Non Floater Quote

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Magma HDI GIC Ltd.

Group Health Insurance Quote

Proposer Details: Policy Details

Name of the Client Sigma Solutions Policy Start Date 04-Mar-24

Location of the Proposer New Delhi Policy End Date 04-Mar-25


Industry Type Transport/Logistics Total SI (in Rs.) 28,000,000
Previous Insurer 0 No. of Employees 19
Intermediary Name RiskBirbal No. of Dependents 37

Quote Date 23/01/2024 Third Party Administrator Health India

Both Cashless &


Policy Construct Employer-Employee Service Category
Reimbursement
No. of Lives 56 Sum Insured Type Non-Floater
Premium Details: Pre-existing Disease Covered
Gross Premium in INR 410,854 Specific disease waiting period Waived off
Add: GST @ 18% 73,954 Initial waiting period Waived off
Premium after GST in INR 484,808 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, spouse and 2 children upto the age of 25 years covered under the policy

Age Band 1day - 70 yrs

Sum Insured Sum Insured of Rs.-,-,-,,-,,-,-,-,-,-,-,-,500000,-,-,-,- Per life 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 2% of SI for Normal & 4% of SI for ICU (Room rent limit incl. of nursing charges). In case of
Room Rent admission in 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 For normal Rs.50,000, C section Rs.50,000 subject to First 2 children.

9 Months Waiting Period 9 months of waiting period waived off


Baby Day 1 New born baby covered from day one

Mid term inclusion of dependents will be possible only in case of: a) spouse (on account of marriage during the policy
Mid-Term Inclusion of dependents term), b) children (childbirth during the policy term and is covered from day 1) subject to not more than two children
being covered in the policy.

Pre/Post Natal Expenses Pre-Post Natal Expenses to the limit of Rs 5000 is covered Within Maternity Limit.
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 Not covered


Ambulance Service Ambulance Charges limited to Rs.1000 Per Person.

Corporate Floater CF not applicable

OPD is covered subject to a maximum of Rs.0 per family. Claims pertaining to each Insured can be lodged only once
during the Period of Insurance. The Company shall not receive any claims prior to completion of 90 days of the
OPD Cover
commencement of the Policy. Claims under this Benefit shall be payable only on Re-imbursement basis. No claim shall
be admissible under this Benefit 30 days after expiry of policy.
Following wellness services will be covered under the policy for maximum upto 4 members per family.
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
Wellness services etc.)
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
Service provider details
that can be 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

Air Ambulance Air ambulance is covered upto FSI or upto Rs.1lac per family whichever is lower

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, Bronchical Thermoplasty, Vaporisation of the prostrate (Green laser treatment or
Special Condition
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 falling within the policy period). Portability option is available as per IRDA guideline under the existing retail
Portability
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
Claim Intimation and Submission of
proved to the satisfaction of the Company that under the circumstances in which the insured was placed it was not
Documents
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 No limit No limit
Cataract No limit No limit
Gall Bladder No limit No limit
Hernia No limit No limit
Hydrocele No limit No limit
Hysterectomy No limit No limit
Piles No limit No limit
Kidney Stone (inc DJ stent removal for same stone) No limit No limit
- No limit No limit
CKD, Cancer, Joint replacement and Heart related No limit No limit

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 0 0 0 0 0 0 0 0 0
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 20 20 14 2 0 0 0 0 0 56
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 20 20 14 2 0 0 0 0 0 56

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 1,710 3,063 5,105 7,536 13,073 18,119 20,958 28,370 32,819
75,000 2,017 3,611 6,026 10,408 18,688 25,896 30,590 39,965 46,240
100,000 2,274 4,050 6,740 11,653 21,331 34,346 37,815 44,771 51,809
125,000 2,395 4,208 6,980 11,985 21,601 34,458 38,280 45,928 53,150
150,000 2,515 4,366 7,221 12,317 21,871 34,570 38,745 47,086 54,490
200,000 2,756 4,681 7,702 12,981 22,410 34,794 39,674 49,402 57,171
250,000 2,897 5,005 8,308 14,210 25,348 40,156 44,887 54,357 62,923
300,000 3,038 5,329 8,914 15,438 28,287 45,518 50,099 59,312 68,675
350,000 3,312 5,818 9,769 16,882 30,909 49,717 54,764 64,815 75,074
400,000 3,586 6,308 10,624 18,327 33,532 53,917 59,429 70,318 81,474
450,000 3,660 6,557 11,039 19,082 35,234 56,963 62,458 73,298 84,935
500,000 3,735 6,806 11,454 19,837 36,935 60,010 65,488 76,278 88,396
600,000 3,959 7,214 12,141 21,027 39,151 63,610 69,417 80,854 93,700
750,000 4,868 8,877 15,177 26,344 49,969 82,040 88,626 101,798 117,977
800,000 5,111 9,321 15,936 27,662 52,467 86,142 93,057 106,888 123,876
1,000,000 5,154 9,736 16,608 29,017 55,362 91,251 98,124 111,868 129,622

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.

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