This Quote is valid for 15 days.
Quote is subject to change with change in information
14-Sep-23
Ecomen Laboratories Pvt Ltd
Policy Details
Product Type Group Mediclaim (Empl only) Policy Type New Business
Corporate Reg. No* PAN Card AAACE6076H
Number*
Member Details
Relation Coverage Count Age Restrictions
Employees YES 56 Upto 100 years
Spouse YES 0 Upto 100 years
Dependent Children YES 0 Upto 25 years
Parents/In Laws NO 0 Upto 100 years
Premium Details
Details Amount in INR
Net Premium 285000
Add: 18% GST 51300
Gross Premium 336300
Demography
SI/Age 0-25 26-35 36-45 46-55 56-65 66-70 71-75 76-80
100000 0 0 0 0 0 0 0 0
150000 0 0 0 0 0 0 0 0
200000 0 0 0 0 0 0 0 0
250000 0 0 0 0 0 0 0 0
300000 0 0 0 0 0 0 0 0
350000 0 0 0 0 0 0 0 0
400000 0 0 0 0 0 0 0 0
450000 0 0 0 0 0 0 0 0
500000 10 26 11 5 4 0 0 0
Coverage Details
Pre Existing Diseases Covered
One Year Waiting Period Not Applicable
30 Days Waiting Period Not Applicable
Not Applicable Caesarean Delivery
Maternity Benefit Covered 9 Months Waiting P Not Applicable
Not Applicable Not Applicable
Maternity Limit
Child Coverage Day One Maternity Not Covered
For No Of Children
Coverage Details
only. Ambulance charges will be applicable for transferring patient to Hospital
Emergency Ambulance or between Hospitals in the Hospital’s ambulance or in an ambulance
Maternity Cover Not Covered
Pre and post natal Cover Not Covered
Family Definition Self
Co-payment Not Applicable
1. Day care Procedure covered as per our policy wordings.
2. Pre and Post Hospitalization covered for 30 days and 60 days respectively.
Other Conditions
3. Infertility treatment not covered under the policy.
4. Psychiatric treatment not covered.
1. Day care Procedure covered as per our policy wordings.
2. Pre and Post Hospitalization covered for 30 days and 60 days respectively.
Other Conditions
3. Infertility treatment not covered under the policy.
4. Psychiatric treatment not covered.
RFQ to be stamped and signed by client, if at all there is a major variation in
Mandatory details at information and data we reserve rights to withdraw and revise the exiting
placement of the policy Complete
quote. and correct Member data (with employee ID numbers as per duty
attendance muster). This quote is valid subject to all salaried employees
covered and there is employee-employer relationship exist. We would be
Coverage Details
resignation from the services (provided these events are falling within the
Continuity Guideline / policy period). Portability option is available under the existing retail health
Portability date of discharge
products, standardofcoverage’s,
the patient.terms, conditions, & guidelines of retail
Submission of Documents:-
For the main claim and pre hospitalization documents–
• Window period for submission of claim documents is 45 calendar days post
date of discharge.
• Delayed submission of claim documents greater than 45 days & less than 3
Claim Intimation and
months will be settled on nonstandard basis at 75% of net payable amount.
Submission of Documents
• Delayed submission of claim documents greater than 3 months will be
settled on nonstandard basis at 50% of net payable amount.
For Post hospitalization documents
• Window period for submission of claim documents is 90 calendar days post
date of discharge
received within 45ofdays.
the main claim. for new employee, spouse / children
Any additions
Guideline for Addition •would
Delayed submission of claim
be allowed within 45 days documents
of date ofgreater
joiningthan 90 days
marriage & less than 4
/ birth
Endorsements respectively. Backdation of 45 days from date of intimation shall not be
Guideline for Deletion Deletion
allowed. to
Anybeendorsements
intimated immediately on the
will be from finalization of last working
date of addition and notdayfromof the
Endorsements employee. In case employee avails the claim after his LWD for which
intimation is received
Transplantation, after
Robotic DOA, insurer
Surgery, Femto would recover paid
laser treatment amount
for eye. from
It will be
applicable for each eye each event. Cochlear Implant treatment shall
of Chamber cases or outside visiting consultant has conducted the surgery or be
is being management
Weight consulted, Insurance
servicescompany wouldrelated
and treatment be liable
toto pay up
weight to the agreed
program's
including treatment of obesity will not be payable.
• Beneficiary name for issue of claim cheques will be assumed as name of the
Other Conditions your employees,
corporate unless you would,specified.
otherwise inter alia, will get additional advantage of online
web integration [subject to accepting terms and conditions, disclaimers,] with
our website
Claims thereby
servicing you can online
and processing will access
be done forbythe purpose
In-house of enabling you to
Health
Administration Team, Bajaj Allianz General Insurance Company.
Rest all as per attached Standard Group Health policy wording.
formation
14-Sep-23
New Business
AAACE6076H
strictions
00 years
00 years
25 years
00 years
Above
80
0
0
0
0
0
0
0
0
0
Not Applicable
Maternity Not Covered
g patient to Hospital
ambulance
days respectively.
days respectively.
major variation in
evise the exiting
mbers as per duty
ed employees
t. We would be
alling within the
ting retail health
ines of retail
calendar days post
days & less than 3
payable amount.
months will be
t.
calendar days post
spouse / children
days & less than 4
e / birth
n shall not be
tonworking
and notday
fromof the
for which
id eye.
or amount from
It will be
ment shall be
cted the surgery or
pay
ightup to the agreed
program's
med as name of the
dvantage of online
s, disclaimers,] with
of enabling you to
ealth
pany.
ding.
