,000 120
1
6 Householders Contents Yes NA Yes A 100,000 400
1 Deductible Amount
7 Traveling Baggage Yes NA Yes D 40,000 800
0
8 Public Liability No NA No A 200,000 0
0 1525.5 0 0.1
Base Premium 1,695
Sectional Discount 170
Long Term Discount 0
Base Premium After Discount 1,526
Service Tax 14.00% 214
Final Premium 1,739
 Hospital Cash

PLEASE ENTER DATA IN YELLOW CELLS ONLY Date : 29-Mar-21

Coverage Coverage Per DOB Cover Option Premium
Relation Age Age Band
Option Day (Rs) DD MMM YYYY (In Days) (Rs)
###
Self Yes 500 1 Jan 1952 69 30 Days 0 Select valid Age
###
Spouse Yes 500 1 Jan 1964 57 30 Days 1,200 55-65 Yrs
###
Child1 Yes 500 1 Jan 1994 27 30 Days 0 Select valid Age
###
Child2 Yes 500 1 Jan 1995 26 30 Days 0 Select valid Age
###
Child3 Yes 500 1 Jan 1995 26 30 Days 0 Select valid Age
###
Child4 Yes 500 1 Jan 1995 26 30 Days 0 Select valid Age
###
Base Premium 1,200 ###
Family Discount Yes ###
Service Tax 14.00% 160 ###
Final Premium 1,300 ###
 Critical Illness Policy

PLEASE ENTER DATA IN YELLOW CELLS ONLY Date : 29-Mar-21

Coverage Sum Insured DOB Premium
Relation Age Age Band
Option (Rs) DD MMM YYYY (Rs)

Self Yes 1,000,000 1 Jan 1949 72 Select valid Age 0

Spouse Yes 1,000,000 1 Jan 1992 29 26-35 Yrs 3,000

Parent1 Yes 1,000,000 1 Jan 1950 71 Select valid Age 0

Parent2 Yes 1,000,000 1 Jan 1952 69 Select valid Age 0

Child1 Yes 1,000,000 1 Jan 2008 13 06-25 Yrs 2,000

Child2 Yes 1,000,000 1 Jan 2009 12 06-25 Yrs 2,000

Other1 Yes 1,000,000 1 Jan 1991 30 26-35 Yrs 3,000

Other2 Yes 1,000,000 1 Jan 1992 29 26-35 Yrs 3,000

Base Premium 13,000

Service Tax 14.00% 1,820
Final Premium 14,820
 Silver Health

PLEASE ENTER DATA IN YELLOW CELLS ONLY Date : 29-Mar-21

Coverage Sum Insured DOB Premium
Relation Age
Option (Rs) DD MMM YYYY (Rs)

Self Yes 200,000 1 Jan 1948 73 Select valid Age

Spouse Yes 150,000 1 Jan 1951 70 13,444

Base Premium 13,444

Family Disocunt Yes
Co-Payment Waiver for Non-Network Hospital 0.0%
Service Tax 14.00% 1,788
Final Premium 14,560
 Health Ensure

PLEASE ENTER DATA IN YELLOW CELLS ONLY Date : 29-Mar-21

Plan Opted A - Non Metro Rest of India (Cities Other Than Metros)
DOB
Relation Coverage Option SI Band Age Premium Age Band
DD MMM YYYY
A - Non Metro
Self Yes 50,000 1 Jan 1951 70 #N/A Select Valid Age
A - Non Metro
Spouse Yes 50,000 1 Jan 1956 65 2,438 61-65 Yrs
B - Metro
Child1 No 50,000 0

Child2 No 50,000 1 Jan 1990 31 0 Select Valid Age

Child3 No 50,000 0

Base Premium #N/A A - Non Metro

Family Discount Yes ###
Service Tax 14.00% #N/A ###
Final Premium #N/A
 Personal Guard

PLEASE ENTER DATA IN YELLOW CELLS ONLY Date : 29-Mar-21

Relation Coverage Type Coverage Option Sum Insured Risk Clss

Basic No 200,000
Wider Yes 100,000 I
Self Comprehensive No 100,000
Medical Expenses Yes
Hospital Confinement No

Basic No 200,000
Wider No 100,000 I
Spouse Comprehensive No 100,000
Medical Expenses No
Hospital Confinement No

Basic No 100,000
I
Wider No 100,000
Child1
Medical Expenses No
Hospital Confinement No

Basic No 100,000
I
Wider No 100,000
Child2
Medical Expenses No
Hospital Confinement No

Basic No 100,000
I
Wider No 100,000
Child3
Medical Expenses No
Hospital Confinement No

Basic Premium 200

Family Discount No
Service Tax 14.00% 28
Final Premium 228
 Premium Personal Guard

PLEASE ENTER DATA IN YELLOW CELLS ONLY Date : 29-Mar-21

Relation Coverage Option Plan Cover Premium

Base ✘ 3,650
Self Yes Plan D
Add on ✘ 1,200

Base ✘ 0
Spouse No -
Add on ✘ 0

Base ✘ 0
Child1 No -
Add on ✘ 0

Base ✘ 0
Child2 No -
Add on ✘ 0

Base ✘ 0
Child3 No -
Add on ✘ 0

Base Premium 4,850

Service Tax 14.00% 679
Final Premium 5,529
 Indiv

HEALTH CARE SUPREME - INDIVIDUAL

Indiv
Individual ###
###
Plan : Individual Add-on Covers Date: 29-Mar-21
Member Age Health Care Critical Loading
Sr No Relation D O B. Gender SI Ancillary Expenses Benefit PA Premium
Coverd DD MM YYYY (as on today) Supreme Plan Illness %
1 Self Yes 3 Jan 1972 49 Male Ultimo Plans 40 Lacs ✘ Ultimo-SI Rs 2500/day SI - 10lac 25 Lac 0 57,036
2 Spouse Yes 2 Jan 1977 44 Female Ultimo Plans 40 Lacs ✘ Ultimo-SI Rs 2500/day SI - 10lac 25 Lac 0 47,747
3 Child1 Yes 2 Jan 2009 12 Male Select Plan Select SI Select SI Select SI Select SI 0 0
4 Child2 No 2 Jan 2007 14 Male Select Member Select SI Select SI Select SI Select SI 0 0
5 Child3 No 1 Jan 2013 8 Female Select Member Select SI Select SI Select SI Select SI 0 0
6 Parent1 No 1 Jan 1950 71 Male Select Member Select SI Select SI Select SI Select SI 0 0
7 Parent2 No 1 Jan 1952 69 Female Select Member Select SI Select SI Select SI Select SI 0 0
Premium 104,783
Family Discount 5,239
Add on Cover Discount 5,239
Other Discount 0
Premium After Discount 94,305
Loading Amount 0
Net Premium incl Loading 94,305
Service Tax 14.00% 13,203
 Indivi

HEALTH CARE SUPREME - FLOATER

Float
Individual ###
###
Plan : Floater Family Member Combination: 2A+2C Add-on Covers Date: 29-Mar-21
Member Age Health Care Critical Loading
Sr No Relation D O B. SI Ancillary Expenses Benefit PA Premium
Coverd DD MM YYYY (as on today) Supreme Plan Illness %
1 Self Yes 1 Jun 1985 35 Smart Plans 20 Lacs ✘ Smart-SI Rs 2000/day Select SI Select SI 0 0
2 Spouse Yes Smart Plans Select SI ✘ Smart-SI Rs 2000/day Select SI Select SI 0 0
3 Child1 Yes Smart Plans Select SI ✘ Smart-SI Rs 2000/day Select SI Select SI 0 0
4 Child2 Yes Smart Plans Select SI ✘ Smart-SI Rs 2000/day Select SI Select SI 0 0
5 Child3 No Select Member Select SI ✘ Select SI Select SI Select SI 0 0
Premium 53,476
Family Discount 0
Add on Cover Discount 0
Other Discount 0
Premium After Discount 53,476
Loading Amount 0
Net Premium incl Loading 53,476
Eldest Member's Age should be basis of premium
calculation. Service Tax 14.00% 7,487
Gross Premium 60,963