Group Mediclaim Policy - Employee 2023-24.ppt

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Group Mediclaim Policy
April 1, 2023 to March 31, 2024
Insurer: HDFC Ergo
TPA : Paramount
Broker : UIB India

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Agenda
Executive Summary
Salient Features of the Policy
Premium
Premium Grids
Closing Note

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Executive Summary
We have the following mediclaim policies
2 Policies for Officers of DCM & SPL from New India (Voluntary Programs)
2 Policies for Sub ordinates of DCM & SPL from New India
Policies for Officers of Sugar Units, Bioseed & BRI from New India (negotiated by Units)
Our current Mediclaim policy is running with New India
We moved from National to New India in 2021-22 and premiums were reduced to
increase participation
Participation increased by 45% (Employee 32%; Parent 79%)
Due to higher parent participation, claim ratio has been higher –almost double
New India has incurred a loss of > Rs 4 crore in last 2 years
Challenges in the current program
Being voluntary program employees opt out when premiums are higher –3 year lock-in
introduced last year & will continue

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Executive Summary
Challenges in the current program cont..
Reputed insurance companies discourage voluntary programs
Parents premiums are highly discounted & claims are higher –higher loading
introduced this year
Waiver has been taken on claim reporting & submission timelines –Insurer raising
questions on genuineness of claims –Waiver being called off –Any claim will have to
be filled within 1 month treatment.
Medical costs are going up and therefore sum insured need to be increased.
Proportionate clause waived beyond Rs 5 lac sum insured is now being offered
only for sum insured upto Rs 10 lac.
Way Forward
We have existing relationships with National, New India, HDFC Ergo & TATA AIG
We have approached all off these along with ICICI Lombard & IFFCO Tokyo to assess
market

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Executive Summary
Way Forward cont..
All insurers not interested in only Employee Benefit (EB) programs and will seek
participation in other programs also (Last year we gave Rs 1.35 cr non EB business to
New India; This year it is likely to be Rs 2.50 cr due to projects in Bharuch)
HDFC Ergo rates are much lower than its competition and we are going ahead with them

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Salient Features of the Policy
Family Definition is Self , Spouse , 3 Dependent Children & 1 Set of Parents
Incase of male child up to 25 years & incase of female unmarried child up to 30 years
Any employee (with members) enrolled in the policy shall remain in the policy for 3 years,
unless someone has retired or left the organization
Members enrolling parents will have to enroll their spouse & children as well
This scheme is now not available to existing employee not already enrolled in the
program. Also any employee opting out (himself or family) of the policy will not be enrolled back
The Sum Insured Slabs are Rs/lac 1, 2, 3, 5, 7, 10, 12 & 15 (subordinate policies
have slabs till Rs5 lac only)
The employee can increase/ decrease the sum insured in the subsequent year by 1 Slab only
Policy Inclusions/ Exclusions
Includes Maternity Benefit (uptoRs50,000) subject to loading of Rs10,000 (Not provided in
subordinate policy) –Can not be taken in the mid of the year & will require a gestation period
of 10 months from next year
Disease-wise capping
Cataract Rs. 50,000/-Per Eye (Rs25,000 -subordinate policy)
Hydrocele, Hernia, Piles, Hysterectomy Rs. 60,000/-
Kidney & Gall Bladder Stone Rs. 75,000/-

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Salient Features of the Policy cont..
Policy Inclusions/ Exclusions cont..
20% copay on non-network hospitals except in emergencies (accident, burn, stroke,
emergency cardiac & emergency renal) & reputed hospitals (incl. Govt.) not covered
by TPA
We recommend employees to go to reputed hospitals having cashless facility for fast &
issueless claim settlement
Proportionate clause applicable for premium slab uptoRs10 lac
Room rent: 1% of Sum Insured for Room and 2% of Sum Insured for ICU
In case employee chooses higher category room, incremental treatment cost as a result of
change in room category will be born by the employee
We recommend employees to get higher insurance coverage considering increase in
medical cost
30 Days Pre Hospitalization & 60 Days Post Hospitalization
All other terms as per retiring policy
All Reimbursement Claims will be routed through M/s UIB India

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Salient Features of the Policy cont..
Differences between Officers & Subordinate Policies: Subordinate
policy does not include the following benefit and therefore premiums
are cheaper by 10%
Maximum sum insured limited to Rs 5 lac
Parents sum Insured is limited to 50%
Cataract expenses limited to Rs 25,000/-
Maternity benefits not included

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Premium
Rs/Cr
Other capping's applicable this year to reduce premiums
Proportionate clause applicable for premium slab upto Rs 10 lac
Disease-wise capping (same as last year)(Cataract –Rs. 50,000/-Per Eye & Hydrocele, Hernia,
Piles, Hysterectomy –Rs. 60,000/-& Kidney & Gall Bladder Stone –Rs. 75,000/-)
20% copay on non-network hospitals (same as last year) except in emergencies (accident,
burn, stroke, emergency cardiac & emergency renal) & reputed hospitals (incl. Govt.) not
covered by TPANoCompany Policy NoPolicy Type 2020-21 2021-22 2022-23
APremium
1DCM 7&4 Officers 180.4 179.3 250.4
2DCM 3 Subordinate 36.8 34.5 36.8
3SPL 5 Officers 3.2 3.5 8.4
4SPL 6 Subordinate 0.7 0.6 0.7
Total 221.2 217.9 296.4
BClaims Actual Actual Estimated
1DCM 7&4 Officers 156.1 455.8 374.3
2DCM 3 Subordinate 36.2 47.3 54.5
3SPL 5 Officers 1.5 1.7 3.3
4SPL 6 Subordinate 1.0 0.9
Total 193.8 505.7 433.0
CClaim Ratio 88 232 146

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Premium Grids (Officer’s Policy)
2020-21 2021-22 2022-23 2023-24
Premium Basis Only No of
members
Onlyon Age SlabsBothon Age slabs
& No of Members
Bothon Age slabs
& No of Members
Parents Loading10% for each
parent
No 25% for each
parent (since base
premium reduced)
60% for 1
st
parent
& 90% for 2
nd
parent
Maternity Benefit100% Loading No No Rs10,000/-
Waiting period is
10 mths

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Premium Slabs for members (Officer’s Policy)
(Loading on 1
st
Parent of 60% & 2
nd
Parent of 90% will be added to premiums below)
Note: Premium includes GSTAge MembersCategory0.50 1.00 2.00 3.00 5.00 7.00 10.00 12.00 15.00
< 35 yrs 1 A1 1,762 3,525 4,790 5,274 7,055 8,186 9,893 10,75612,196
A 2 A2 4,582 6,227 6,856 9,172 10,64112,86113,98315,855
3 A3 5,640 7,664 8,438 11,28813,09715,82917,21019,514
4 A4 6,697 9,101 10,02013,40515,55318,79720,43723,173
5 A5 7,755 10,53811,60215,52118,00821,76523,66426,832
6 A6 8,812 11,97513,18417,63820,46424,73326,89130,491
7 A7 9,870 13,41214,76619,75422,92027,70130,11834,150
36 to 45 1 B1 1,866 3,731 5,074 5,590 7,481 8,682 10,49511,41012,940
B 2 B2 4,850 6,596 7,267 9,726 11,28613,64314,83316,821
3 B3 5,970 8,118 8,945 11,97013,89116,79218,25620,703
4 B4 7,089 9,640 10,62214,21516,49519,94021,68024,585
5 B5 8,208 11,16212,29916,45919,10023,08925,10328,467
6 B6 9,328 12,68413,97618,70421,70426,23728,52632,349
7 B7 10,44714,20715,65320,94824,30929,38631,94936,231
46 to 50 1 C1 3,020 6,040 8,363 9,289 12,40914,38717,37718,88921,408
C 2 C2 7,852 10,87212,07516,13118,70322,59024,55527,831
3 C3 9,665 13,38114,86219,85423,01927,80330,22234,253
4 C4 11,47715,89017,64823,57627,33533,01635,88940,675
5 C5 13,28918,39920,43527,29931,65138,22941,55547,098
6 C6 15,10120,90723,22131,02235,96743,44247,22253,520
7 C7 16,91323,41626,00834,74440,28348,65552,88859,943
Slabs (Rs/ Lac) : 2023-24

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Premium Slabs for members (Officer’s Policy) cont..
(Loading on 1
st
Parent of 60% & 2
nd
Parent of 90% will be added to premiums below)
Note: Premium includes GSTAge MembersCategory0.50 1.00 2.00 3.00 5.00 7.00 10.00 12.00 15.00
51 to 55 1 D1 4,506 9,013 12,61914,06918,76821,75126,25528,53232,330
D 2 D2 11,71716,40418,29024,39828,27634,13237,09142,028
3 D3 14,42120,19022,51130,02834,80142,00945,65151,727
4 D4 17,12423,97626,73135,65941,32649,88554,21161,426
5 D5 19,82827,76130,95241,28947,85157,76262,77071,125
6 D6 22,53231,54735,17346,91954,37665,63871,33080,824
7 D7 25,23635,33339,39452,55060,90173,51579,88990,523
56 to 60 1 E1 5,81911,63916,55118,57924,67428,54034,38437,33642,260
E 2 E2 15,13121,51624,15332,07637,10244,69948,53654,938
3 E3 18,62226,48129,72739,47845,66455,01459,73767,616
4 E4 22,11431,44635,30046,88054,22665,32970,93880,293
5 E5 25,60636,41140,87454,28262,78875,64482,13892,971
6 E6 29,09741,37746,44861,68571,35085,95993,3391,05,649
7 E7 32,58946,34252,02269,08779,91296,2741,04,5401,18,327
61 to 65 1 F1 7,02914,05922,00824,79632,85937,97745,70849,61556,130
F 2 F2 28,61028,61032,23542,71749,37059,42064,50072,969
3 F3 35,21235,21239,67352,57560,76473,13379,38489,808
4 F4 41,81541,81547,11262,43372,15786,84594,2691,06,647
5 F5 48,41748,41754,55172,29183,5501,00,5571,09,1531,23,486
6 F6 55,01955,01961,98982,14994,9431,14,2701,24,0381,40,325
7 F7 61,62261,62269,42892,0061,06,3361,27,9821,38,9221,57,164
Slabs (Rs/ Lac) : 2022-23

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Premium Slabs for members (Officer’s Policy) cont..
(Loading on 1
st
Parent of 60% & 2
nd
Parent of 90% will be added to premiums below)
These premiums are still lower compared to market rates. Competitive quotes taken from
New India, Oriental, HDFC Ergo & TATA AIG
Note: Premium includes GSTAge MembersCategory0.50 1.00 2.00 3.00 5.00 7.00 10.00 12.00 15.00
>65 yrs 1 G1 8,07116,14229,68034,90546,46353,79664,87870,47879,818
G 2 G2 38,58438,58445,37760,40269,93584,34291,6211,03,763
3 G3 47,48847,48855,84974,34186,0741,03,8051,12,7651,27,708
4 G4 56,39256,39266,32088,2801,02,2131,23,2691,33,9081,51,654
5 G5 65,29665,29676,7921,02,2191,18,3511,42,7321,55,0521,75,599
6 G6 74,20074,20087,2631,16,1581,34,4901,62,1961,76,1951,99,544
7 G7 83,10483,10497,7351,30,0971,50,6291,81,6601,97,3382,23,490
Slabs (Rs/ Lac) : 2022-23

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Premium Calculation (Officer’s Policy)
for Rs 10 lac sum insured
2020-21 2021-22 2022-23 2023-24
Employee–45 yrs
Spouse
No of members 2
Premium –50,704
Age group : 36 to 45
Premium –18,000
No of Members 2
Age group : 36 to 45
Premium –13,643 ↓
No of Members 2
Age group : 36 to 45
Premium –13,643~
Employee–45 yrs
Spouse
Parents –2 nos
No of members 4
Premium for 4 members
59,921
Parents Loading @ 20%
Premium –71,905
Age group : 36 to 45
Premium –18,000
No of Members 4
Age group : 36 to 45
Premium –18,891
Parents Loading @ 50%
Premium –28,336 ↑
No of Members 4
Age group : 36 to 45
Premium –19,940
Parents Loading @ 60&90%
Premium –49,851 ↑
Employee –55 yrs
Spouse
No of members 2
Premium –50,704
Age group : 51 to 55
Premium –45,035
No of Members 2
Age group : 51 to 55
Premium –34,132 ↓
No of Members 2
Age group : 51 to 55
Premium –34,132~
Employee–55 yrs
Spouse
Parents –1 nos
No of members 3
Premium for 3 members
55,314
Parents Loading @ 10%
Premium –60,845
Age group : 51 to 55
Premium –45,035
No of Members 3
Age group : 51 to 55
Premium –40696
Parents Loading @ 25%
Premium –50,870 ↑
No of Members 3
Age group : 51 to 55
Premium –42,009
Parents Loading @ 60%
Premium –67,214 ↑
Employee–55 yrs
Spouse
Parents –2 nos
No of members 4
Premium for 4 members
59,921
Parents Loading @ 20%
Premium –71,905
Age group : 51 to 55
Premium –45,035
No of Members 4
Age group : 51 to 55
Premium –47,260
Parents Loading @ 50%
Premium –70,890 ↑
No of Members 4
Age group : 51 to 55
Premium –49,885
Parents Loading @ 60&90%
Premium –124,713 ↑

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Comparative Quotes (Officer’s Policy)
(Floater Policy -Rs 5 lac: Employee 41 years + 1 spouse + 2 children + 2 parents aged 61 & 64 years resp.)
NoInsuranceCompany Basis Premium
A Group MediclaimPolicies –where employeebear the cost
1New India –Proposed 46,759
2New India –2022-23 25,811
3New India –2021-22 12,833
4National –2020-21 37,342
B Retail Policies
1New India 15% discount on the total premium of all the members based on the
premium grid fixed by the insurer
58,523
2Oriental 2 full premium for oldest members + 50% loading for 3
rd
& 40%
loading for subsequent members
53,655
3HDFCErgo Base premium on the eldest slab & 45% premium on others 78,297
4Tata AIG Base premium on the eldest slab & 20/28/32% discounton premium
of 2/3/more members
80,447
The above premiums are for standard life. In case of any pre-existing medical condition there will be loading on premium. Also
waiting period applicable for pre existing disease.
Maximum entry age in most of the policies is 65 years
Group Mediclaim policies where employee bear the cost -Parents loading done of 60% to 90% (base premium) depending on
corporates & claim ratio

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Closing Note
Our endeavour is to provide best services to our employees at lower
than market costs
Cost (Insurance Premiums)
Base premium increased only by 5% on more than 2 members
Loading increased for parents since risk profile is higher
Maternity benefit loading introduced to reduce burden on others
Disease wise capping has been kept at last year levels as these treatments are
available at Delhi good hospitals (Max, Fortis, etc.) at these prices
Co-pay of 20% has been kept as last year to contain medical treatment costs (During
cashless TPA carries out audit of Hospital bills and result in hospital bills reduction
without any incidence on employees)
Services
New TPA –Paramount introduced –expected to have larger coverage
Online Portal also developed and entire process will be app based this year

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Thank You

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New IndiaAge 2.00 3.00 5.00 8.00 10.00 12.00 15.00
<18 yrs 1,628 2,043 2,576 3,169 3,587 3,872 4,141
18-35 yrs 3,110 3,947 5,021 6,216 7,056 7,630 8,172
36-45 yrs 3,947 5,021 6,400 7,934 9,013 9,749 10,445
46-50 yrs 7,409 9,466 12,109 15,047 17,114 18,526 19,856
51-55 yrs 10,97214,042 17,983 22,367 25,449 27,555 29,540
56-60 yrs 12,10915,502 19,856 24,702 28,108 30,435 32,631
61-65 yrs 15,50219,856 25,449 31,670 36,045 39,032 41,851
New India Slabs
Discount on number of members
For 2 members -5%
For 3 members -10%
For 4 members & members -15%
Once the Insured Person crosses the age of 65 years, the applicable premium on renewal will be
loaded by 2.5% per year. This loading is applicable on premium for the age band of 61 years to 65
years.

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OrientalAge 1.00 2.00 3.00 5.00 7.00 10.00 12.00 15.00
<20 yrs 1,506 2,099 2,646 3,656 4584 5642 6279 7158
21-35 yrs 2,496 3,603 4,380 5,361 6,899 8,561 9,492 10,908
36-45 yrs 2,938 4,354 5,483 7,507 10,055 13,250 15,273 17,916
46-50 yrs 3,577 5,284 6,968 9,849 14,741 19,581 22,497 26,243
51-55 yrs 3,769 5,828 7,709 10,902 16,067 21,245 24,295 28,197
56-60 yrs 6,243 9,38912,320 17,016 24,074 30,635 34,865 39,899
61-65 yrs 8,00212,70517,112 21,987 30,790 39,092 43,949 49,493
66-70 yrs 10,17816,50721,447 27,466 39,486 48,590 53,596 59,257
71-75 yrs 12,13418,65524,588 30,944 44,110 53,524 58,582 64,314
76-80 yrs 13,31920,10626,162 32,842 46,223 55,875 61,048 66,939
>80 yrs 13,63421,78427,902 35,106 49,678 59,679 65,004 71,121
Oriental Slabs
Computation of Premium:
Charge 100% premium for the primary and secondary members
Charge 50% premium for the tertiary member i.e. give a discount of 50% on third member’s premium
Charge 40% premium for other members i.e. give a discount of 60% on additional members’ premium
Eldest member of the family is the primary member. Second eldest is secondary member, while third
eldest is the tertiary member.
Proportionate Clause Waiver -25%

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HDFC ErgoAge 3.00 5.00 10.00 15.00
<18 yrs 7,937 9,262 10,062 11,559
18-35 yrs 10,284 11,509 14,468 16,370
36-45 yrs 11,638 13,523 16,701 19,215
46-50 yrs 17,628 19,048 24,648 27,874
51-55 yrs 21,524 24,085 30,812 36,626
56-60 yrs 27,789 31,093 40,406 48,030
61-65 yrs 34,483 39,856 54,169 63,231
66-70 yrs 47,584 54,997 75,280 87,877
71-75 yrs 57,486 66,441 91,851 1,07,223
76-80 yrs 68,983 79,729 1,11,443 1,30,089
>80 yrs 91,6881,30,782 1,52,667 1,70,957
HDFC ERGO Slabs
Family floater discount of 55% on every member -other than the eldest member
Sum Insured slabs are limited

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TATA AIGAge 3.00 5.00 7.50 10.00 15.00
<18 yrs 5,678 6,925 7,478 7,740 8,699
18-35 yrs 8,884 10,780 11,546 11,949 13,491
36-45 yrs 11,040 13,479 14,435 14,955 16,860
46-50 yrs 16,100 19,524 20,906 21,565 24,276
51-55 yrs 20,106 23,864 25,615 26,379 29,677
56-60 yrs 24,276 28,961 31,121 31,795 35,629
61-65 yrs 32,274 38,748 41,639 42,638 47,881
66-70 yrs 50,274 60,774 65,265 66,972 75,416
>71 yrs 62,276 75,879 81,375 83,938 94,621
TATA AIG Slabs
Discount on number of members
For 2 members -20%
For 3 members -28%
For 4 members & members -32%
Sum Insured slabs are limited