Configuration Details

Product Name ArogyaSanjeevaniPolicyManipalCignaTest

Product Code ASPMCT
LoB Health
CoB Health
Effective Date From 5/21/2024
Effective Date To 5/21/2034
Product Status Active
Product Type Indmenity
Template Insurance Certificate
PolicyType Retail
Single Risk/Multiple Risk Multiple Risk
Insurable Category Person
Insurable Item Person
C/W/E (Insurable Item level)

Cover 1
Cover Name In-patient Hospitalization
Cover Description In-patient Hospitalization
C/W/E (Cover level)
Benefit
Benefit Name In-patient Hospitalization
Benefit Criteria Per Cover
Currency INR
BenefitType Indemnity
Parent Cover
BasedOn Standard SI CoverSI

50000, 100000, 150000, 200000, 250000,

300000, 350000, 400000, 450000, 500000,
550000, 600000, 650000, 700000, 750000,
SI Options 800000, 850000, 900000, 950000, 1000000
Maximum Benefit Amount
Maximum Benefit Criteria Value
Limit List (%)
Deductible Value
Deductible Unit
C/W/E (Benefit level)

Insurable Category Person

Insurable Item Person
C/W/E (Insurable Item level)

Cover 2
Cover Name Room Rent
 Cover Description Room Rent
C/W/E (Cover level)
Benefit 1
Benefit Name Room Rent
Benefit Criteria Per Cover
Currency INR
BenefitType Indemnity
Parent Cover In-patient Hospitalization
BasedOn Cover SI
SI Options
Maximum Benefit Amount 5000
Maximum Benefit Criteria Value
Limit List (%) 2
Deductible Value
Deductible Unit
C/W/E (Benefit level)

Insurable Category Person

Insurable Item Person
C/W/E (Insurable Item level)

Benefit 2
Benefit Name ICU Charges
Benefit Criteria Per Cover
Currency INR
BenefitType Indemnity
Parent Cover In-patient Hospitalization
BasedOn Cover SI
SI Options
Maximum Benefit Amount 10000
Maximum Benefit Criteria Value
Limit List (%) 5
Deductible Value
Deductible Unit
C/W/E (Benefit level)

Insurable Category Person

Insurable Item Person
C/W/E (Insurable Item level)

Cover 3
Cover Name Pre-Hospitalization
Cover Description Pre-Hospitalization
 C/W/E (Cover level)
Benefit 1
Benefit Name Pre-Hospitalization
Benefit Criteria Per Cover
Currency INR
BenefitType Indemnity
Parent Cover In-patient Hospitalization
BasedOn Cover SI
SI Options
Maximum Benefit Amount
Maximum Benefit Criteria Value
Limit List (%) 10-100
Deductible Value
Deductible Unit
C/W/E (Benefit level)

Insurable Category Person

Insurable Item Person
C/W/E (Insurable Item level)

Cover 4
Cover Name Post-Hospitalization
Cover Description Post-Hospitalization
C/W/E (Cover level)
Benefit 1
Benefit Name Post-Hospitalization
Benefit Criteria Per Cover
Currency INR
BenefitType Indemnity
Parent Cover In-patient Hospitalization
BasedOn Cover SI
SI Options
Maximum Benefit Amount
Maximum Benefit Criteria Value
Limit List (%) 10-100
Deductible Value
Deductible Unit
C/W/E (Benefit level)

Insurable Category Person

Insurable Item Person
C/W/E (Insurable Item level)
Cover 5
Cover Name In-patient hospitalization for AYUSH
Cover Description In-patient hospitalization for AYUSH
C/W/E (Cover level)
Benefit 1
Benefit Name In-patient hospitalization for AYUSH
Benefit Criteria Per Cover
Currency INR
BenefitType Indemnity
Parent Cover In-patient Hospitalization
BasedOn Cover SI
SI Options
Maximum Benefit Amount
Maximum Benefit Criteria Value
Limit List (%) 10-100
Deductible Value
Deductible Unit
C/W/E (Benefit level)

Insurable Category Person

Insurable Item Person
C/W/E (Insurable Item level)

Cover 6
Cover Name All Day Care Treatments
Cover Description All Day Care Treatments
C/W/E (Cover level)
Benefit 1
Benefit Name All Day Care Treatments
Benefit Criteria Per Cover
Currency INR
BenefitType Indemnity
Parent Cover In-patient Hospitalization
BasedOn Cover SI
SI Options
Maximum Benefit Amount
Maximum Benefit Criteria Value
Limit List (%) 10-100
Deductible Value
Deductible Unit
C/W/E (Benefit level)

Insurable Category Person

Insurable Item Person
C/W/E (Insurable Item level)

Cover 7
Cover Name Modern Treatments/Procedures
Cover Description Modern Treatments/Procedures
C/W/E (Cover level)
Benefit 1
Benefit Name Modern Treatments/Procedures
Benefit Criteria Per Cover
Currency INR
BenefitType Indemnity
Parent Cover In-patient Hospitalization
BasedOn Cover SI
SI Options
Maximum Benefit Amount
Maximum Benefit Criteria Value
Limit List (%) 10,20,30,40,50
Deductible Value
Deductible Unit
C/W/E (Benefit level)

Insurable Category Person

Insurable Item Person
C/W/E (Insurable Item level)

Cover 8
Cover Name Road Ambulance Cover
Cover Description Road Ambulance Cover
C/W/E (Cover level)
Benefit 1
Benefit Name Road Ambulance Cover
Benefit Criteria Per Event
Currency INR
BenefitType Indemnity
Parent Cover
BasedOn Standard SI
SI Options
Maximum Benefit Amount 2000
Maximum Benefit Criteria Value Per Event
Limit List (%)
Deductible Value
Deductible Unit
C/W/E (Benefit level)
Insurable Category Person
Insurable Item Person
C/W/E (Insurable Item level)

Cover 9
Cover Name Other Expenses
Cover Description Other Expenses
C/W/E (Cover level)
Benefit 1
Benefit Name Cataract Treatment
Benefit Criteria Per Cover
Currency INR
BenefitType Indemnity
Parent Cover
BasedOn
SI Options
Maximum Benefit Amount 40000
Maximum Benefit Criteria Value
Limit List (%) 25
Deductible Value
Deductible Unit
C/W/E (Benefit level)

Insurable Category Person

Insurable Item Person
C/W/E (Insurable Item level)

Benefit 2
Benefit Name Dental Treatment
Benefit Criteria Per Cover
Currency INR
BenefitType Indemnity
Parent Cover In-patient Hospitalization
BasedOn Cover SI
SI Options
Maximum Benefit Amount
Maximum Benefit Criteria Value
Limit List (%) 10-100
Deductible Value
Deductible Unit
C/W/E (Benefit level)
Insurable Category Person
Insurable Item Person
C/W/E (Insurable Item level)

Benefit 3
Benefit Name Plastic Surgery
Benefit Criteria Per Cover
Currency INR
BenefitType Indemnity
Parent Cover In-patient Hospitalization
BasedOn Cover SI
SI Options
Maximum Benefit Amount
Maximum Benefit Criteria Value
Limit List (%) 10-100
Deductible Value
Deductible Unit
C/W/E (Benefit level)

Insurable Category Person

Insurable Item Person
C/W/E (Insurable Item level)
 Covers Benefit 1 Benefit 2 Benefit 3
In-patient Hospitalization
Room Rent Room Rent ICU Charges
Pre-Hospitalization
Post-Hospitalization
In-patient hospitalization for AYUSH
All Day Care Treatments
Modern Treatments/Procedures
Road Ambulance Cover
Other Expenses Cataract Treatment Dental Treatment Plastic Surgery

Base SI
Incomplete JSON
{ {
"Policy Start Date": "Date & Time",
"Policy End Date": "Date & Time",
"Policy Term": "numeric",
"CoverType": "string",
"Sum insured": "numeric",
"ProposerDetails": {
"Name": "string",
"ContactNo": "string",
"Nationality": "string",
"Salutation": "string",
"EmailId": "string",
"Gender": "string",
"MaritalStatus": "string",
"FirstName": "string",
"LastName": "string",
"DOB": "DateTime",
"OccupationCode": "string",
"PanNo": "string",
"AnnualIncome": "string",
"GSTNumber": "string",
"AadharCard": "string",
"AlternateMobileNo": "string",
"RelationWithInsured": "string",
"RuralAndSocialSectorCategory": "string",
"CKYCNo": "string",
"AddressLine1": "string",
"AddressLine2": "string",
"AddressLine3": "string",
"CityDistrict": "string",
"State": "string",
"Country": "string",
"Pincode": "string",
"CommunicationAddress": {
"AddressLine1": "string",
"AddressLine2": "string",
"AddressLine3": "string",
"CityDistrict": "string",
"State": "string",
"Country": "string",
"Pincode": "string"
Complete JSON
"Policy Start Date": "Date & Time",
"Policy End Date": "Date & Time",
"Policy Term": "numeric",
"CoverType": "string",
"Sum insured": "numeric",
"ProposerDetails": {
"Name": "string",
"ContactNo": "string",
"Nationality": "string",
"Salutation": "string",
"EmailId": "string",
"Gender": "string",
"MaritalStatus": "string",
"FirstName": "string",
"LastName": "string",
"DOB": "DateTime",
"OccupationCode": "string",
"PanNo": "string",
"AnnualIncome": "string",
"GSTNumber": "string",
"AadharCard": "string",
"AlternateMobileNo": "string",
"RelationWithInsured": "string",
"RuralAndSocialSectorCategory": "string",
"CKYCNo": "string",
"AddressLine1": "string",
"AddressLine2": "string",
"AddressLine3": "string",
"CityDistrict": "string",
"State": "string",
"Country": "string",
"Pincode": "string",
"CommunicationAddress": {
"AddressLine1": "string",
"AddressLine2": "string",
"AddressLine3": "string",
"CityDistrict": "string",
"State": "string",
"Country": "string",
"Pincode": "string"
 }, },
"PermanentAddress": { "PermanentAddress": {
"AddressLine1": "string", "AddressLine1": "string",
"AddressLine2": "string", "AddressLine2": "string",
"AddressLine3": "string", "AddressLine3": "string",
"CityDistrict": "string", "CityDistrict": "string",
"State": "string", "State": "string",
"Country": "string", "Country": "string",
"Pincode": "string" "Pincode": "string"
} }
}, },
"InsurableItem": [ "InsurableItem": [
{ {
"InsurableName": "Person", "InsurableName": "Person",
"RiskItems": [ "RiskItems": [
{ {
"Date of Birth": "datetime", "Date of Birth": "datetime",
"Name": "CheckBox", "Name": "CheckBox",
"Injury Hospitalization Cover": "string", "Injury Hospitalization Cover": "string",
"Health Declaration": "", "Health Declaration": "",
"No of hospitalisation benefits ": "numeric", "No of hospitalisation benefits ": "numeric",
"Premium Pay Term": "numeric", "Premium Pay Term": "numeric",
"Age": "", "Age": "",
"Death Cover": "string", "Death Cover": "string",
"LastExpenseSI": "numeric", "LastExpenseSI": "numeric",
"LastExpense": "string", "LastExpense": "string",
"AnnualMedicalSurgerySI": "numeric", "AnnualMedicalSurgerySI": "numeric",
"AnnualMedicalSurgery": "string", "AnnualMedicalSurgery": "string",
"Risk Count": "numeric", "Risk Count": "numeric",
"HospitalizationSI": "numeric", "HospitalizationSI": "numeric",
"Gender": "", "Gender": "",
"Member Age": "numeric", "Member Age": "numeric",
"DOB": "CheckBox", "DOB": "CheckBox",
"Relationship": "string", "Relationship": "string",
"RoomType": "string", "RoomType": "string",
"No. of Days of Hospitalization": "numeric", "No. of Days of Hospitalization": "numeric",
"Email ID": "string", "Email ID": "string",
"Contact Number": "numeric", "Contact Number": "numeric",
"Address": "string", "Address": "string",
"MemberType": "string" "MemberType": "string"
} }
], ],
"Covers": [ "Covers": [
{
] "CoverName": "In-patient Hospitalization",
 } "IsOptional": "False"
], },
"NomineeDetails": [ {
{ "CoverName": "Room Rent",
"NomineeName": "string", "IsOptional": "False"
"NomineeDOB": "string", },
"NomineeRelationWithProposer": "string", {
"PercentageOfShare": "string", "CoverName": "Pre-Hospitalization",
"GuardianName": "string", "IsOptional": "False"
"GuardianDOB": "string", },
"RelationshoipWithGuardian": "string", {
"RelationWithInsured": "string", "CoverName": "Post-Hospitalization",
"NomineeAddressLine1": "string", "IsOptional": "False"
"NomineeAddressLine2": "string", },
"NomineeAddressLine3": "string", {
"NomineeMobile": "string", "CoverName": "In-patient hospitalization for AYUSH",
"NomineeEmailID": "string", "IsOptional": "False"
"AppointeeName": "string", },
"NomineeCity": "string", {
"NomineeState": "string", "CoverName": "All Day Care Treatments",
"NomineePincode": "string" "IsOptional": "False"
} },
], {
"Channel": { "CoverName": "Modern Treatments/Procedures",
"BranchCode": "string", "IsOptional": "False"
"BranchLocation": "string", },
"AgentID": "string", {
"AgentName": "string", "CoverName": "Road Ambulance",
"Salespersoncode": "string", "IsOptional": "False"
"Salespersonname": "string", },
"ChannelType": "string" {
}, "CoverName": "Other Expenses",
"PremiumDetail": { "IsOptional": "False"
"BasicPremium": "string", }
"Discount": "string", ]
"GrossPremium": "string", }
"TaxAmount": "string", ],
"TotalPremium": "string", "NomineeDetails": [
"TaxDetails": [ {
{ "NomineeName": "string",
"Amount": "Number", "NomineeDOB": "string",
"TaxType": "string" "NomineeRelationWithProposer": "string",
} "PercentageOfShare": "string",
] "GuardianName": "string",
}, "GuardianDOB": "string",
 "PaymentDetails": { "RelationshoipWithGuardian": "string",
"TransactionNo": "string", "RelationWithInsured": "string",
"Amount": "string", "NomineeAddressLine1": "string",
"PaymentGateway": "string", "NomineeAddressLine2": "string",
"PaymentStatus": "string", "NomineeAddressLine3": "string",
"EmailId": "string", "NomineeMobile": "string",
"TransactionType": "string", "NomineeEmailID": "string",
"Description": "string", "AppointeeName": "string",
"ModeOfPayment": "string", "NomineeCity": "string",
"DocumentType": "string", "NomineeState": "string",
"Payments": [ "NomineePincode": "string"
{ }
"TransactionNo": "string", ],
"Amount": "string", "Channel": {
"PaymentGateway": "string", "BranchCode": "string",
"PaymentStatus": "string", "BranchLocation": "string",
"TransactionType": "string", "AgentID": "string",
"Description": "string", "AgentName": "string",
"ModeOfPayment": "string" "Salespersoncode": "string",
} "Salespersonname": "string",
] "ChannelType": "string"
}, },
"DocumentDetails": [ "PremiumDetail": {
{ "BasicPremium": "string",
"DocumentType": "string", "Discount": "string",
"DocumentId": "string", "GrossPremium": "string",
"DocumentName": "string", "TaxAmount": "string",
"ContentType": "string" "TotalPremium": "string",
} "TaxDetails": [
] {
} "Amount": "Number",
"TransactionType": "string", "TaxType": "string"
"Description": "string", }
"ModeOfPayment": "string", ]
"DocumentType": "string", },
"Payments": [ "PaymentDetails": {
{ "TransactionNo": "string",
"TransactionNo": "string", "Amount": "string",
"Amount": "string", "PaymentGateway": "string",
"PaymentGateway": "string", "PaymentStatus": "string",
"PaymentStatus": "string", "EmailId": "string",
"TransactionType": "string", "TransactionType": "string",
"Description": "string", "Description": "string",
"ModeOfPayment": "string" "ModeOfPayment": "string",
} "DocumentType": "string",
 ] "Payments": [
}, {
"DocumentDetails": [ "TransactionNo": "string",
{ "Amount": "string",
"DocumentType": "string", "PaymentGateway": "string",
"DocumentId": "string", "PaymentStatus": "string",
"DocumentName": "string", "TransactionType": "string",
"ContentType": "string" "Description": "string",
} "ModeOfPayment": "string"
] }
} ]
},
"DocumentDetails": [
{
"DocumentType": "string",
"DocumentId": "string",
"DocumentName": "string",
"ContentType": "string"
}
]
}
ation for AYUSH",

/Procedures",
AgeF AgeTo SumInsured Gender Rate
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61 65 650000 Transgender 21976
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IndiRateParam
ArogyaIndividualRates
AgeF AgeTo SumInsured No. of Adults No. of Kids Rate
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36 45 50000 2 0 3886
46 50 50000 2 0 5801
51 55 50000 2 0 8074
56 60 50000 2 0 10165
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51 55 200000 2 0 11937
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61 65 250000 2 0 21005
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0 17 550000 2 0 3200
18 25 550000 2 0 7543
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46 50 550000 2 0 13527
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56 60 750000 2 1 32343
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51 55 200000 2 2 16999
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61 65 200000 2 2 26166
66 70 200000 2 2 29746
71 75 200000 2 2 35372
76 80 200000 2 2 41723
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0 17 400000 2 2 3000
18 25 400000 2 2 10586
26 35 400000 2 2 12245
36 45 400000 2 2 11662
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51 55 400000 2 2 21396
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86 200 700000 2 2 104976
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18 25 750000 2 2 13846
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66 70 50000 2 3 21111
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81 85 50000 2 3 31591
86 200 50000 2 3 36978
0 17 100000 2 3 3500
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56 60 400000 2 3 31940
61 65 400000 2 3 39080
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86 200 400000 2 3 87502
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18 25 500000 2 3 13850
26 35 500000 2 3 15907
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46 50 500000 2 3 21032
51 55 500000 2 3 27059
56 60 500000 2 3 35294
61 65 500000 2 3 43307
66 70 500000 2 3 48768
71 75 500000 2 3 59455
76 80 500000 2 3 69781
81 85 500000 2 3 81957
86 200 500000 2 3 96323
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26 35 550000 2 3 16861
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61 65 550000 2 3 45905
66 70 550000 2 3 51694
71 75 550000 2 3 63022
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81 85 750000 2 3 97778
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66 70 900000 2 3 59945
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Parameter Group Name FamilyRateParam
Rate Table Name ArogyaFamilyRate1
 1
2
3
4
5

1
2
3
4
5
6

ArogyaIndividualTestCal

ArogyaIndividualArrayTestCal
Individual Table IndividualPremium
Family Table Family Premium
If(PlanType=Individual,IndividualPremium,FamilyPremium) BasePremium
BasePremium*0.18 GST
BasePremium+GST FinalPremium

Array Cal
basecalcultor.basepremium*1 TotalBasepremium
IIF({FamilyCount}>1 AND {CoverType}='Individual',TotalBasepremium*0.15,0) MultimemberDiscount
TotalBasepremium-MultimemberDiscount NetPremium
NetPremium*0.18 GST
NetPremium+GST FinalPremium

Base Rating
Individual Table IndividualPremium

Array Rating
basecalcultor.IndividualPremium*1 SumIndiviualPremium
If ('Covertype'=' FamilyFloater',FamilyTable,0) FamilyPremium
If('Cover Type'= Individual,SumIndiviualPremium,Family Premium) BasePremium
IIF({FamilyCount}>1 AND {CoverType}='Individual',TotalBasepremium*0.15,0) MultimemberDiscount
TotalBasepremium-MultimemberDiscount NetPremium
NetPremium*0.18 GST
NetPremium+GST FinalPremium
 Family Count >1
Cover type Individual

Array
1 basecalcultor.IndividualPremium*1
2 Family premium
3 Base Premium
4 Discount
5 Net Premium
6 GST
7 Final Premum

Multi In dividual

1000
0
1000
150
850
Plan Type = Individual and
Min Adult Age >= 18 and
Max Adult Age <= 65 and
Policy Term = 1

Plan Type = Family and

Min Adult Age >= 18 and
Max Adult Age <= 65 and Rule 2
No. of Adults <= 2 and
No. of Children = 0

Plan Type = Family and

Min Adult Age >= 18 and
Max Adult Age <= 65 and
Min Child Age >= 1 and Rule 3
Max Child Age <= 25 and
No. of Adults <= 2 and
No. of Children <= 3
 Adult agerule
Rule 1 Min Adult Age >= 18
Max Adult Age <= 65

Child agerule
Min Child Age >= 1
or Rule 5 Max Child Age <= 25

Indirule
Plan type = Individual
Policy Term = 1

or Rule 4 Family rule

Plan type = Family
Policy Term = 1

Grop1 Grop2
Familyrule Indirule
and and
FamilyCount Adult agerule
and
Adult agerule
and
Child agerule
Family count rule
No. of Adults <= 2
No. of Children <= 3

Grop1
or
Grop2