| 7(a)- Group Health Insurance of Named Person |
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| Source New India |
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| Whereas the existing requirement of upward revision of premium in policies where loss experience exceeds 80%will continue, the discounts already granted on insurance contracts currently alive and eligible as eligible as per criterion already circulated and conforming to the provision of [l] above may be allowed to continue provided the claims experience for the last 3 years remains within 60%. If the claims experience exceeds 6% such existing discount will be considered as per new schedule of discounts, as above and the upper limit of discount will be 30%. |
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| Bonus/malus: |
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| a) LOW CLAIM TATIO DISCOUNT (BONUS) |
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| Low claim Ratio Discount at the following scale will be allowed of the Total premium at renewal only depending upon the incurred claims ratio for the entire group insured under policy for the preceding 3 complete years excluding the year immediately preceding the date of renewals Where the Group Mediclaim Policy has not been in force for 3 completed years, such shorter period of completed years for which it was in force will be taken into account. |
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| Incurred Claims ratio under the group policy |
Discount% |
| Not exceeding 60% |
5 |
| Not exceeding 50% |
15 |
| Not exceeding 40% |
25 |
| Not exceeding 30% |
35 |
| Not exceeding 25% |
45 |
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| b) HIGH CLAIM RATION LOADING (MALUS): |
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| The total premium payable at renewal of the Group Policy will be loaded at the following scale depending upon the incurred claims ratio for the entire group Insured ender the Group Mediclaim Policy for the preceding 3 completed years excluding the year immediately preceding the date of renewal. Where the Group Mediclaim Policy has not been in force for the 3 completed years, such shorter periods of completed years, excluding the year immediately preceding the date of renews will be taken into account. |
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| Incurred Claims ratio under the group policy |
Loading in % |
| Between 70% and 100% |
15 |
| Between 101% and 125% |
35 |
| Between 126% and 150% |
55 |
| Between 151% and 175% |
75 |
| Between 176% and 200% |
120 |
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| Note : |
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1) Incurred claim would means claims paid+claims outstanding in respect of the entire group insured under the policy during the relevant period.
2) Addition & Deletion of names during the Currency of Policy is allowed on Prorata basis. However no refund Premium will be allowed for deletion of insured person if the claim is made recovered in the policy.
3) Additional people joining group or covered persons resigning/retiring or due to death going out of scheme, to be adjusted from the DOJ/DOC.
4) Policy may be adjusted to include or delete any addition/deletion once a month or twice in case of large group.
5) Additions/deletions during policy will not alter group discount for policy period.
6) Below 100 persons, policy can be given without group discount.
7) No deletion of domiciliary hospitalization benefit under standard group mediclaim policy.
8) Income tax certificate to be issued to an employee for premium paid on behalf of his dependents to claim I. T. exemption.
9) No policies to be issued for unnamed group.
10) Now all discount would be restricted to maximum of 30% i.e. other technical discount/ deduction it any granted in edition to group discount like Long-term discount, Special feature discount, No claim discount and/or discounts/deduction of any other nature except special discount in lieu of agency commission.
11) All tailor-made policies, whether existing or new, are to be referred to the GM (Tech.) for consideration and written approval without which such policies/ schemes cannot continue or be issued even provisionally.
12) Group Mediclaim-Floater cover:-Existing floater cover will be renewed on expiring terms where the claims experience is less than 70%. For fresh cover to be reffered to H.O. |
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