RFQ for Group Mediclaim Insurance
Client Name
Address
Proposal Detail Renewal / Fresh
Occupation
Inception Date
Third Party Administrator (TPA)
Family Definition
No. of Employees covered
No. of Dependents covered
No. of Lives
Claim Experience
Benefits required
Sum Insured
Previous Poilcy Details - At Policy Inception
Insurance Company
Employees
Dependants
No. of Lives
Premium Pre Tax
Claims Experience As on date
Total Claims Paid + O/s (As on 18-Aug-21)
Disclaimer: The information supplied in this document is collected from the prospective client/customer/policyh
to the best of our knowledge. turtlemint Insurance Broking Services Pvt. Ltd. (“turtlemint”) accepts no liability f
of your reliance on information which has been supplied to turtlemint by or on behalf of turtlemint’ clients. No
provisions of the policy and any other relevant rules pertaining to the insurance granted in respect of the subjec
hereby agreed that the insured's right of recovery under this policy shall not be prejudiced due to any error aris
computation and / or applying provisions of the tariff so long as the insured have paid the premium shown on th
Subject otherwise to the terms and conditions of the policy, it may please be noted that no cover is to be attach
formally requested to do so. In view of the underwriting information provided here on or with this Quotation S
submit a proposal form should your quotation prove successful.
RFQ for Group Mediclaim Insurance
*
*
*
*
Self + Spouse + 2 Kids
As mentioned in sheet
*
Previous Poilcy Details - At Policy Inception
Claims Experience As on date
lied in this document is collected from the prospective client/customer/policyholder and is accurate
rtlemint Insurance Broking Services Pvt. Ltd. (“turtlemint”) accepts no liability for any loss arising out
which has been supplied to turtlemint by or on behalf of turtlemint’ clients. Notwithstanding the
other relevant rules pertaining to the insurance granted in respect of the subject-matter insured it is
right of recovery under this policy shall not be prejudiced due to any error arising out of premium
ovisions of the tariff so long as the insured have paid the premium shown on the face of the policy.
nd conditions of the policy, it may please be noted that no cover is to be attached until you are
iew of the underwriting information provided here on or with this Quotation Slip, it is not proposed to
our quotation prove successful.
[Link] Benefits/Extensions
1 Standard Hospitalization
2 Maternity Covered
Normal Delivery (Amount)
Caesarean section (Amount)
3 Maternity Waiting Period waiver
Day one cover for new born baby and spouse after
4 marriage
5 Waiting Period- 9 Months
6 New Born Baby Expenses
Pre & Post Hospitalization - 30 days prior to
7 hospitalization & 60 days post hospitalization
8 Pre-existing Disease Waiver
30 Days Wait Period / 1st Year exclusions / 2nd Year
9 Exclusions waiver/4 years Exclusion waiver
10 Standard Day Care Procedures.
11 Critical Illness Covered
12 Ambulance / Private TAXI Cover for emergency cases
13 Room Rent Charges
Dental treatment arising out of accident/illness for
14 specified limit.
15 Vision
16 Co-Payment applicable - mention Percentage
17 Corportae Buffer Sum insured
18 Corporate Buffer Limit- Per person/Family
19 Corporate Buffer Applicable only for Critical Illness
20 Domicillary Hospitalization
*Monthly additions / deletions of employee and their dependents allowed on pro-rata premium.
Coverage
Yes
Yes
30000
50000
Waived (covered from day 1 )
Yes
Waived Off
Yes within maternity Limits
Yes
Yes
Yes
Yes
Yes
INR 2500/- Per Incident
No restriction
Covered with restriction (In case of Accident)
Covered with restriction (In case of Accident)
e and their dependents allowed on pro-rata premium.
Employee details
Sr No. Employee Name GENDER Designation Relationship
1 PRAVIN PANDURANG PAWAR M Manager Self
1 SUSHAMA PRAVIN PAWAR F Wife
1 Ajay Pravin Pawar M Son
1 Pooja Pravin Pawar F Daughter
1 SUNANDA PANDURANG PAWAR F Mother
1 PANDURANG VISHNU PAWAR M Father
2
2
2
2
DOB SI AGE
18-Mar-86 200000
4-Nov-88
15-Mar-05
20-Mar-07
4-Jan-67
16-Mar-59
