Magma HDI GIC Ltd.

Group Health Insurance Quote

Proposer Details: Policy Details

ISHWAR CORRUGATION & PACKAGING
Name of the Client Policy Start Date 07-Jun-23
INDUSTRY
Location of the Proposer Jaipur Policy End Date 05-Jun-24
Industry Type Packaging Total SI (in Rs.) 8,700,000
Previous Insurer ICICI Lombard No. of Employees 29
Intermediary Name GIRNAR BROKER No. of Dependents 0
Medi Assist Insurance TPA Private
Quote Date 06/06/2023 Third Party Administrator
Limited

Policy Construct Employer-Employee Service Category Both Cashless & Reimbursement

No. of Lives 29 Sum Insured Type Floater

Premium Details: Pre-existing Disease Covered
Gross Premium in INR 82,683 Specific disease waiting period Waived off
Add: GST @ 18% 14,883 Initial waiting period Waived off
Premium after GST in INR 97,566 Domiciliary Hospitalisation Not covered

The quote is valid for 30 days and for given information. The quote is valid if the client gives us a written declaration that given is the fresh proposal and there was no such
arrangements previously under any mode. Same needs to be mentioned on the proposal form duly signed & stamped.

Conditions:
Family Definition Employee only covered under the policy

Age Band 18 Years-70 years

Sum Insured Sum Insured of Rs.-,-,-,,-,,-,-,-,300000,-,-,-,-,-,-,-,- Per family during the policy period of one year.
Pre - Post Hospitalisation Pre and Post Hospitalisation for 30 days & 60 days respectively are covered under the policy.

Room Rent is restricted to 1% of SI for Normal & 2% of SI for ICU (Room rent limit incl. of nursing charges). In case of admission in
Room Rent normal room, if insured is admitted in a higher category, then insured will bear difference of all associated medical expenses as in
final hospital bill in same proportion.
Day care procedures Day care procedures are covered as per Magma HDI Day care list.
Maternity Benefit for Normal & C-Section Maternity not covered
9 Months Waiting Period Not covered
Baby Day 1 Not covered

Mid-Term Inclusion of dependents NA

Pre/Post Natal Expenses Pre-post natal expenses not covered

Co-Payment Copay not applicable
- -
PPN Option Not applicable
Add-Del of Lives Premium to be charged on Pro-Rata basis for addition/deletion endorsement.
Ayush treatment Ayush treatment covered under the policy upto 25% of FSI in govt. recognised hospitals only
Ambulance Service Ambulance Charges limited to Rs.1000 Per Person.

Corporate Floater CF not applicable

OPD Cover OPD Not covered

Following wellness services will be covered under the policy.

1. E consultation: Tele Doctor Consultations for General physician can be availed through our service provider.
2. Fitness Pass (Daily Live classes by Fitness experts on our service provider Platform - Yoga, Zumba, Functional fitness etc.)
Wellness services
3. Exclusive Platform Benefits:
-up to 50% discounts on Doctor consultation, Health Tests, Health Check-up packages,
-Up to 15% discount on prescription medicines online orders via our service provider.

Health Assure is our authorized service provider for Wellness and Value add benefits under this policy. You can avail these
benefits through Health Assure’s website www.healthassure.in/products Or through mobile Health Assure App that can be
Service provider details
downloaded from App store/Google Play store. You can also contact on 022-61676633. You will receive SMS on your registered
mobile no. with all these details along with login credentials.

Id cards E-cards to be issued

Domiciliary Hospitalization Not covered

- -

Septoplasty, Infertility & Related Ailments including Male sterility; Treatment on trial/experimental basis;
Exclusion Admin/Registration/Service/Misc. Charges; Expenses on fitting of Prosthesis; Any device/instrument/machine
contributing/replacing the function of an organ; Holter Monitoring are outside the scope of the policy.
Special Condition Liability for Nasal Sinus Surgeries upto Rs.35,000; Hospitalisation arising out of Psychiatric ailments upto Rs.30,000;

- -

Special Condition Lasik surgery covered above +/- 7.5

50% Co-Pay for cyberknife treatment, Stem Cell Transplantation, Uterine Artery Embolization and HIFU, Balloon Sinuplasty, Deep
Brain stimulation, Immunotherapy - Monoclonal Antibody to be given as injection, Robotic surgeries, Stereotactic radio surgeries,
Special Condition Bronchical Thermoplasty, Vaporisation of the prostrate (Green laser treatment or holmium laser treatment), IONM - (Intra
Operative Neuro Monitoring). Cochlear Implant treatment and Oral chemotherapy shall be restricted to 50% of the Sum
Insured(SI). Intra vitreal injection is covered upto 50% of SI maximum upto Rs.50,000 per family.

Special Condition No Refund for deletion if lives less than minimum required & if insured has claimed during policy.

Special Condition Internal Congenital disease is covered and external Congenital disease is covered under life threatening situation.

Special Condition Hospitalization due to terrorism is covered under the policy.

Portability/Migration benefit can be availed at the time of retirement or resignation from the services (Provided these events are
Portability falling within the policy period). Portability option is available as per IRDA guideline under the existing retail health products.
Standard coverage, terms & conditions, prevailing underwriting guidelines of retail product would apply.

All reimbursement claims have to be intimated within 15 days of discharge.

Claims have to be submitted for reimbursement within 30 days of date of discharge of the patient. However, the Company may at
its absolute discretion consider waiver of this Condition in extreme cases of hardship where it is proved to the satisfaction of the
Claim Intimation and Submission of Documents
Company that under the circumstances in which the insured was placed it was not possible for him or any other person to give
such notice or file claim within the prescribed time-limit. The claims would invite additional 10% co-payment over and above
payable amount only in case of delay in submission of claims beyond 30 days.
 Diseases Wise Sublimits Metro Non-Metro
Appendix 12,000 10,000
Cataract 17,000 15,000
Gall Bladder 15,000 15,000
Hernia 12,000 10,000
Hydrocele 7,000 5,000
Hysterectomy 20,000 17,000
Piles 10,000 7,000
Kidney Stone (inc DJ stent removal for same stone) 30,000 25,000
Joint Replacement including Vertebral joints 75,000 70,000
CKD, Cancer and Heart related ailments 100,000 100,000

Demography Details (No. of lives)

SI/Age Band 0-18 19-35 36-45 46-55 56-65 66-70 71-75 76-80 Above 80 Total
50,000 0 0 0 0 0 0 0 0 0 0
75,000 0 0 0 0 0 0 0 0 0 0
100,000 0 0 0 0 0 0 0 0 0 0
125,000 0 0 0 0 0 0 0 0 0 0
150,000 0 0 0 0 0 0 0 0 0 0
200,000 0 0 0 0 0 0 0 0 0 0
250,000 0 0 0 0 0 0 0 0 0 0
300,000 0 21 3 5 0 0 0 0 0 29
350,000 0 0 0 0 0 0 0 0 0 0
400,000 0 0 0 0 0 0 0 0 0 0
450,000 0 0 0 0 0 0 0 0 0 0
500,000 0 0 0 0 0 0 0 0 0 0
600,000 0 0 0 0 0 0 0 0 0 0
750,000 0 0 0 0 0 0 0 0 0 0
800,000 0 0 0 0 0 0 0 0 0 0
1,000,000 0 0 0 0 0 0 0 0 0 0
Total Lives 0 21 3 5 0 0 0 0 0 29

Premium per life for addition /deletion purpose 18% GST EXTRA
SI/Age Band 0-18 19-35 36-45 46-55 56-65 66-70 71-75 76-80 Above 80
50,000 655 1,173 1,955 2,887 5,008 6,941 8,029 10,868 12,572
75,000 773 1,383 2,308 3,987 7,159 9,920 11,719 15,310 17,714
100,000 871 1,552 2,582 4,464 8,172 13,157 14,486 17,151 19,847
125,000 917 1,612 2,674 4,591 8,275 13,200 14,664 17,595 20,361
150,000 963 1,672 2,766 4,719 8,378 13,243 14,843 18,038 20,874
200,000 1,056 1,793 2,951 4,973 8,585 13,329 15,199 18,925 21,901
250,000 1,110 1,917 3,183 5,444 9,711 15,383 17,195 20,823 24,105
300,000 1,164 2,041 3,415 5,914 10,836 17,437 19,192 22,722 26,308
350,000 1,269 2,229 3,742 6,467 11,841 19,046 20,979 24,830 28,760
400,000 1,374 2,417 4,070 7,021 12,846 20,655 22,766 26,938 31,211
450,000 1,402 2,512 4,229 7,310 13,498 21,822 23,927 28,079 32,537
500,000 1,431 2,607 4,388 7,599 14,149 22,989 25,087 29,221 33,863
600,000 1,517 2,764 4,651 8,055 14,998 24,368 26,593 30,974 35,895
750,000 1,865 3,401 5,814 10,092 19,142 31,428 33,951 38,997 45,195
800,000 1,958 3,571 6,105 10,597 20,099 33,000 35,649 40,947 47,455
1,000,000 1,975 3,730 6,362 11,116 21,208 34,957 37,590 42,855 49,656

Grievances

Grievance: For resolution of any query or grievance, Insured may contact the respective branch office of the company or may call the toll free no. 1800-2663202 or may approach us at the sub-section “Grievance
Redressal ” on our website www.magma-hdi.co.in (Customer Care Section). However, if the resolution provided by us is not satisfactory you may approach Insurance & Regulatory Development Authority (IRDA)
through the integrated Grievance Management System (IGMS) or IRDA Grievance Call Centre (IGCC) at their toll free no. 155255.