Insurer: The New India Assurance Co.

Ltd Claims Analysis Report

Policy Holder: JOHN COCKERILL INDIA LTD Report date: 08-Jun-2021
Policy No: 14210034200400000013
This Report Generated By sachin.ghorpade
Policy period: 01-Jul-2020 To 30-Jun-2021 On Tue Jun 08 11:31:11 IST 2021

Total Claims Experience Report

Claims Value (Rs.) % Claims % Value

Cashless Settled 61 4,588,405.00 44.85 % 64.05 %
Cashless Processed 1 122,935.00 0.74 % 1.72 %
Reimbursement Settled 69 2,382,286.00 50.74 % 33.25 %
Reimbursement Processed 1 70,334.00 0.74 % 0.98 %
Denials 4 0.00 2.94 % 0.0 %
Denials due to Shortfall 0 0.00 0.0 % 0%
Closed 0 0.00 0.0 % 0.0 %
Domicilary claims 0 0.00 0.0 % 0.0 %
Total 136 7,163,960.00
Cashless in Process* 4 361,950.00
Reimbursement in Process* 4 213,935.00
Grand Total (Rs.) 144 7,739,845.00
First Time Premium (Rs.)^ 5,219,589.00

Endo Premium (Rs.)^ 16,166.00

Deletion Premium (Rs.)^ 541,776.00

Total Premium (Rs.)^ 4,693,979.00

Claims Ratio (%) 164.89 %

Claims Ratio (%) - On Earned Premium# 175.46 %

Value of Denied claims (Rs.): 135,524.00

Value of Denied(Document Shortfall) claims (Rs.): 0.00

Value of Closed claims (Rs.): 0.00

* Depicts the claimed amount for claims in process. The settlement amount will be less than the above figures and will result in
respective decrease in the claims ratio.
** The value is for preauthorisation issued and awaiting for final documentation. Depicts the Processed PA amount for PA issued.
The settlement amount will be less than or equal to the above figures and could result in respective decrease in the claims ratio.
# Does not apply to policies with Instalment Premium
^ Premium details as received from insurer & updated in our data as on date

Morbidity Ratio

Descriptions Values
No. of lives Insured 1559
No. of Claims 140
No. of Claims made per 100 Lives Insured 8.98 %
No. of lives Inception 1538
Addition 21
Deletion 263
CurrentLives 1296

c2e30164-7601-43cd-bab6-e56a2fda25d4 Confidential Page No: 1

 Insurer: The New India Assurance Co. Ltd Claims Analysis Report
Policy Holder: JOHN COCKERILL INDIA LTD Report date: 08-Jun-2021
Policy No: 14210034200400000013
This Report Generated By sachin.ghorpade
Policy period: 01-Jul-2020 To 30-Jun-2021 On Tue Jun 08 11:31:11 IST 2021

Ailments Profile

ICD Group No. of Claims Value (Rs.) % of Claims % of Value

DISORDERS OF THE RESPIRATORY SYSTEM 55.0 3,229,227.00 41.67 % 45.08 %
INFECTIOUS DISEASES (BACTERIAL / VIRAL / 20.0 598,776.00 15.15 % 8.36 %
Others)
DISORDERS OF THE GASTROINTESTINAL 9.0 534,225.00 6.82 % 7.46 %
SYSTEM
CARDIAC DISORDERS 4.0 477,650.00 3.03 % 6.67 %
DISORDERS OF THE MUSCULOSKELTAL 4.0 370,031.00 3.03 % 5.17 %
SYSTEM
CANCER 2.0 290,968.00 1.52 % 4.06 %
CATARACT 9.0 252,468.00 6.82 % 3.52 %
GYNECOLOGICAL DISORDERS 3.0 238,258.00 2.27 % 3.33 %
CAESAREAN SECTION 5.0 230,122.00 3.79 % 3.21 %
HYPERTENSIVE DISORDERS 7.0 186,415.00 5.3 % 2.6 %
All Other Ailment Groups 14.0 755,820.00 10.61 % 10.55 %
Total 132.0 7,163,960.00
Based on Settled/Processed Cashless/Reimbursement Claims Only

Distribution Across Age

Age Band No. of Claims Value (Rs.) % Claims % Value

0-5 4 195,147.00 3.0 % 2.0 %
6-35 37 1,564,922.00 28.0 % 21.0 %
36-40 18 934,003.00 13.0 % 13.0 %
41-45 18 1,005,558.00 13.0 % 14.0 %
46-50 25 1,613,279.00 18.0 % 22.0 %
51-55 26 1,539,933.00 19.0 % 21.0 %
56-60 4 311,118.00 3.0 % 4.0 %
Total 132 7,163,960.00
Based on Settled/Processed Cashless/Reimbursement Claims Only

Distribution Across Category of Beneficiaries Report

Beneficiary No. of Claims Value (Rs.) % Claims % Value

Self 75.0 3,785,549.00 56.82 % 52.84 %
Spouse 45.0 2,844,407.00 34.09 % 39.7 %
Child 12.0 534,004.00 9.09 % 7.45 %
Total 132.0 7,163,960.00
Based on Settled/Processed Cashless/Reimbursement Claims Only

Distribution Across Amount Bands Report

Amount Band No. of Claims Value (Rs.) % Claims % Value

c2e30164-7601-43cd-bab6-e56a2fda25d4 Confidential Page No: 2

 Insurer: The New India Assurance Co. Ltd Claims Analysis Report
Policy Holder: JOHN COCKERILL INDIA LTD Report date: 08-Jun-2021
Policy No: 14210034200400000013
This Report Generated By sachin.ghorpade
Policy period: 01-Jul-2020 To 30-Jun-2021 On Tue Jun 08 11:31:11 IST 2021

Rs. 10,000/- And less 23 128,753.00 17.0 % 1.0 %

Rs. 10,001/- to Rs. 25,000/- 28 509,323.00 21.0 % 7.0 %
Rs. 25,001/- to Rs. 50,000/- 31 1,203,731.00 23.0 % 16.0 %
Rs. 50,001/- to Rs. 1,00,000/- 29 2,062,993.00 21.0 % 28.0 %
Rs. 1,00,001/- to Rs. 1,50,000/- 12 1,474,884.00 9.0 % 20.0 %
Rs. 1,50,001/- to Rs. 2,00,000/- 5 813,021.00 3.0 % 11.0 %
Rs. 2,00,001/- to Rs. 2,50,000/- 3 693,122.00 2.0 % 9.0 %
Rs. 2,50,001/- to Rs. 3,00,000/- 1 278,133.00 0.0 % 3.0 %
Total 132 7,163,960.00
Based on Settled/Processed Cashless/Reimbursement Claims Only

Utilization Report for Employee

No. of Claims in current policy No. of Value (Rs.) % Claims % Value

Employees
1 26 1,912,639.00 57.78 % 50.52 %
2 13 857,907.00 28.89 % 22.66 %
3 2 412,980.00 4.44 % 10.91 %
4 3 439,381.00 6.67 % 11.61 %
5 1 162,642.00 2.22 % 4.3 %
Total 45 3,785,549.00
Based on Settled/Processed Cashless/Reimbursement Claims Only

Utilization Report for Dependents

No. of Claims in current policy No. of Value (Rs.) % Claims % Value

Employees
1 28.0 1,966,190.00 70.0 % 58.2 %
2 8.0 872,125.00 20.0 % 25.81 %
3 3.0 394,387.00 7.5 % 11.67 %
4 1.0 145,709.00 2.5 % 4.31 %
Total 40.0 3,378,411.00
Based on Settled/Processed Cashless/Reimbursement Claims Only

Provider Profile Report

Hospital Name No. of Claims Value (Rs.) % Claims % Value

Dr L H Hiranandani Hospital 8.0 319,254.00 6.06 % 4.46 %
Veer Hospital And Icu 14.0 305,180.00 10.61 % 4.26 %
Kokilaben Dhirubhaiambani Hospital And Medical Research 2.0 290,968.00 1.52 % 4.06 %
Institute
Global Hospital 1.0 278,133.00 0.76 % 3.88 %
Life Point Multispeciality Hospital 3.0 266,612.00 2.27 % 3.72 %
Ashtvinayak Hospital 3.0 263,071.00 2.27 % 3.67 %
Neon Hospital 1.0 243,288.00 0.76 % 3.4 %
Fortis Hospitals Ltd 5.0 242,225.00 3.79 % 3.38 %
Niramaya Hospital 5.0 240,771.00 3.79 % 3.36 %
Life Line Hospital. 3.0 238,867.00 2.27 % 3.33 %

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 Insurer: The New India Assurance Co. Ltd Claims Analysis Report
Policy Holder: JOHN COCKERILL INDIA LTD Report date: 08-Jun-2021
Policy No: 14210034200400000013
This Report Generated By sachin.ghorpade
Policy period: 01-Jul-2020 To 30-Jun-2021 On Tue Jun 08 11:31:11 IST 2021

Others 87.0 4,475,591.00 65.91 % 62.47 %

Total 132.0 7,163,960.00
Based on Settled/Processed Cashless/Reimbursement Claims Only

Add-Del Endorsement Details

Endo No Endo Date Endo WEF Remarks Addition Deletion

Premium^ Premium^
14210034200484000026 01-Mar-2021 03-Feb-2021 Additions (4): New born babies of 50738, 51288 0.00 0
& spouse of 51328,51351
14210034200484000026 01-Mar-2021 03-Feb-2021 Deletions of members for the 0 7,705.00
month of February 2021 under abovementioned
policy as below:
Additions (4): New born babies of 50738, 51288
& spouse of 51328,51351 Extra `5653
Deletions (10) : Family No.50091, 50757, 51058
: Refund `13358
14210034200484000024 08-Feb-2021 04-Jan-2021 Additions 0.00 0
14210034200482000006 08-Jul-2020 01-Jul-2020 1533 lives added 0.00 0
14210034200484000013 09-Jul-2020 01-Jul-2020 Additions of members : 3 : Child of 50821, 0.00 0
Spouse of 51296, 51398,Corrections : As per
excel
14210034200484000013 09-Jul-2020 01-Jul-2020 PASS ENDORSEMENT FOR ADDITIONS & 0 91,930.00
DELETIONS,CORRECTIONS OF FOLLOWING
MEMBERS UNDER WITHIN MENTIONED
POLICY SINCE INCEPTION:-Deletion of
members : (16+14) Family
Nos.51356,51238,51386,51402,51405, 51412,
50850, 51391,90003, 51399, 51400
14210034200484000017 11-Aug-2020 06-Aug-2020 Deletion 3 0 9,347.00
14210034200482000026 11-Dec-2020 03-Dec-2020 Correction 0.00 0
14210034200484000023 11-Dec-2020 03-Dec-2020 Deletion 0 24,272.00
14210034200484000027 12-Mar-2021 02-Mar-2021 Deletion 0 4,823.00
14210034210484000001 13-Apr-2021 06-Apr-2021 Deletion 0 140.00
14210034200484000024 16-Jan-2021 04-Jan-2021 Deletion 0 245,408.00
14210034200483000010 17-Aug-2020 07-Aug-2020 Addition 1 3,050.00 0
14210034200482000014 17-Aug-2020 07-Aug-2020 Correction 0.00 0
14210034200484000021 17-Oct-2020 06-Oct-2020 Deletion 0 29,756.00
14210034210484000002 18-May-2021 04-May-2021 Deletion 0 14,272.00
14210034200484000022 20-Nov-2020 11-Nov-2020 12 lives deleted 0 21,325.00
14210034210482000004 21-Apr-2021 07-Apr-2021 correction 0.00 0
14210034200483000006 22-Jul-2020 04-Jul-2020 1 lives added 3,405.00 0
14210034200484000022 24-Nov-2020 11-Nov-2020 3 lives added & 12 lives deleted 0.00 0
14210034200482000021 25-Sep-2020 03-Sep-2020 Correction 0.00 0
14210034200484000019 25-Sep-2020 03-Sep-2020 Deletion 0 92,798.00
14210034200482000010 28-Jul-2020 14-Jul-2020 Correction 0.00 0
14210034200483000008 28-Jul-2020 14-Jul-2020 Addition 6,810.00 0
14210034200483000011 30-Aug-2020 22-Aug-2020 Addition 2,901.00 0
Grand Total 16,166.00 541,776.00
^ Premium details as received from insurer & updated in our data as on date

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