STANDARD FIRE & SPECIAL PERIL POLICY

Charts Prepared by : MR. GULSHAN RAI, Asstt. Manager, UIIC - DO AGRA (Mobile : 09868338009) Email: gulshanrai@uiic.co.in
Section Risk Covered
II Coverage : Fire, Lightning, Explosion/Implosion, Aircraft Damage, Riot, Strike & Malicious Damages (RSMD) Earth Quake
Storm, Cyclone-Tempest and Flood & Inundation (STFI), Impact Damage by Rail / Road Vehicle or Animal, Zone-II DELHI
Subsidence and Landslide, Bursting and/or Overflowing of water tanks, Bush Fire etc. Zone-III AGRA
RATES OF PREMIUM + GST @ 18% EXTRA Rate Per mille
Building Rate Stock Rate
Section Description - Dwelling, Offices, Hotel, Shops Per mille Per mille
STFI Earth Quake Terrorism

Dwellings, Places of Worship, Libraries, Museums, School, College, Hospital including X-ray
& other Diagnostic Clinics, Office Premises, Meeting Rooms, Auditoriums, Planetarium,
0.26 per 0.26 per 0.075 per 0.05 per 0.08 per
III Mess, Houses, Club, Marriage Halls, Showrooms & Display Centres, Educational & Research
Thousand Thousand Thousand Thousand Thousand
Institutes imparting Training in Various crafts, Lodging/Boardings, Houses, Cycle sheds &
Dish Antenna indoor Stadiums

RATING: BASIC RATE (-) Disc. 30% (-) Old STFI 0.09 (i.e. 0.50 - 0.15 - 0.09= 0.26)
1.17 per 1.17 per 0.1125 per 0.05 per 0.15 per
III Cafes, Restaurants, Hotels, Confectioners & Sweetmeat Seller
Thousand Thousand Thousand Thousand Thousand
Shops Dealing in Goods otherwise not provided for including Laundries, Battery Charging Service
1.17 per 1.87 per 0.1125 per 0.05 per 0.15 per
III Stations, Dry Cleaning, Amusement Parks, Hoarding Neon Signs and Sports Galleries, Outdoor
Thousand Thousand Thousand Thousand Thousand
Stadiums
Shops dealing in Hazardous Goods, Arms & Vehicle Showrooms including Sales and Service 1.17 per 2.57 per 0.1125 per 0.05 per 0.15 per
III
Petrol Pump, Dry Cleaners,Chemical Thousand Thousand Thousand Thousand Thousand
Bldg. RATING: BASIC RATE (-) Disc. 30% (-) Old STFI 0.09 (i.e. 1.80 - 0.54 - 0.09= 1.17)
Stock RATING: BASIC RATE (-) Disc. 30% (-) Old STFI 0.09 (i.e. 2.80 - 0.84 - 0.09= 1.87)
Stock RATING: BASIC RATE (-) Disc. 30% (-) Old STFI 0.09 (i.e. 3.80 - 1.14 - 0.09= 2.57)

IV Industrial Risk - FACTORY / MANUFACTURING

Stock in
Godown Rate
Stock in
Open Rate
STFI Earth Quake Terrorism

Mfg. - Engineering Workshop - Fabrication work, Steel, Metal Work (Rating BR 1.25 - Zone-II = 0.25
0.725 per 0.1875 per 0.23 per
IV Zone-III 0.10 per
0.375 (30% Disc) (-) Old STFI 0.15 = Rs.0.725) Thousand Thousand Thousand
Thousand
Zone-II = 0.25
Mfg. - Engineering Workshop - Clock/Watch Mfg., Motor Vehicle Garages (Rating BR 1.75 - 1.075 per 0.1875 per 0.23 per
IV Zone-III 0.10 per
0.525 (30% Disc) (-) 0.15 Old STFI = Rs.1.075) Thousand Thousand Thousand
Thousand
Zone-II = 0.25
Mfg. - Garments, Atta Chakki & Cereal (excluding Dal Mill), Leather, Shoe Mfg. (Rating BR 1.25 per 0.1875 per 0.23 per
IV Zone-III 0.10 per
2.00 - 0.60 (30% Disc) (-) 0.15 Old STFI = Rs.1.25) Thousand Thousand Thousand
Thousand
Zone-II = 0.25
Mfg. - Plastic - Granuales Heating Below Degree Celcius - and Printing Press - Ink, Printing & 1.60 per 0.1875 per 0.23 per
IV Zone-III 0.10 per
Stationery (Rating BR 2.50 - 0.75 (30% Disc) (-) 0.15 Old STFI = Rs.1.60) Thousand Thousand Thousand
Thousand
Zone-II = 0.25
Mfg. - Flour Mills, Plastic - Granuales Heating Above 15000 (Rating BR 3.50 - 1.05 (30% Disc) 2.30 per 0.1875 per 0.23 per
IV Zone-III 0.10 per
(-) 0.15 Old STFI = Rs.2.30) Thousand Thousand Thousand
Thousand
Zone-II = 0.25
Building in Course of Construction (Rating BR 1.00 - 0.30 (30% Disc) (-) 0.15 Old STFI = 0.55 per 0.1875 per 0.23 per
IV Zone-III 0.10 per
Rs.0.55) Thousand Thousand Thousand
Thousand
Zone-II = 0.25
Card Board Box Mfg., Hosiery, Lace, Embroideries, Thread Factory, Mfg./Assembly of 1.425 per 0.1875 per 0.23 per
IV Zone-III 0.10 per
Electronic Goods (Rating BR 2.25 - 0.675 (30% Disc) (-) 0.15 Old STFI = Rs.1.425) Thousand Thousand Thousand
Thousand
Mfg. - Bakeries, Biscuit-Sugar Factory, Cement Mfg., Milk Dairies, Ice Factory, Automobile Zone-II = 0.25
0.90 per 0.1875 per 0.23 per
IV Mfg., Poultry Farm, Film Editing, Bridges, Confectionary (Rating BR 1.50 - 0.45 (30% Disc) (-) Zone-III 0.10 per
Thousand Thousand Thousand
0.15 STFI = Rs.0.90) Thousand

Stock in Stock in
VI STORAGE RISK - GODOWN Godown Rate
Per mille
Open Rate
Per mille
STFI Earth Quake Terrorism

Storage of Non-hazardous goods subject to warranty that hazardous goods of Category I, II, 0.1875 per Zone-II = 0.25
III , Coir waste, Coir fibre and Caddies are not stored therein. (Rating BR 1.00 - 0.30 (30% 0.55 per 1.60 per Thousand & Open 0.23 per
VI Disc) (-) 0.15 STFI = Rs.0.55) & Open Stock (Rating BR 2.50 - 0.75 (30% Disc) (-) 0.15 Old Thousand Thousand Godown 1.125 per
Zone-III 0.10 per
Thousand
Thousand Thousand
STFI = Rs.1.60)
Storage of Hazardous Goods i.e. All Types of Food Grains, Oil Seeds, Dry Goods, Sugar,
Cement, Shoe etc. Vehicle Parked in Open Mentioned in Category-I, Storage of Category I
Zone-II = 0.25
hazardous Goods subject to warranty that goods listed in Category II, III, Coir waste, Coir 1.60 per 4.05 per 0.1875 per 0.23 per
VI fibre and Caddies are not stored therein - Cold Storage (Rating BR 2.50 - 0.75 (30% Disc) (-) Thousand Thousand Thousand
Zone-III 0.10 per
Thousand
Thousand
0.15 Old STFI = Rs.1.60) & Open Stock (Rating BR 6.00 - 1.80 (30% Disc) (-) 0.15 Old STFI =
Rs.4.05)

FIRE DECLINE LIST - Pre-Approval required from R.O.

Chemical including Pharmaceuticals Paper (Including Waste Paper, Bagasse)
Cotton Godowns - Stand alone as well as inside Factory Premises Standalone Policies covering Stock of Coal
Plastics, Foam and Rubber Single Block Godowns
Jute, Salt Bund Textile Mills / Carpets of PANIPAT / SONEPAT
Agri products like Biomass, Timber, Tobacco / Tendu leaves, Herbs / Herbal Products etc.

Declare Individual Sum Insured for (1) Building, (2) FFF, (3) P&M (4) Stock - Declare Individual Stock Amount Towards :
(1) Raw Material, (2) Stock in Process, (3) Semi Finished Stock, (4) Finished Goods
All Plant & Machinery (P&M) including Electrical Installation
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 MOTOR PREMIUM CHART EFFECTIVE FROM 01.04.2018
ZONE C ZONE B ZONE-A ( METRO CITIES ) New
Car TP
Age of the TP PREMIUM FROM Car TP for
TYPE OF VEHICLE
vehicle
<1000 UPTO 1000-1500 >150- >1500CC >350CC <1000 UPTO 1000-1500 >150- >1500CC >350CC
150 <12000KG 350 >12000KG >12000KG 150 <12000KG 350 >12000KG >12000KG
<1000 UP TO 1000-1500 >150- >1500CC >350CC
150 <12000KG 350 >12000KG >12000KG
01.04.2018 - 1 Year cc for 1
Year
3 Years

< 5 YEARS 2.190 2.430 2.250 3.039 3.191 3.343 3.127 3.283 3.440 1850 UPTO 1000CC < 1000 1,850 5,286
PRIVATE CAR 5 & 10 YRS 2.190 2.430 2.250 3.191 3.351 3.510 3.283 3.447 3.612 2863 >1000CC <= 1500 2,863 9,534
> 10 YRS 2.190 2.430 2.250 3.267 3.430 3.594 3.362 3.529 3.698 7890 >1500CC > 1500 7,890 24,305
< 5 YEARS 1.341 1.408 1.475 1.676 1.760 1.844 1.708 1.793 1.879 720 >75 < 150CC
TWO WHEELER 5 & 10 YRS 1.408 1.478 1.549 1.760 1.848 1.936 1.793 1.883 1.973 985 >150<350CC Scooter Scooter
> 10 YRS 1.442 1.514 1.586 1.802 1.892 1.982 1.836 1.928 2.020 2323 >350CC cc 1 Years 5 Years
ZONE C ZONE B ZONE A upto 12000 Kg. 427 <75 < 75 cc 427 1,045
<5YEARS 1.726 1.726+27 each 100kg 1.743 1.743+27 each 100kg 1.751 1.751+27 each 100kg 14390<7500kg <=150 720 3,285
GOOD CARRYING
5 & 7 YRS 1.770 1.770+27 each 100kg 1.787 1.787+27 each 100kg 1.795 1.795+27 each 100kg 24190>7500<12000kg <= 350 985 5,453
VEHICLE - PUBLIC
CARRIER 4 & > 4 32367>12000<20000kg > 350 2,323 13,034
1.812 1.812+27 each 100kg 1.830 1.830+27 each 100kg 1.839 1.839+27 each 100kg
WHEELER A1 >7YRS 39849 >20000<40000kg
38308 >40000KG
<5YEARS 1.208 1.208+27 each 100kg 1.220 1.220+27 each 100kg 1.226 1.226+27 each 100kg 7144 <7500kg
GOODS CARRYING 5 & 7 YRS 1.239 1.239+27 each 100kg 1.251 1.251+27 each 100kg 1.257 1.257+27 each 100kg 15620>7500<12000kg
VEHICLE - PRIVATE 9871>12000<20000kg
CARRIER 4 & > 4 1.268 1.268+27 each 100kg 1.281 1.281+27 each 100kg 1.287 1.287+27 each 100kg
WHEELER A2
>7YRS 15397>20000<40000kg
21318> 40000KG cc Taxi TP + Per Pass.
<5YEARS 3.191 3.351 3.51 3.284 3.448 3.612 5437+1046PP <1000CC < 1000 5,437 1,046
TAXI NOT EXCEEDING 6
PASS C-1a
5 & 7 YRS NA 3.271 3.435 3.598 3.366 3.534 3.703 7147+880PP >1000CC<1500CC <= 1500 7,147 880
>7YRS 3.351 3.519 3.686 3.448 3.62 3.793 9472+1006 PP >1500CC > 1500 9,472 1,006
THREE WHEELER <5YEARS 1.640 1.656 1.664 E-Cart - 3175 <1200KG
PUBLIC GOODS CARR. 5 & 7 YRS 1.681 1.697 1.706
A3 >7YRS 1.722 1.739 1.747 Except E-Carts 4544
<5YEARS 1.148 1.159 1.165 E-Cart - 2579 <1200KG
THREE WHEELER PVT.
5 & 7 YRS 1.177 1.188 1.194
GOODS CARR. A4
>7YRS 1.205 1.217 1.223 Except E-Carts 3150
<5YRS >5 < 7YRS >7YRS <5YRS >5 < 7YRS >7YRS <5YRS >5 < 7YRS >7YRS BUS Per Pass.
PASS. CARR 4 <18 PASS 350+1.656 350+1.697 350+1.739 350+1.672 350+1.714 350+1.756 350+1.680 350+1.722 350+1.764 13176 805
>18<36 450+1.656 450+1.697 450+1.739 450+1.672 450+1.714 450+1.756 450+1.680 450+1.722 450+1.764 13176+805 PER PASSENGER AS PER
WHEELER >6
PASS/THREE WHEELER >36<60 550+1.656 550+1.697 550+1.739 550+1.672 550+1.714 550+1.756 550+1.680 550+1.722 550+1.764 REGISTERED CAPACITY
>17 PASS. >60 680+1.656 680+1.697 680+1.739 680+1.672 680+1.714 680+1.756 680+1.680 680+1.722 680+1.764
THREE WHEELER PASS <5YEARS 1.260 1.272 1.278
Except E-Rickshaw 2595+1241 PP,
CARR.< 6 PASS - Electronic 5 & 7 YRS 1.292 1.304 1.310
Rikshaw C-1b >7YRS 1.323 1.336 1.342 E-Rickshaw Rs.1685+806 PP
<5YEARS 1.759 1.777 1.785
THREE WHEELER PASS 5 & 7 YRS 1.803 1.821 1.830 Rs. 6222+1241 PP
CARR. > 6 < 17 Pass. C3 >7YRS 1.847 1.866 1.874
<5YEARS 1.190 1.202 1.208 Pedestrian controlled Agriculture
5 & 7 YRS 1.22 1.232 1.238 Tractor < 6 Hrs. Power Hearse & Plane
MISC. & SPECIAL TYPE OF Loaders Rs.1435/- Other
VEHICLE 'B' 'D' >7YRS 1.25 1.262 1.268 Misc.&Spl.Type Rs.6115/-
AMBULANCE Rs.60 Per Pass. Above TP Rate for Misc. Veh. UNIFORM NCB FOR ALL CLASS VEHICLE 20/25/35/45/50 Trailer-Ag.Tractor up 6HP - 816
HEARSES Rs.115 Per Pass. Above TP Rate for Misc. Veh. CNG EXTRA @4% ON IDV, IN INBUILT 5% OF OD PREMIUM RS. 60 FOR TP PREMIUM Other Misc. & Spl. - 2091/-
OVERTURNING IN MISC.VEHICLE DURING OPERATIONAL USE AS A TOOL OF TRADE AT AN ADDITIONAL RATE OF 0.5%OF IDV OF THE VEHICLE SUBJECT TO MINIMUM OF RS. 100/-. DRIVER RS.50/-
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 United India Insurance Co. Ltd. Individual Health Policy Prem. Chart w.e.f. 01.05.2011 + GST @ 18% EXTRA (Minimum Sum Insured Rs. 1 Lacs)
Charts Prepared by : MR. GULSHAN RAI, Asstt. Manager, UIIC DO AGRA , (Mobile No.09868338009) - Email ID : gulshanrai@uiic.co.in
Platinum Pol. Max.SI 10 Lacs Gold Policy S.I. Max. 5 Lacs Sr. Citizen Policy S.I. Max. 3 Lacs Pre-Acceptance Health Check Up
Dom. Test for person of > 45 Years age, if
Sum Insured 3m-25 yrs 26-30 yrs 31-35 yrs 36-40 yrs 41-45 yrs 46-55 yrs 56-60 yrs 61-65 yrs. 66-70 yrs. 71-75 yrs. 76-80 yrs. required
Hosp.Limit
50000 10000 900 1000 1100 1300 1600 1950 2700 2950 3600 4000 5000 1. Physical Examinations
75000 15000 1050 1150 1300 1500 1800 2225 3300 3725 4550 4950 6150 2. ECG
100000 20000 1200 1300 1500 1700 2000 2500 3900 4500 5500 5900 7300 3. Fasting & P.P. Blood Sugar
125000 23750 1500 1600 1725 1950 2300 3200 4700 5350 6750 7175 8850 4. HBA 1c
150000 27250 1800 1850 1950 2200 2600 3900 5500 6200 8000 8450 10400 5. Hypertension (B.P. Either Value)
175000 31250 2000 2175 2350 2725 3250 4450 6200 6900 8675 9525 11700 6. Stress Test
200000 35000 2200 2500 2750 3250 4100 5000 6900 7600 9350 10600 13000 7. SGPT
225000 37500 2350 2675 2950 3500 4300 5375 7475 8200 10125 11525 14175 8. Serum Cholestrol/Lipid Profile
250000 40000 2500 2850 3150 3750 4550 5750 8050 8800 10900 12450 15350 9. Sr. Creatinine
275000 42500 2650 3075 3325 3950 4800 6100 8525 9350 11575 13250 16325
300000 45000 2800 3300 3500 4150 5100 6450 9000 9900 12250 14050 17300
325000 47500 2926 3474 3657 4373 5450 6823 9569 10488 13011 14833 18244
350000 50000 3096 3677 3870 4628 5800 7258 10196 11176 13881 15825 19464
375000 50000 3267 3880 4084 4883 6150 7695 10823 11863 14750 16815 20682
400000 50000 3438 4082 4297 5137 6500 8129 11451 12551 15620 17807 21902
425000 50000 3608 4285 4510 5393 6750 8566 12076 13237 16490 18799 23122
450000 50000 3778 4487 4723 5649 7000 9001 12705 13926 17360 19791 24342
475000 50000 3950 4690 4937 5904 7400 9438 13331 14612 18229 20781 25560
500000 50000 4121 4893 5151 6158 7800 9873 13958 15299 19099 21772 26780
525000 50000 4300 5106 5375 6426 8364 10302 14565 Note:
550000 50000 4487 5328 5609 6705 8728 10750 15199 1. GST Tax as applicable will be charged extra
575000 50000 4682 5560 5853 6997 9107 11218 15860 2.Family Discount of 5% will be allowed in case of two or more family persons are covered.
600000 50000 4886 5802 6107 7301 9504 11706 16550 3. For PED of diabetes, hypertension & hyperlipidemia premium will be loaded by 10% each
625000 50000 5099 6054 6373 7619 9917 12215 17270 4. Renewals beyond 80 Yrs will be done at the same premium as 80 Yrs slab
650000 50000 5320 6318 6650 7950 10348 12747 18021 5. Cap on Certain Disease: Gold & Sr.Citizen Policy.
675000 50000 5552 6593 6940 8296 10799 13301 18805 Cataract 25% of SI or actual expenses whichever is less
700000 50000 5793 6879 7242 8657 11268 13880 19623 Hernia 25% of SI or actual expenses whichever is less
725000 50000 6045 7179 7557 9034 11758 14483 20476 Hysterectomy 25% of SI or actual expenses whichever is less
750000 50000 6308 7491 7885 9426 12270 15113 21367 Major Surgeries 70% of SI or actual expenses whichever is less
775000 50000 6583 7817 8228 9837 12804 15771 22297 Co-Pay : Under Sr.Citizen Policy 20% claim will be borne by Insured.
800000 50000 6869 8157 8586 10264 13361 16457 23267
825000 50000 7168 8512 8960 10711 13942 17173 24279
850000 50000 7480 8882 9349 11177 14548 17920 25335
Under Gold & Sr. Citizen Policy, during the first two years of the operation of the policy, the
875000 50000 7805 9268 9756 11663 15181 18699 26437
expenses on treatment of diseases such as Cataract, Benign Prostatic Hyperthrophy, Hysterectomy
900000 50000 8144 9672 10181 12170 15842 19513 27587
for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal disease, Fistula in Anus,
925000 50000 8499 10092 10623 12700 16531 20362 28787
Piles, Sinusitis and related disorders, Gall Bladder Stone Removal, Gout & Rheumatism, Calculus
950000 50000 8868 10531 11086 13252 17250 21247 30039
Diseases, Joint Replacement due to Degenerative Condition and Age-related Osteoarthiritis &
975000 50000 9254 10989 11568 13829 18000 22171 31346
Osteoporosis are not payable.
1000000 50000 9657 11467 12071 14430 18783 23136 32709
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 United India Insurance Co. Ltd. Individual Health Policy Prem. Chart w.e.f. 01.05.2011 Inclusive of GST @ 18% (Minimum Sum Insured Rs. 1 Lacs)
Charts Prepared by : MR. GULSHAN RAI, Asstt. Manager, UIIC DO AGRA , (Mobile No.09868338009) - Email ID : gulshanrai@uiic.co.in
Platinum Pol. Max.SI 10 Lacs Gold Policy S.I. Max. 5 Lacs Sr. Citizen Policy S.I. Max. 3 Lacs Pre-Acceptance Health Check
Dom. 56-60 Up Test for person of > 45
Sum Insured 3m-25 yrs 26-30 yrs 31-35 yrs 36-40 yrs 41-45 yrs 46-55 yrs 61-65 yrs. 66-70 yrs. 71-75 yrs. 76-80 yrs. Years age, if required
Hosp.Limit yrs
50000 10000 1062 1180 1298 1534 1888 2301 3186 3481 4248 4720 5900 1. Physical Examinations
75000 15000 1239 1357 1534 1770 2124 2626 3894 4396 5369 5841 7257 2. ECG
100000 20000 1416 1534 1770 2006 2360 2950 4602 5310 6490 6962 8614 3. Fasting & P.P. Blood Sugar
125000 23750 1770 1888 2036 2301 2714 3776 5546 6313 7965 8467 10443 4. HBA 1c
150000 27250 2124 2183 2301 2596 3068 4602 6490 7316 9440 9971 12272 5. Hypertension (B.P. Either Value)
175000 31250 2360 2567 2773 3216 3835 5251 7316 8142 10237 11240 13806 6. Stress Test
200000 35000 2596 2950 3245 3835 4838 5900 8142 8968 11033 12508 15340 7. SGPT
225000 37500 2773 3157 3481 4130 5074 6343 8821 9676 11948 13600 16727 8. Serum Cholestrol/Lipid Profile
250000 40000 2950 3363 3717 4425 5369 6785 9499 10384 12862 14691 18113 9. Sr. Creatinine
275000 42500 3127 3629 3924 4661 5664 7198 10060 11033 13659 15635 19264
300000 45000 3304 3894 4130 4897 6018 7611 10620 11682 14455 16579 20414
325000 47500 3453 4099 4315 5160 6431 8051 11291 12376 15353 17503 21528
350000 50000 3653 4339 4567 5461 6844 8564 12031 13188 16380 18674 22968
375000 50000 3855 4578 4819 5762 7257 9080 12771 13998 17405 19842 24405
400000 50000 4057 4817 5070 6062 7670 9592 13512 14810 18432 21012 25844
425000 50000 4257 5056 5322 6364 7965 10108 14250 15620 19458 22183 27284
450000 50000 4458 5295 5573 6666 8260 10621 14992 16433 20485 23353 28724
475000 50000 4661 5534 5826 6967 8732 11137 15731 17242 21510 24522 30161
500000 50000 4863 5774 6078 7266 9204 11650 16470 18053 22537 25691 31600

525000 50000 5074 6025 6343 7583 9870 12156 17187 Note:
550000 50000 5295 6287 6619 7912 10299 12685 17935 1. Premium is Inclusive of GST @ 18%
575000 50000 5525 6561 6907 8256 10746 13237 18715 2.Family Discount of 5% will be allowed in case of two or more family persons are covered.
600000 50000 5765 6846 7206 8615 11215 13813 19529 3. For PED of diabetes, hypertension & hyperlipidemia premium will be loaded by 10% each
625000 50000 6017 7144 7520 8990 11702 14414 20379 4. Renewals beyond 80 Yrs will be done at the same premium as 80 Yrs slab
650000 50000 6278 7455 7847 9381 12211 15041 21265 5. Cap on Certain Disease: Gold & Sr.Citizen Policy.
675000 50000 6551 7780 8189 9789 12743 15695 22190 Cataract 25% of SI or actual expenses whichever is less
700000 50000 6836 8117 8546 10215 13296 16378 23155 Hernia 25% of SI or actual expenses whichever is less
725000 50000 7133 8471 8917 10660 13874 17090 24162 Hysterectomy 25% of SI or actual expenses whichever is less
750000 50000 7443 8839 9304 11123 14479 17833 25213 Major Surgeries 70% of SI or actual expenses whichever is less
775000 50000 7768 9224 9709 11608 15109 18610 26310 Co-Pay : Under Sr.Citizen Policy 20% claim will be borne by Insured.
800000 50000 8105 9625 10131 12112 15766 19419 27455
825000 50000 8458 10044 10573 12639 16452 20264 28649
850000 50000 8826 10481 11032 13189 17167 21146 29895
Under Gold & Sr. Citizen Policy, during the first two years of the operation of the policy, the
875000 50000 9210 10936 11512 13762 17914 22065 31196
expenses on treatment of diseases such as Cataract, Benign Prostatic Hyperthrophy,
900000 50000 9610 11413 12014 14361 18694 23025 32553
Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal disease,
925000 50000 10029 11909 12535 14986 19507 24027 33969
Fistula in Anus, Piles, Sinusitis and related disorders, Gall Bladder Stone Removal, Gout &
950000 50000 10464 12427 13081 15637 20355 25071 35446
Rheumatism, Calculus Diseases, Joint Replacement due to Degenerative Condition and Age-
975000 50000 10920 12967 13650 16318 21240 26162 36988
related Osteoarthiritis & Osteoporosis are not payable.
1000000 50000 11395 13531 14244 17027 22164 27300 38597
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 UNITED INDIA INSURANCE CO. LTD.
FAMILY MEDICARE POLICY-2014 PREMIUM CHART W.E.F. 01/08/2014 Plus GST @ 18% EXTRA (MIN.SI RS.2 LACS)
Charts Prepared by : MR. GULSHAN RAI, Asstt. Manager, UIIC DO AGRA (Mobile No.09868338009) - Email ID: gulshanrai@uiic.co.in

Age 3 Months
100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000
to 35

2A 3,970 4,460 4,860 6,150 7,200 8,040 8,330 8,530 9,620 10,610 11,710 12,700 13,690 14,680
2A + 1C 4,330 4,870 5,300 6,710 7,850 8,760 9,080 9,300 10,490 11,570 12,760 13,840 14,920 16,000
2A + 2C 4,680 5,270 5,740 7,260 8,500 9,480 9,830 10,070 11,350 12,530 13,810 14,980 16,150 17,320
1A + 1C 3,800 4,270 4,650 5,890 6,890 7,690 7,980 8,170 9,210 10,160 11,200 12,150 13,100 14,050
1A + 2C 4,150 4,670 5,090 6,440 7,540 8,410 8,720 8,930 10,080 11,110 12,260 13,300 14,330 15,370
Per Addl. Child 350 400 440 550 650 720 750 770 860 960 1,050 1,140 1,230 1,320

Age 36 to 40 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A 4,090 4,600 5,010 6,340 7,420 8,280 8,590 8,790 9,910 10,940 12,060 13,080 14,100 15,130
2A + 1C 4,460 5,010 5,460 6,910 8,090 9,020 9,360 9,580 10,810 11,920 13,150 14,260 15,370 16,490
2A + 2C 4,820 5,430 5,910 7,480 8,750 9,770 10,130 10,370 11,700 12,900 14,230 15,440 16,640 17,850
1A + 1C 3,910 4,400 4,790 6,070 7,100 7,920 8,220 8,410 9,490 10,470 11,540 12,520 13,500 14,480
1A + 2C 4,280 4,820 5,240 6,640 7,770 8,670 8,990 9,200 10,380 11,450 12,630 13,700 14,770 15,840
Per Addl. Child 360 420 450 570 660 750 770 790 890 980 1,080 1,180 1,270 1,360

Age 41 to 45 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 4,570 5,140 5,600 7,080 8,290 9,250 9,600 9,820 11,080 12,220 13,480 14,620 15,760 16,910
2A + 1C 4,980 5,600 6,100 7,720 9,040 10,090 10,460 10,710 12,080 13,320 14,690 15,940 17,180 18,430
2A + 2C 5,390 6,070 6,600 8,360 9,780 10,920 11,320 11,590 13,070 14,420 15,910 17,250 18,600 19,950
1A + 1C 4,370 4,920 5,360 6,780 7,940 8,860 9,180 9,400 10,610 11,700 12,900 13,990 15,090 16,180
1A + 2C 4,780 5,380 5,860 7,420 8,680 9,690 10,050 10,290 11,600 12,800 14,110 15,310 16,510 17,700
Per Addl. Child 410 470 500 640 740 830 860 880 990 1,100 1,220 1,310 1,420 1,520

Age 46 to 50 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 6,610 7,440 8,100 10,250 12,000 13,390 13,890 14,220 16,040 17,690 19,510 21,160 22,820 24,470
2A + 1C 7,210 8,110 8,830 11,180 13,080 14,600 15,140 15,500 17,480 19,280 21,270 23,070 24,870 26,670
2A + 2C 7,800 8,780 9,560 12,100 14,160 15,800 16,390 16,780 18,920 20,880 23,020 24,970 26,920 28,870
1A + 1C 6,330 7,120 7,750 9,810 11,490 12,820 13,290 13,610 15,350 16,930 18,670 20,250 21,840 23,420
1A + 2C 6,920 7,790 8,480 10,740 12,570 14,020 14,540 14,890 16,790 18,520 20,430 22,160 23,890 25,620
Per Addl. Child 590 670 730 920 1,080 1,200 1,250 1,280 1,440 1,600 1,750 1,900 2,050 2,200

Age 51 to 55 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 8,180 9,200 10,020 12,680 14,840 16,560 17,170 17,580 19,830 21,870 24,120 26,170 28,210 30,250
2A + 1C 8,910 10,030 10,920 13,820 16,170 18,050 18,720 19,160 21,610 23,840 26,290 28,520 30,750 32,980
2A + 2C 9,650 10,850 11,820 14,960 17,510 19,540 20,260 20,740 23,400 25,810 28,460 30,870 33,290 35,700
1A + 1C 7,830 8,800 9,590 12,130 14,200 15,850 16,430 16,830 18,980 20,930 23,090 25,040 27,000 28,960
1A + 2C 8,560 9,630 10,490 13,270 15,540 17,340 17,980 18,410 20,760 22,900 25,260 27,400 29,540 31,680
Per Addl. Child 740 820 900 1,140 1,340 1,490 1,540 1,580 1,790 1,970 2,170 2,350 2,540 2,720

Age 56 to 60 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 9,500 10,690 11,640 14,730 17,240 19,240 19,950 20,420 23,040 25,410 28,020 30,400 32,770 35,150
2A + 1C 10,350 11,650 12,680 16,050 18,790 20,970 21,740 22,260 25,110 27,700 30,550 33,140 35,720 38,310
2A + 2C 11,210 12,610 13,730 17,380 20,340 22,700 23,540 24,100 27,180 29,980 33,070 35,870 38,670 41,470
1A + 1C 9,090 10,230 11,140 14,100 16,500 18,410 19,090 19,550 22,050 24,320 26,820 29,090 31,370 33,640
1A + 2C 9,950 11,190 12,180 15,420 18,050 20,140 20,890 21,380 24,120 26,610 29,340 31,830 34,310 36,800
Per Addl. Child 860 960 1,050 1,330 1,550 1,730 1,800 1,840 2,070 2,280 2,520 2,730 2,950 3,160

Age 61 to 65 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 11,420 12,850 13,990 17,710 20,730 23,130 23,990 24,560 27,700 30,560 33,700 36,550 39,410 42,270
2A + 1C 12,450 14,010 15,250 19,310 22,600 25,220 26,150 26,770 30,200 33,310 36,730 39,850 42,960 46,070
2A + 2C 13,480 15,160 16,510 20,900 24,460 27,300 28,310 28,980 32,690 36,060 39,760 43,130 46,500 49,870
1A + 1C 10,930 12,300 13,390 16,950 19,840 22,140 22,960 23,510 26,510 29,250 32,250 34,990 37,720 40,450
1A + 2C 11,960 13,460 14,650 18,540 21,710 24,220 25,120 25,720 29,000 31,990 35,280 38,270 41,260 44,250
Per Addl. Child 1,030 1,150 1,260 1,590 1,860 2,080 2,160 2,210 2,490 2,750 3,030 3,280 3,540 3,800
 UNITED INDIA INSURANCE CO. LTD.
FAMILY MEDICARE POLICY-2014 PREMIUM CHART W.E.F. 01/08/2014 Plus GST @ 18% EXTRA (MIN.SI RS.2 LACS)
Charts Prepared by : MR. GULSHAN RAI, Asstt. Manager, UIIC DO AGRA (Mobile No.09868338009) - Email ID: gulshanrai@uiic.co.in

Age 66 to 70 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 12,630 14,200 15,470 19,580 22,910 25,570 26,510 27,150 30,620 33,770 37,250 40,400 43,560 46,720
2A + 1C 13,760 15,480 16,860 21,340 24,980 27,870 28,900 29,590 33,370 36,810 40,600 44,040 47,480 50,920
2A + 2C 14,900 16,760 18,250 23,100 27,040 30,170 31,290 32,030 36,130 39,850 43,950 47,670 51,400 55,120
1A + 1C 12,080 13,590 14,800 18,740 21,930 24,470 25,380 25,980 29,300 32,320 35,650 38,670 41,690 44,710
1A + 2C 13,220 14,870 16,190 20,500 23,990 26,770 27,760 28,420 32,060 35,360 39,000 42,300 45,610 48,910
Per Addl. Child 1,140 1,280 1,390 1,760 2,060 2,300 2,390 2,440 2,760 3,040 3,350 3,630 3,920 4,200

Age 71 to 75 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 15,030 16,910 18,410 23,300 27,280 30,440 31,560 32,320 36,450 40,210 44,340 48,100 51,860 55,610
2A + 1C 16,380 18,430 20,070 25,400 29,730 33,180 34,410 35,230 39,730 43,830 48,330 52,430 56,520 60,620
2A + 2C 17,740 19,950 21,730 27,500 32,190 35,920 37,250 38,130 43,010 47,440 52,320 56,760 61,190 65,620
1A + 1C 14,390 16,180 17,620 22,300 26,110 29,130 30,210 30,930 34,890 38,480 42,440 46,030 49,630 53,230
1A + 2C 15,740 17,700 19,280 24,400 28,560 31,870 33,050 33,840 38,160 42,100 46,430 50,360 54,290 58,230
Per Addl. Child 1,360 1,520 1,660 2,100 2,460 2,740 2,840 2,900 3,280 3,610 3,990 4,330 4,670 5,000

Age 76 to 80 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 17,070 19,210 20,920 26,470 30,990 34,580 35,860 36,710 41,410 45,670 50,370 54,640 58,910 63,180
2A + 1C 18,610 20,940 22,800 28,860 33,780 37,690 39,090 40,020 45,130 49,790 54,910 59,560 64,210 68,870
2A + 2C 20,150 22,670 24,680 31,240 36,560 40,800 42,310 43,320 48,860 53,900 59,440 64,470 69,510 74,550
1A + 1C 16,340 18,380 20,020 25,340 29,660 33,090 34,320 35,140 39,630 43,710 48,210 52,290 56,380 60,470
1A + 2C 17,880 20,110 21,900 27,720 32,440 36,200 37,540 38,440 43,350 47,820 52,740 57,210 61,680 66,150
Per Addl. Child 1,540 1,730 1,880 2,380 2,780 3,110 3,220 3,300 3,730 4,110 4,530 4,910 5,300 5,680
Applicable GST Tax @ 18% extra
A = Adult C = Child Age of the oldest person of the family to be taken
For persons above 80 years, an additional premium of 5% on the 76-80 would be charged. This 5% is applicable for all persons aged 81 and above.

During the first two years of the operation of the policy, the expenses on treatment of diseases such as
Cataract, Benign Prostatic Hyperthrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Pre-Acceptance Health
Hydrocele, Congenital internal disease, Fistula in anus, piles, Sinusitis and related disorders, Gall Check Up Test for
Bladder Stone removal, Gout & Rheumatism, Calculus Diseases, Joint Replacement due to person of > 45 Years
Degenerative Condition and age-related Osteoarthiritis & Osteoporosis are not payable. Co-Pay for age, if required
Senior Citizen and they will borne 10% of each Claim.
Cap on Certain Disease: Cataract 10% of SI or Max. 25,000/- Per Eye whichever is less 1. Physical Examinations
Hernia 15% of SI or Max. 1,00,000/-whichever is less Hysterectomy 20% of SI or Max. 1,00,000/- whichever is less 2. ECG
Major Surgeries : No Limit Remote Medical Second Opinion for qualified Medical Conditions. 3. Fasting & P.P. Blood Sugar
AMBULANCE CHARGES = PREMIUM RS.100/- PLUS SERVICE TAX MAXIMUM ALLOWED CHARGES RS.2500/- 4. HBA 1c
DAILY CASH BANEFIT ADDITIONAL PREM. RS.150/- PLUS SERVICE TAX IF ADMITTED MORE THAN 3 DAYS @ 250 PER DAY SUBJECT TO MAX.2500/- 5. Hypertension (B.P. Either Value)
DAILY CASH BANEFIT PREM. RS.300/- PLUS SERVICE TAX IF ADMITTED MORE THAN 3 DAYS @ 500 PER DAY SUBJECT TO MAX.5000/- 6. Stress Test
7. SGPT
*gul* 8. Serum Cholestrol/Lipid Profile
9. Sr. Creatinine
 UNITED INDIA INSURANCE CO. LTD.
FAMILY MEDICARE POLICY-2014 PREMIUM CHART W.E.F. 01/08/2014 (PREMIUM INCLUSIVE OF GST @ 18% (MIN.SI RS.2 LACS)
Charts Prepared by : MR. GULSHAN RAI, Asstt. Manager, UIIC (Mobile No.09868338009) Email: gulshanrai@uiic.co.in

Age 3 Months
100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000
to 35

2A 4685 5263 5735 7257 8496 9487 9829 10065 11352 12520 13818 14986 16154 17322
2A + 1C 5109 5747 6254 7918 9263 10337 10714 10974 12378 13653 15057 16331 17606 18880
2A + 2C 5522 6219 6773 8567 10030 11186 11599 11883 13393 14785 16296 17676 19057 20438
1A + 1C 4484 5039 5487 6950 8130 9074 9416 9641 10868 11989 13216 14337 15458 16579
1A + 2C 4897 5511 6006 7599 8897 9924 10290 10537 11894 13110 14467 15694 16909 18137
Per Addl. Child 413 472 519 649 767 850 885 909 1015 1133 1239 1345 1451 1558

Age 36 to 40 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A 4826 5428 5912 7481 8756 9770 10136 10372 11694 12909 14231 15434 16638 17853
2A + 1C 5263 5912 6443 8154 9546 10644 11045 11304 12756 14066 15517 16827 18137 19458
2A + 2C 5688 6407 6974 8826 10325 11529 11953 12237 13806 15222 16791 18219 19635 21063
1A + 1C 4614 5192 5652 7163 8378 9346 9700 9924 11198 12355 13617 14774 15930 17086
1A + 2C 5050 5688 6183 7835 9169 10231 10608 10856 12248 13511 14903 16166 17429 18691
Per Addl. Child 425 496 531 673 779 885 909 932 1050 1156 1274 1392 1499 1605

Age 41 to 45 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 5393 6065 6608 8354 9782 10915 11328 11588 13074 14420 15906 17252 18597 19954
2A + 1C 5876 6608 7198 9110 10667 11906 12343 12638 14254 15718 17334 18809 20272 21747
2A + 2C 6360 7163 7788 9865 11540 12886 13358 13676 15423 17016 18774 20355 21948 23541
1A + 1C 5157 5806 6325 8000 9369 10455 10832 11092 12520 13806 15222 16508 17806 19092
1A + 2C 5640 6348 6915 8756 10242 11434 11859 12142 13688 15104 16650 18066 19482 20886
Per Addl. Child 484 555 590 755 873 979 1015 1038 1168 1298 1440 1546 1676 1794

Age 46 to 50 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 7800 8779 9558 12095 14160 15800 16390 16780 18927 20874 23022 24969 26928 28875
2A + 1C 8508 9570 10419 13192 15434 17228 17865 18290 20626 22750 25099 27223 29347 31471
2A + 2C 9204 10360 11281 14278 16709 18644 19340 19800 22326 24638 27164 29465 31766 34067
1A + 1C 7469 8402 9145 11576 13558 15128 15682 16060 18113 19977 22031 23895 25771 27636
1A + 2C 8166 9192 10006 12673 14833 16544 17157 17570 19812 21854 24107 26149 28190 30232
Per Addl. Child 696 791 861 1086 1274 1416 1475 1510 1699 1888 2065 2242 2419 2596

Age 51 to 55 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 9652 10856 11824 14962 17511 19541 20261 20744 23399 25807 28462 30881 33288 35695
2A + 1C 10514 11835 12886 16308 19081 21299 22090 22609 25500 28131 31022 33654 36285 38916
2A + 2C 11387 12803 13948 17653 20662 23057 23907 24473 27612 30456 33583 36427 39282 42126
1A + 1C 9239 10384 11316 14313 16756 18703 19387 19859 22396 24697 27246 29547 31860 34173
1A + 2C 10101 11363 12378 15659 18337 20461 21216 21724 24497 27022 29807 32332 34857 37382
Per Addl. Child 873 968 1062 1345 1581 1758 1817 1864 2112 2325 2561 2773 2997 3210

Age 56 to 60 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 11210 12614 13735 17381 20343 22703 23541 24096 27187 29984 33064 35872 38669 41477
2A + 1C 12213 13747 14962 18939 22172 24745 25653 26267 29630 32686 36049 39105 42150 45206
2A + 2C 13228 14880 16201 20508 24001 26786 27777 28438 32072 35376 39023 42327 45631 48935
1A + 1C 10726 12071 13145 16638 19470 21724 22526 23069 26019 28698 31648 34326 37017 39695
1A + 2C 11741 13204 14372 18196 21299 23765 24650 25228 28462 31400 34621 37559 40486 43424
Per Addl. Child 1015 1133 1239 1569 1829 2041 2124 2171 2443 2690 2974 3221 3481 3729

Age 61 to 65 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 13476 15163 16508 20898 24461 27293 28308 28981 32686 36061 39766 43129 46504 49879
2A + 1C 14691 16532 17995 22786 26668 29760 30857 31589 35636 39306 43341 47023 50693 54363
2A + 2C 15906 17889 19482 24662 28863 32214 33406 34196 38574 42551 46917 50893 54870 58847
1A + 1C 12897 14514 15800 20001 23411 26125 27093 27742 31282 34515 38055 41288 44510 47731
1A + 2C 14113 15883 17287 21877 25618 28580 29642 30350 34220 37748 41630 45159 48687 52215
Per Addl. Child 1215 1357 1487 1876 2195 2454 2549 2608 2938 3245 3575 3870 4177 4484
 UNITED INDIA INSURANCE CO. LTD.
FAMILY MEDICARE POLICY-2014 PREMIUM CHART W.E.F. 01/08/2014 (PREMIUM INCLUSIVE OF GST @ 18% (MIN.SI RS.2 LACS)
Charts Prepared by : MR. GULSHAN RAI, Asstt. Manager, UIIC (Mobile No.09868338009) Email: gulshanrai@uiic.co.in

Age 66 to 70 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 14903 16756 18255 23104 27034 30173 31282 32037 36132 39849 43955 47672 51401 55130
2A + 1C 16237 18266 19895 25181 29476 32887 34102 34916 39377 43436 47908 51967 56026 60086
2A + 2C 17582 19777 21535 27258 31907 35601 36922 37795 42633 47023 51861 56251 60652 65042
1A + 1C 14254 16036 17464 22113 25877 28875 29948 30656 34574 38138 42067 45631 49194 52758
1A + 2C 15600 17547 19104 24190 28308 31589 32757 33536 37831 41725 46020 49914 53820 57714
Per Addl. Child 1345 1510 1640 2077 2431 2714 2820 2879 3257 3587 3953 4283 4626 4956

Age 71 to 75 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 17735 19954 21724 27494 32190 35919 37241 38138 43011 47448 52321 56758 61195 65620
2A + 1C 19328 21747 23683 29972 35081 39152 40604 41571 46881 51719 57029 61867 66694 71532
2A + 2C 20933 23541 25641 32450 37984 42386 43955 44993 50752 55979 61738 66977 72204 77432
1A + 1C 16980 19092 20792 26314 30810 34373 35648 36497 41170 45406 50079 54315 58563 62811
1A + 2C 18573 20886 22750 28792 33701 37607 38999 39931 45029 49678 54787 59425 64062 68711
Per Addl. Child 1605 1794 1959 2478 2903 3233 3351 3422 3870 4260 4708 5109 5511 5900

Age 76 to 80 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 600,000 700,000 800,000 900,000 10,00,000

2A + 0C 20143 22668 24686 31235 36568 40804 42315 43318 48864 53891 59437 64475 69514 74552
2A + 1C 21960 24709 26904 34055 39860 44474 46126 47224 53253 58752 64794 70281 75768 81267
2A + 2C 23777 26751 29122 36863 43141 48144 49926 51118 57655 63602 70139 76075 82022 87969
1A + 1C 19281 21688 23624 29901 34999 39046 40498 41465 46763 51578 56888 61702 66528 71355
1A + 2C 21098 23730 25842 32710 38279 42716 44297 45359 51153 56428 62233 67508 72782 78057
Per Addl. Child 1817 2041 2218 2808 3280 3670 3800 3894 4401 4850 5345 5794 6254 6702
Premium inclusive of GST Tax
A = Adult C = Child Age of the oldest person of the family to be taken
For persons above 80 years, an additional premium of 5% on the 76-80 would be charged. This 5% is applicable for all persons aged 81 and above.

During the first two years of the operation of the policy, the expenses on treatment of diseases such as
Cataract, Benign Prostatic Hyperthrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Pre-Acceptance Health
Hydrocele, Congenital internal disease, Fistula in anus, piles, Sinusitis and related disorders, Gall Check Up Test for
Bladder Stone removal, Gout & Rheumatism, Calculus Diseases, Joint Replacement due to Degenerative person of > 45 Years
Condition and age-related Osteoarthiritis & Osteoporosis are not payable. Co-Pay for Senior Citizen age, if required
and they will borne 10% of each Claim.
Cap on Certain Disease: Cataract 10% of SI or Max. 25,000/- Per Eye whichever is less 1. Physical Examinations
Hernia 15% of SI or Max. 1,00,000/-whichever is less Hysterectomy 20% of SI or Max. 1,00,000/- whichever is less 2. ECG
Major Surgeries : No Limit Remote Medical Second Opinion for qualified Medical Conditions. 3. Fasting & P.P. Blood Sugar
4. HBA 1c
AMBULANCE CHARGES = PREMIUM RS.100/- PLUS SERVICE TAX MAXIMUM ALLOWED CHARGES RS.2500/- 5. Hypertension (B.P. Either Value)
DAILY CASH BANEFIT ADDITIONAL PREM. RS.150/- PLUS SERVICE TAX IF ADMITTED MORE THAN 3 DAYS @ 250 PER DAY SUBJECT TO MAX.2500/- 6. Stress Test
DAILY CASH BANEFIT PREM. RS.300/- PLUS SERVICE TAX IF ADMITTED MORE THAN 3 DAYS @ 500 PER DAY SUBJECT TO MAX.5000/- 7. SGPT
8. Serum Cholestrol/Lipid Profile
*gul* 9. Sr. Creatinine
 UII PREMIUM CHART FOR FLOATER MEDICLAIM POLICY w.e.f. 01.08.2014 + GST @ 18% EXTRA (Min. S.I. Rs. 2 Lacs)
Charts Prepared by : MR. GULSHAN RAI, Asstt. Manager, UIIC (Mobile No.09868338009- Email: gulshanrai@uiic.co.in)
0-35 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 3,970 4,460 4,860 6,150 7,200 8,040 8,330 8,530 9,620 10,610 11,710 12,700 13,690 14,680
2A+1C 4,330 4,870 5,300 6,710 7,850 8,760 9,080 9,300 10,490 11,570 12,760 13,840 14,920 16,000
2A+2C 4,680 5,270 5,740 7,260 8,500 9,480 9,830 10,070 11,350 12,530 13,810 14,980 16,150 17,320
1A+1C 3,800 4,270 4,650 5,890 6,890 7,690 7,980 8,170 9,210 10,160 11,200 12,150 13,100 14,050
1A+2C 4,150 4,670 5,090 6,440 7,540 8,410 8,720 8,930 10,080 11,110 12,260 13,300 14,330 15,370
Per Addl. child 350 400 440 550 650 720 750 770 860 960 1,050 1,140 1,230 1,320
36-40 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 4,090 4,600 5,010 6,340 7,420 8,280 8,590 8,790 9,910 10,940 12,060 13,080 14,100 15,130
2A+1C 4,460 5,010 5,460 6,910 8,090 9,020 9,360 9,580 10,810 11,920 13,150 14,260 15,370 16,490
2A+2C 4,820 5,430 5,910 7,480 8,750 9,770 10,130 10,370 11,700 12,900 14,230 15,440 16,640 17,850
1A+1C 3,910 4,400 4,790 6,070 7,100 7,920 8,220 8,410 9,490 10,470 11,540 12,520 13,500 14,480
1A+2C 4,280 4,820 5,240 6,640 7,770 8,670 8,990 9,200 10,380 11,450 12,630 13,700 14,770 15,840
Per addl. child 360 420 450 570 660 750 770 790 890 980 1,080 1,180 1,270 1,360
41-45 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 4,570 5,140 5,600 7,080 8,290 9,250 9,600 9,820 11,080 12,220 13,480 14,620 15,760 16,910
2A+1C 4,980 5,600 6,100 7,720 9,040 10,090 10,460 10,710 12,080 13,320 14,690 15,940 17,180 18,430
2A+2C 5,390 6,070 6,600 8,360 9,780 10,920 11,320 11,590 13,070 14,420 15,910 17,250 18,600 19,950
1A+1C 4,370 4,920 5,360 6,780 7,940 8,860 9,180 9,400 10,610 11,700 12,900 13,990 15,090 16,180
1A+2C 4,780 5,380 5,860 7,420 8,680 9,690 10,050 10,290 11,600 12,800 14,110 15,310 16,510 17,700
Per addl. child 410 470 500 640 740 830 860 880 990 1,100 1,220 1,310 1,420 1,520
46-50 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 6,610 7,440 8,100 10,250 12,000 13,390 13,890 14,220 16,040 17,690 19,510 21,160 22,820 24,470
2A+1C 7,210 8,110 8,830 11,180 13,080 14,600 15,140 15,500 17,480 19,280 21,270 23,070 24,870 26,670
2A+2C 7,800 8,780 9,560 12,100 14,160 15,800 16,390 16,780 18,920 20,880 23,020 24,970 26,920 28,870
1A+1C 6,330 7,120 7,750 9,810 11,490 12,820 13,290 13,610 15,350 16,930 18,670 20,250 21,840 23,420
1A+2C 6,920 7,790 8,480 10,740 12,570 14,020 14,540 14,890 16,790 18,520 20,430 22,160 23,890 25,620
Per addl. child 590 670 730 920 1,080 1,200 1,250 1,280 1,440 1,600 1,750 1,900 2,050 2,200
51-55 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 8,180 9,200 10,020 12,680 14,840 16,560 17,170 17,580 19,830 21,870 24,120 26,170 28,210 30,250
2A+1C 8,910 10,030 10,920 13,820 16,170 18,050 18,720 19,160 21,610 23,840 26,290 28,520 30,750 32,980
2A+2C 9,650 10,850 11,820 14,960 17,510 19,540 20,260 20,740 23,400 25,810 28,460 30,870 33,290 35,700
1A+1C 7,830 8,800 9,590 12,130 14,200 15,850 16,430 16,830 18,980 20,930 23,090 25,040 27,000 28,960
1A+2C 8,560 9,630 10,490 13,270 15,540 17,340 17,980 18,410 20,760 22,900 25,260 27,400 29,540 31,680
Per addl. child 740 820 900 1,140 1,340 1,490 1,540 1,580 1,790 1,970 2,170 2,350 2,540 2,720
56-60 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 9,500 10,690 11,640 14,730 17,240 19,240 19,950 20,420 23,040 25,410 28,020 30,400 32,770 35,150
2A+1C 10,350 11,650 12,680 16,050 18,790 20,970 21,740 22,260 25,110 27,700 30,550 33,140 35,720 38,310
2A+2C 11,210 12,610 13,730 17,380 20,340 22,700 23,540 24,100 27,180 29,980 33,070 35,870 38,670 41,470
1A+1C 9,090 10,230 11,140 14,100 16,500 18,410 19,090 19,550 22,050 24,320 26,820 29,090 31,370 33,640
1A+2C 9,950 11,190 12,180 15,420 18,050 20,140 20,890 21,380 24,120 26,610 29,340 31,830 34,310 36,800
Per addl. child 860 960 1,050 1,330 1,550 1,730 1,800 1,840 2,070 2,280 2,520 2,730 2,950 3,160
61-65 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 11,420 12,850 13,990 17,710 20,730 23,130 23,990 24,560 27,700 30,560 33,700 36,550 39,410 42,270
2A+1C 12,450 14,010 15,250 19,310 22,600 25,220 26,150 26,770 30,200 33,310 36,730 39,850 42,960 46,070
2A+2C 13,480 15,160 16,510 20,900 24,460 27,300 28,310 28,980 32,690 36,060 39,760 43,130 46,500 49,870
1A+1C 10,930 12,300 13,390 16,950 19,840 22,140 22,960 23,510 26,510 29,250 32,250 34,990 37,720 40,450
1A+2C 11,960 13,460 14,650 18,540 21,710 24,220 25,120 25,720 29,000 31,990 35,280 38,270 41,260 44,250
Per addl. child 1,030 1,150 1,260 1,590 1,860 2,080 2,160 2,210 2,490 2,750 3,030 3,280 3,540 3,800
66-70 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 12,630 14,200 15,470 19,580 22,910 25,570 26,510 27,150 30,620 33,770 37,250 40,400 43,560 46,720
2A+1C 13,760 15,480 16,860 21,340 24,980 27,870 28,900 29,590 33,370 36,810 40,600 44,040 47,480 50,920
2A+2C 14,900 16,760 18,250 23,100 27,040 30,170 31,290 32,030 36,130 39,850 43,950 47,670 51,400 55,120
1A+1C 12,080 13,590 14,800 18,740 21,930 24,470 25,380 25,980 29,300 32,320 35,650 38,670 41,690 44,710
1A+2C 13,220 14,870 16,190 20,500 23,990 26,770 27,760 28,420 32,060 35,360 39,000 42,300 45,610 48,910
Per addl. child 1,140 1,280 1,390 1,760 2,060 2,300 2,390 2,440 2,760 3,040 3,350 3,630 3,920 4,200
71-75 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 15,030 16,910 18,410 23,300 27,280 30,440 31,560 32,320 36,450 40,210 44,340 48,100 51,860 55,610
2A+1C 16,380 18,430 20,070 25,400 29,730 33,180 34,410 35,230 39,730 43,830 48,330 52,430 56,520 60,620
2A+2C 17,740 19,950 21,730 27,500 32,190 35,920 37,250 38,130 43,010 47,440 52,320 56,760 61,190 65,620
1A+1C 14,390 16,180 17,620 22,300 26,110 29,130 30,210 30,930 34,890 38,480 42,440 46,030 49,630 53,230
1A+2C 15,740 17,700 19,280 24,400 28,560 31,870 33,050 33,840 38,160 42,100 46,430 50,360 54,290 58,230
Per addl. child 1,360 1,520 1,660 2,100 2,460 2,740 2,840 2,900 3,280 3,610 3,990 4,330 4,670 5,000
76-80 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 17,070 19,210 20,920 26,470 30,990 34,580 35,860 36,710 41,410 45,670 50,370 54,640 58,910 63,180
2A+1C 18,610 20,940 22,800 28,860 33,780 37,690 39,090 40,020 45,130 49,790 54,910 59,560 64,210 68,870
2A+2C 20,150 22,670 24,680 31,240 36,560 40,800 42,310 43,320 48,860 53,900 59,440 64,470 69,510 74,550
1A+1C 16,340 18,380 20,020 25,340 29,660 33,090 34,320 35,140 39,630 43,710 48,210 52,290 56,380 60,470
1A+2C 17,880 20,110 21,900 27,720 32,440 36,200 37,540 38,440 43,350 47,820 52,740 57,210 61,680 66,150
Per addl. child 1,540 1,730 1,880 2,380 2,780 3,110 3,220 3,300 3,730 4,110 4,530 4,910 5,300 5,680
A = Adult C = Child Age of the oldest person of the family to be taken Applicable GST Tax @ 18% extra
For persons above 80 years, an additional premium of 5% on the 76-80 would be charged. This 5% is applicable for all persons aged 81 and above.
AMBULANCE CHARGES = PREMIUM RS.100/- PLUS SERVICE TAX MAXIMUM ALLOWED CHARGES RS.2500/- Pre-Acceptance Health Check Up Test for
DAILY CASH BANEFIT ADDITIONAL PREM. RS.150/- PLUS SERVICE TAX IF ADMITTED MORE THAN 3 DAYS @ 250 PER DAY SUBJECT TO MAX.2500/- person of > 45 Years age, if required
DAILY CASH BANEFIT PREM. RS.300/- PLUS SERVICE TAX IF ADMITTED MORE THAN 3 DAYS @ 500 PER DAY SUBJECT TO MAX.5000/- 1. Physical Examinations
*gul* Note: 2. ECG
1. For PED of diabetes, hypertension & hyperlipidemia premium will be loaded by 10% each 3. Fasting & P.P. Blood Sugar
2. Co-Pay for Sr.Citizen 60 years & above and 10% claim will be borne by Insured. 4. HBA 1c
3. Cap on Certain Disease: 1. Cataract 10% of SI or Max. Rs.25,000/- per Eye whichever is less 5. Hypertension (B.P. Either Value)
2. Hernia 15% of SI or Max. Rs.1,00,000/- whichever is less 3. Hysterectomy 20% of SI or Max. Rs.1,00,000/- whichever is less 6. Stress Test
Major Surgeries - No Capping Major Surgeries i.e. Cardiac, Cancer, Brain Tumour, Pacemaker Implantation for Sick, Sinus syndrome, 7. SGPT
Hip Replacement, Knee Joint Replacement Surgeries 8. Serum Cholestrol/Lipid Profile
4. Pre & Post Hospitalization expenses 10% of S.I. will be payable 5. NCD 3% after 3 years and continuous after every year Max. 15% NCD 9. Sr. Creatinine

During the first two years of the operation of the policy, the expenses on treatment of diseases such as Cataract, Benign Prostatic Hyperthrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia,
Hydrocele, Congenital internal disease, Fistula in anus, piles, Sinusitis and related disorders, Gall Bladder Stone removal, Gout & Rheumatism, Calculus Diseases, Joint Replacement due to Degenerative
Condition and age-related Osteoarthiritis & Osteoporosis are not payable. Senior Citizen will borne 10% of each Claim
 UII PREMIUM CHART FOR FLOATER MEDICLAIM POLICY w.e.f. 01.08.2014 inclusive of GST @ 18% (Min. S.I. Rs. 2 Lacs)
Charts Prepared by : MR. GULSHAN RAI, Asstt. Manager, UIIC DO AGRA (Mobile No.09868338009 - Email: gulshanrai@uiic.co.in)
0-35 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 4685 5263 5735 7257 8496 9487 9829 10065 11352 12520 13818 14986 16154 17322
2A+1C 5109 5747 6254 7918 9263 10337 10714 10974 12378 13653 15057 16331 17606 18880
2A+2C 5522 6219 6773 8567 10030 11186 11599 11883 13393 14785 16296 17676 19057 20438
1A+1C 4484 5039 5487 6950 8130 9074 9416 9641 10868 11989 13216 14337 15458 16579
1A+2C 4897 5511 6006 7599 8897 9924 10290 10537 11894 13110 14467 15694 16909 18137
Per Addl. child 413 472 519 649 767 850 885 909 1015 1133 1239 1345 1451 1558
36-40 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 4826 5428 5912 7481 8756 9770 10136 10372 11694 12909 14231 15434 16638 17853
2A+1C 5263 5912 6443 8154 9546 10644 11045 11304 12756 14066 15517 16827 18137 19458
2A+2C 5688 6407 6974 8826 10325 11529 11953 12237 13806 15222 16791 18219 19635 21063
1A+1C 4614 5192 5652 7163 8378 9346 9700 9924 11198 12355 13617 14774 15930 17086
1A+2C 5050 5688 6183 7835 9169 10231 10608 10856 12248 13511 14903 16166 17429 18691
Per addl. child 425 496 531 673 779 885 909 932 1050 1156 1274 1392 1499 1605
41-45 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 5393 6065 6608 8354 9782 10915 11328 11588 13074 14420 15906 17252 18597 19954
2A+1C 5876 6608 7198 9110 10667 11906 12343 12638 14254 15718 17334 18809 20272 21747
2A+2C 6360 7163 7788 9865 11540 12886 13358 13676 15423 17016 18774 20355 21948 23541
1A+1C 5157 5806 6325 8000 9369 10455 10832 11092 12520 13806 15222 16508 17806 19092
1A+2C 5640 6348 6915 8756 10242 11434 11859 12142 13688 15104 16650 18066 19482 20886
Per addl. child 484 555 590 755 873 979 1015 1038 1168 1298 1440 1546 1676 1794
46-50 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 7800 8779 9558 12095 14160 15800 16390 16780 18927 20874 23022 24969 26928 28875
2A+1C 8508 9570 10419 13192 15434 17228 17865 18290 20626 22750 25099 27223 29347 31471
2A+2C 9204 10360 11281 14278 16709 18644 19340 19800 22326 24638 27164 29465 31766 34067
1A+1C 7469 8402 9145 11576 13558 15128 15682 16060 18113 19977 22031 23895 25771 27636
1A+2C 8166 9192 10006 12673 14833 16544 17157 17570 19812 21854 24107 26149 28190 30232
Per addl. child 696 791 861 1086 1274 1416 1475 1510 1699 1888 2065 2242 2419 2596
51-55 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 9652 10856 11824 14962 17511 19541 20261 20744 23399 25807 28462 30881 33288 35695
2A+1C 10514 11835 12886 16308 19081 21299 22090 22609 25500 28131 31022 33654 36285 38916
2A+2C 11387 12803 13948 17653 20662 23057 23907 24473 27612 30456 33583 36427 39282 42126
1A+1C 9239 10384 11316 14313 16756 18703 19387 19859 22396 24697 27246 29547 31860 34173
1A+2C 10101 11363 12378 15659 18337 20461 21216 21724 24497 27022 29807 32332 34857 37382
Per addl. child 873 968 1062 1345 1581 1758 1817 1864 2112 2325 2561 2773 2997 3210
56-60 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 11210 12614 13735 17381 20343 22703 23541 24096 27187 29984 33064 35872 38669 41477
2A+1C 12213 13747 14962 18939 22172 24745 25653 26267 29630 32686 36049 39105 42150 45206
2A+2C 13228 14880 16201 20508 24001 26786 27777 28438 32072 35376 39023 42327 45631 48935
1A+1C 10726 12071 13145 16638 19470 21724 22526 23069 26019 28698 31648 34326 37017 39695
1A+2C 11741 13204 14372 18196 21299 23765 24650 25228 28462 31400 34621 37559 40486 43424
Per addl. child 1015 1133 1239 1569 1829 2041 2124 2171 2443 2690 2974 3221 3481 3729
61-65 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 13476 15163 16508 20898 24461 27293 28308 28981 32686 36061 39766 43129 46504 49879
2A+1C 14691 16532 17995 22786 26668 29760 30857 31589 35636 39306 43341 47023 50693 54363
2A+2C 15906 17889 19482 24662 28863 32214 33406 34196 38574 42551 46917 50893 54870 58847
1A+1C 12897 14514 15800 20001 23411 26125 27093 27742 31282 34515 38055 41288 44510 47731
1A+2C 14113 15883 17287 21877 25618 28580 29642 30350 34220 37748 41630 45159 48687 52215
Per addl. child 1215 1357 1487 1876 2195 2454 2549 2608 2938 3245 3575 3870 4177 4484
66-70 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 14903 16756 18255 23104 27034 30173 31282 32037 36132 39849 43955 47672 51401 55130
2A+1C 16237 18266 19895 25181 29476 32887 34102 34916 39377 43436 47908 51967 56026 60086
2A+2C 17582 19777 21535 27258 31907 35601 36922 37795 42633 47023 51861 56251 60652 65042
1A+1C 14254 16036 17464 22113 25877 28875 29948 30656 34574 38138 42067 45631 49194 52758
1A+2C 15600 17547 19104 24190 28308 31589 32757 33536 37831 41725 46020 49914 53820 57714
Per addl. child 1345 1510 1640 2077 2431 2714 2820 2879 3257 3587 3953 4283 4626 4956
71-75 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 17735 19954 21724 27494 32190 35919 37241 38138 43011 47448 52321 56758 61195 65620
2A+1C 19328 21747 23683 29972 35081 39152 40604 41571 46881 51719 57029 61867 66694 71532
2A+2C 20933 23541 25641 32450 37984 42386 43955 44993 50752 55979 61738 66977 72204 77432
1A+1C 16980 19092 20792 26314 30810 34373 35648 36497 41170 45406 50079 54315 58563 62811
1A+2C 18573 20886 22750 28792 33701 37607 38999 39931 45029 49678 54787 59425 64062 68711
Per addl. child 1605 1794 1959 2478 2903 3233 3351 3422 3870 4260 4708 5109 5511 5900
76-80 Yrs 100000 150000 200000 250000 300000 350000 400000 450000 500000 600000 700000 800000 900000 1000000
2A 20143 22668 24686 31235 36568 40804 42315 43318 48864 53891 59437 64475 69514 74552
2A+1C 21960 24709 26904 34055 39860 44474 46126 47224 53253 58752 64794 70281 75768 81267
2A+2C 23777 26751 29122 36863 43141 48144 49926 51118 57655 63602 70139 76075 82022 87969
1A+1C 19281 21688 23624 29901 34999 39046 40498 41465 46763 51578 56888 61702 66528 71355
1A+2C 21098 23730 25842 32710 38279 42716 44297 45359 51153 56428 62233 67508 72782 78057
Per addl. child 1817 2041 2218 2808 3280 3670 3800 3894 4401 4850 5345 5794 6254 6702
A = Adult C = Child Age of the oldest person of the family to be taken INCLUSIVE OF GST Tax
For persons above 80 years, an additional premium of 5% on the 76-80 would be charged. This 5% is applicable for all persons aged 81 and above.
AMBULANCE CHARGES = PREMIUM RS.100/- PLUS SERVICE TAX MAXIMUM ALLOWED CHARGES RS.2500/- Pre-Acceptance Health Check Up Test for
DAILY CASH BANEFIT ADDITIONAL PREM. RS.150/- PLUS SERVICE TAX IF ADMITTED MORE THAN 3 DAYS @ 250 PER DAY SUBJECT TO MAX.2500/- person of > 45 Years age, if required
DAILY CASH BANEFIT PREM. RS.300/- PLUS SERVICE TAX IF ADMITTED MORE THAN 3 DAYS @ 500 PER DAY SUBJECT TO MAX.5000/- 1. Physical Examinations
*gul* Note: 2. ECG
1. For PED of diabetes, hypertension & hyperlipidemia premium will be loaded by 10% each 3. Fasting & P.P. Blood Sugar
2. Co-Pay for Sr.Citizen 60 years & above and 10% claim will be borne by Insured. 4. HBA 1c
3. Cap on Certain Disease: 1. Cataract 10% of SI or Max. Rs.25,000/- per Eye whichever is less 5. Hypertension (B.P. Either Value)
2. Hernia 15% of SI or Max. Rs.1,00,000/- whichever is less 3. Hysterectomy 20% of SI or Max. Rs.1,00,000/- whichever is less 6. Stress Test
Major Surgeries - No Capping Major Surgeries i.e. Cardiac, Cancer, Brain Tumour, Pacemaker Implantation for Sick, Sinus syndrome, 7. SGPT
Hip Replacement, Knee Joint Replacement Surgeries 8. Serum Cholestrol/Lipid Profile
4. Pre & Post Hospitalization expenses 10% of S.I. will be payable 5. NCD 3% after 3 years and continuous after every year Max. 15% NCD 9. Sr. Creatinine

During the first two years of the operation of the policy, the expenses on treatment of diseases such as Cataract, Benign Prostatic Hyperthrophy, Hysterectomy for Menorrhagia or
Fibromyoma, Hernia, Hydrocele, Congenital internal disease, Fistula in anus, piles, Sinusitis and related disorders, Gall Bladder Stone removal, Gout & Rheumatism, Calculus Diseases,
Joint Replacement due to Degenerative Condition and age-related Osteoarthiritis & Osteoporosis are not payable. Senior Citizen will borne 10% of each Claim
 SUPER TOP UP MEDICARE POLICY PREMIUM CHART + Add : GST @ 18%
Charts Prepared by : MR. GULSHAN RAI, Asstt. Manager, UIIC - DO Agra (Mobile No.09868338009) Email: gulshanrai@uiic.co.in

0 - 45 YEARS 46 - 60 YEARS ABOVE 60 YEARS

FAMILY FAMILY FAMILY
OPTION SUM INSURED THRESHOLD LEVEL
INDIVIDUAL MORE THAN 2 INDIVIDUAL MORE THAN 2 INDIVIDUAL MORE THAN 2
2 PERSONS 2 PERSONS 2 PERSONS
PERSONS PERSONS PERSONS

A 300000 200000 2100 3400 4200 2600 4200 5200 2900 4600 5800

B 500000 200000 2900 4600 5800 3600 5800 7200 4000 6400 8000

C 300000 300000 1700 2700 3400 2100 3400 4200 2300 3700 4600

D 500000 300000 2300 3700 4600 2900 4600 5800 3200 5100 6400

E 700000 300000 2900 4600 5800 3600 5800 7200 4000 6400 8000

F 500000 500000 1900 3000 3800 2300 3700 4600 2600 4200 5200

G 1000000 500000 3700 5900 7400 4600 7400 9200 5100 8200 10200

H 1500000 500000 5200 8300 10400 6500 10400 13000 7200 11500 14400

SUPER TOP UP MEDICARE POLICY PREMIUM CHART INCLUSIVE OF GST @ 18%

0 - 45 YEARS 46 - 60 YEARS ABOVE 60 YEARS
OPTION SUM INSURED THRESHOLD LEVEL FAMILY FAMILY FAMILY
INDIVIDUAL MORE THAN 2 INDIVIDUAL MORE THAN 2 INDIVIDUAL MORE THAN 2
2 PERSONS 2 PERSONS 2 PERSONS
PERSONS PERSONS PERSONS
A 300000 200000 2478 4012 4956 3068 4956 6136 3422 5428 6844
B 500000 200000 3422 5428 6844 4248 6844 8496 4720 7552 9440
C 300000 300000 2006 3186 4012 2478 4012 4956 2714 4366 5428
D 500000 300000 2714 4366 5428 3422 5428 6844 3776 6018 7552
E 700000 300000 3422 5428 6844 4248 6844 8496 4720 7552 9440

F 500000 500000 2242 3540 4484 2714 4366 5428 3068 4956 6136
G 1000000 500000 4366 6962 8732 5428 8732 10856 6018 9676 12036
H 1500000 500000 6136 9794 12272 7670 12272 15340 8496 13570 16992

A declaration is must from the insured that during the last 730 days (2 Years), he/she or his/her family have not admitted/not taken any treatment for any disease/illness.
 United India Insurance Co. Ltd.
SYNDAROGYA (SYNDICATE BANK) MEDICLAIM-CUM-PERSONAL ACCIDENT POLICY
Charts Prepared by : MR. GULSHAN RAI, Asstt. Manager, UIIC - DO Agra, Email: gulshanrai@uiic.co.in

FAMILY (1+3) PLAN-A FAMILY (1+5) PLAN-B

MEDICLAIM TOTAL Family Sum MEDICLAIM PA GST TOTAL Family

Sum Insured PA PREM. TOTAL GST @18% TOTAL
PREMIUM (1+3) Insured PREMIUM PREM. @18% (1+5)

50000 831 21 852 154 1006 50000 1400 21 1421 256 1677
100000 1603 42 1645 296 1941 100000 2704 42 2746 494 3240
150000 2348 63 2411 434 2845 150000 3959 63 4022 724 4746
200000 3019 84 3103 560 3663 200000 5091 84 5175 932 6107
250000 3606 105 3711 668 4379 250000 6096 105 6201 1116 7317
300000 4214 126 4340 782 5122 300000 7100 126 7226 1302 8528
350000 4734 147 4881 878 5759 350000 7979 147 8126 1464 9590
400000 5256 168 5424 976 6400 400000 8858 168 9026 1626 10652
450000 5779 189 5968 1074 7042 450000 9741 189 9930 1788 11718
500000 6301 210 6511 1172 7683 500000 10620 210 10830 1950 12780

FAMILY (1+3) INSURED + SPOUSE + 2 DEPENDENT CHILDREN

FAMILY (1+5) INSURED + SPOUSE + 2 DEPENDENT CHILDREN + DEPENDENT PARENTS 1% of S.I. - Free Health Check up after 3 claim free years

In case of No Claim in Previous Policy, Sum Insured can be enhanced by 2 Slabs only Pre-Existing Disese covered after 3 Policy Years

During the first year of the operation of the policy, the expenses on treatment of diseases such as Cataract, Benign Prostatic Hyperthrophy, Hysterectomy for Menorrhagia or
Fibromyoma, Hernia, Hydrocele, Congenital internal disease, Fistula in anus, piles, Sinusitis and related disorders, Gall Bladder Stone removal, Gout & Rheumatism, Calculus Diseases,
Joint Replacement due to Degenerative Condition and age-related Osteoarthiritis & Osteoporosis are not payable, Covered after 1 Years

SYNDAROGYA (SYNDICATE BANK) MEDICLAIM POLICY

PLAN-A PLAN-B Email: insurancediv@syndicatebank.co.in

Family
Sum Insured Family (1+3) GST @18% Total GST @18% Total
(1+5)
50000 852 154 1006 1421 256 1677
100000 1645 296 1941 2746 494 3240
150000 2411 434 2845 4022 724 4746
200000 3103 560 3663 5175 932 6107
250000 3711 668 4379 6201 1116 7317
300000 4340 782 5122 7226 1302 8528
350000 4881 878 5759 8126 1464 9590
400000 5424 976 6400 9026 1626 10652
450000 5968 1074 7042 9930 1788 11718
500000 6511 1172 7683 10830 1950 12780

FAMILY (1+3) INSURED + SPOUSE + 2 DEPENDENT CHILDREN

FAMILY (1+5) INSURED + SPOUSE + 2 DEPENDENT CHILDREN + DEPENDENT PARENTS
 UNITED INDIA INSURANCE CO.LTD. - UNIHOME CARE PREMIUM CHART
(Charts Prepared by : Gulshan Rai, Asstt. Manager, DO Agra , Mobile : 9868338009, Email : gulshanrai@uiic.co.in)
SUM Policy Term (ADD: GST @ 18% EXTRA) (Coverage : Fire, Earthquake, & Personal Accident Coverage by Accidental Death)
INSURED 3 Yrs. 4 Yrs. 5 Yrs. 6 Yrs. 7 Yrs. 8 Yrs. 9 Yrs. 10 Yrs. 11 12 13 14 15 Yrs. 16 17 18 19 20 Yrs. 21 22 23 24 25 Yrs.
100000 180 229 272 308 340 367 387 401 441 481 522 561 602 643 684 725 766 807 848 889 930 971 1012
200000 360 458 544 618 681 732 773 802 882 962 1042 1123 1203 1286 1368 1450 1532 1614 1696 1778 1860 1942 2024
300000 541 686 815 927 1021 1099 1159 1203 1324 1443 1564 1683 1805 1929 2052 2175 2298 2421 2544 2667 2790 2913 3036
400000 720 915 1087 1236 1362 1465 1546 1604 1761 1925 2084 2246 2405 2572 2736 2900 3064 3228 3392 3556 3720 3884 4048
500000 901 1144 1359 1545 1703 1832 1933 2005 2205 2405 2606 2806 3007 3215 3420 3625 3830 4035 4240 4445 4650 4855 5060
600000 1081 1372 1631 1853 2042 2199 2319 2405 2646 2886 3127 3368 3608 3858 4104 4350 4596 4842 5088 5334 5580 5826 6072
700000 1260 1602 1902 2162 2383 2564 2706 2806 3087 3368 3649 3929 4210 4501 4788 5075 5362 5649 5936 6223 6510 6797 7084
800000 1441 1830 2174 2472 2724 2931 3091 3207 3528 3848 4170 4490 4811 5144 5472 5800 6128 6456 6784 7112 7440 7768 8096
900000 1621 2059 2446 2781 3065 3296 3478 3608 3970 4330 4691 5051 5413 5787 6156 6525 6894 7263 7632 8001 8370 8739 9108
1000000 1802 2288 2718 3089 3405 3663 3865 4009 4401 4811 5212 5613 6014 6430 6840 7250 7660 8070 8480 8890 9300 9710 10120
1100000 1982 2516 2988 3398 3745 4034 4252 4410 4851 5292 5734 6174 6615 7073 7524 7975 8426 8877 9328 9779 10230 10681 11132
1200000 2161 2746 3260 3707 4086 4395 4638 4811 5292 5773 6254 6736 7216 7716 8202 8700 9192 9684 10176 10668 11160 11652 12144
1300000 2342 2973 3532 4016 4427 4763 5024 5212 5734 6254 6776 7296 7818 8359 8892 9425 9958 10491 11024 11557 12090 12623 13156
1400000 2521 3203 3804 4326 4767 5128 5410 5613 6174 6736 7296 7857 8419 9002 9576 10150 10724 11298 11872 12446 13020 13594 14168
1500000 2702 3431 4075 4634 5107 5495 5797 6014 6615 7216 7818 8419 9021 9645 10260 10875 11490 12105 12720 13335 13950 14565 15180
1600000 2882 3660 4527 4943 5448 5862 6183 6414 7163 7697 8339 8980 9622 10288 10944 11600 12256 12912 13568 14224 14880 15536 16192
1700000 3062 3889 4619 5252 5788 6227 6570 6815 7497 8178 8860 9541 10223 10931 11628 12325 13022 13719 14416 15113 15810 16507 17204
1800000 3242 4117 4891 5561 6128 6594 6957 7216 7938 8659 9381 10163 10824 11574 12312 13050 13788 14526 15264 16002 16740 17478 18216
1900000 3423 4347 5162 5870 6469 6960 7343 7617 8379 9141 9903 10664 11426 12217 12996 13775 14554 15333 16112 16891 17670 18449 19228
2000000 3602 4575 5434 6179 6810 7326 7729 8018 8820 9622 10423 11225 12027 12860 13680 14500 15320 16140 16960 17780 18600 19420 20240
2100000 3782 4804 5706 6487 7150 7693 8116 8419 9261 10103 10945 11786 12629 13503 14364 15225 16086 16947 17808 18669 19530 20391 21252
2200000 3963 5033 5978 6797 7491 8059 8629 8820 9702 10584 11466 12348 13230 14146 15048 15950 16852 17754 18656 19558 20460 21362 22264
2300000 4143 5261 6249 7105 7831 8426 8888 9221 10143 11065 11987 12909 13832 14789 15732 16675 17618 18561 19504 20447 21390 22333 23276
2400000 4322 5491 6521 7415 8171 8791 9275 9622 10584 11546 12508 13470 14432 15432 16416 17400 18384 19368 20352 21336 22320 23304 24288
2500000 4503 5719 6793 7724 8492 9158 9662 10023 11025 12027 13030 14032 15034 16075 17100 18125 19150 20175 21200 22225 23250 24275 25300
2600000 4836 6136 7280 8268 9100 10400 10998 11440 11726 12792 13858 14924 15990 17056 18122 19188 20254 21320 22386 23452 24518 25584 26650
2700000 5022 6372 7560 8586 9450 10800 11421 11880 12177 13284 14391 15498 16605 17712 18819 19926 21033 22140 23247 24354 25461 26568 27675
2800000 5208 6608 7840 8904 9800 11200 11844 12320 12628 13776 14924 16072 17220 18368 19516 20664 21812 22960 24108 25256 26404 27552 28700
2900000 5394 6844 8120 9222 10150 11600 12267 12760 13079 14268 15457 16646 17835 19024 20213 21402 22591 23780 24969 26158 27347 28536 29725
3000000 5580 7080 8400 9540 10500 12000 12690 13200 13530 14760 15990 17220 18450 19680 20910 22140 23370 24600 25830 27060 28290 29520 30750
3100000 5766 7316 8680 9858 10850 12400 13113 13640 13981 15252 16523 17794 19065 20336 21607 22878 24149 25420 26691 27962 29233 30504 31775
3200000 5952 7552 8960 10176 11200 12800 13536 14080 14432 15744 17056 18368 19680 20992 22304 23616 24928 26240 27552 28864 30176 31488 32800
3300000 6138 7788 9240 10494 11550 13200 13959 14520 14883 16236 17589 18942 20295 21648 23001 24354 25707 27060 28413 29766 31119 32472 33825
3400000 6324 8024 9520 10812 11900 13600 14382 14960 15334 16728 18122 19516 20910 22304 23698 25092 26486 27880 29274 30668 32062 33456 34850
3500000 6510 8260 9800 11130 12250 14000 14805 15400 15785 17220 18655 20090 21525 22960 24395 25830 27265 28700 30135 31570 33005 34440 35875
3600000 6696 8496 10080 11448 12600 14400 15228 15840 16236 17712 19188 20664 22140 23616 25092 26568 28044 29520 30996 32472 33948 35424 36900
3700000 6882 8732 10360 11766 12950 14800 15651 16280 16687 18204 19721 21238 22755 24272 25789 27306 28823 30340 31857 33374 34891 36408 37925
3800000 7068 8968 10640 12084 13300 15200 16074 16720 17138 18696 20254 21812 23370 24928 26486 28044 29602 31160 32718 34276 35834 37392 38950
3900000 7254 9204 10920 12402 13650 15600 16497 17160 17589 19188 20787 22386 23985 25584 27183 28782 30381 31980 33579 35178 36777 38376 39975
4000000 7440 9440 11200 12720 14000 16000 16920 17600 18040 19680 21320 22960 24600 26240 27880 29520 31160 32800 34440 36080 37720 39360 41000
4100000 7626 9676 11480 13038 14350 16400 17343 18040 18491 20172 21853 23534 25215 26896 28577 30258 31939 33620 35301 36982 38663 40344 42025
4200000 7812 9912 11760 13356 14700 16800 17766 18480 18942 20664 22386 24108 25830 27552 29274 30996 32718 34440 36162 37884 39606 41328 43050
4300000 7998 10148 12040 13674 15050 17200 18189 18920 19393 21156 22919 24682 26445 28208 29971 31734 33497 35260 37023 38786 40549 42312 44075
4400000 8184 10384 12320 13992 15400 17600 18612 19360 19844 21648 23452 25256 27060 28864 30668 32472 34276 36080 37884 39688 41492 43296 45100
4500000 8370 10620 12600 14310 15750 18000 19035 19800 20295 22140 23985 25830 27675 29520 31365 33210 35055 36900 38745 40590 42435 44280 46125
4600000 8556 10856 12880 14628 16100 18400 19458 20240 20746 22632 24518 26404 28290 30176 32062 33948 35834 37720 39606 41492 43378 45264 47150
4700000 8742 11092 13160 14946 16450 18800 19881 20680 21197 23124 25051 26978 28905 30832 32759 34686 36613 38540 40467 42394 44321 46248 48175
4800000 8928 11328 13440 15264 16800 19200 20304 21120 21648 23616 25584 27552 29520 31488 33456 35424 37392 39360 41328 43296 45264 47232 49200
4900000 9114 11564 13720 15582 17150 19600 20727 21560 22099 24108 26117 28126 30135 32144 34153 36162 38171 40180 42189 44198 46207 48216 50225
5000000 9300 11800 14000 15900 17500 20000 21150 22000 22550 24600 26650 28700 30750 32800 34850 36900 38950 41000 43050 45100 47150 49200 51250
 PERSONAL ACCIDENT INSURANCE POLICY
(Charts Prepared by : Gulshan Rai, Asstt. Manager, DO Agra , Mobile : 9868338009, Email : gulshanrai@uiic.co.in)
This policy provides monetary compensation in case of death or Disablement resulting
from Accidental Injury arising out of external violent and visible means. RATES per Mille-GST Extra
Benefit Description Table Risk Group-I Risk Group-II Risk Group-III
1 Death Only Risk (100% of CSI) I 0.45 0.60 0.90
2 Death, Permanent Total Disablement (PTD) II 0.65 0.90 1.30
3 Death, PTD and Permanent Partial Disablement (PPD) III 0.95 1.25 1.75
4 Death, PTD, PPD and Temporary Total Disablement (TTD) IV 1.50 2.00 3.00
N.B.: TTD at 1% of Capital Sum Insured per week upto Maximum of 100 weeks - Maximum weekly benefit not to exceed Rs. 5,000/-
Sum Insured Limits: Overall Sum Insured will be restricted to 60 times (5 Years Salary) monthly emoluments for all Tables.
Under Table-IV, 24 times emoluments will be considered & overall Sum Insured should not be more than 60 months emoluments.
On Duty Cover : If P.A. cover is required only for the restricted hours of duty (and not for all the 24 hours of the day and night), reduced premium
equivalent to 75% of the appropriate premium shall be charged. The cover is meant for employees only taken out by employer for accident to
employees arising out of and in the course of employment only.
Risk Group Description: Net Minimum Premium : Chargeable is Rs.100/-
Risk Group-I: Accountant, Doctors, Lawyers, Architects, Consulting Engineers, Teachers, Bankers, Person engaged in Administrative functions, persons primarily
engaged in occupations of similar hazard.

Risk Group-II: Builders, Contractors and Engineers engaged in Superintending functions only, Veterinary Doctors, Paid Drivers of Motor Cars and Light Motor Vehicles
and persons engaged in occupations of similar hazard and not engaged in manual labour. All persons engaged in Manual Labouor (except those falling under Group-III),
Cash Carrying employees, Garage and Motor Mechanics, Machine Operators, Drivers of Truck or Lorries and other Heavy Vehicles, Professional Athletes and
Sportsmen, Woodworking machinists and persons engaged in Occupations of similar hazard.

Risk Group-III: Persons working in underground mines, explosives, magazines, workers involved in electrical installation with high tension supply, dockeys, Circus
Personnel, Persons engaged in activities like racing on wheels or Horseback, big game bunting, Mountaineering, Winter sports, Skiing Ice Hockey, Ballooning, and
Gliding, River rafting, Polo and persons engaged in occupations/activities of similar hazard.

1. Family Discount : 5% if two or more members covered. 2. Cumulative Bonus on SI : After 1 year 5% per year subject to 50% Maximum.

PROFESSIONAL INDEMNITY INSURANCE-DR.& MEDICAL PRACTITIONERS

The Policy will indemnify any act committed by the insured, who shall be a Registered Medical Practitioner, giving rise to any legal liability to Third
Parties. The Insured includes the policy holder and his qualified assistants or employees named in the proposal.

GST TAX EXTRA RATES per mille

Schedule of Rates Any One Accident (AOA)/Any One Year (AOY) Ratio

Category 01:01 01:02 01:03 01:04

Physician without despensing of other Facilities, General
1 Pathologist, Radiologist
0.50 0.40 0.35 0.30
2 Specialists/Consulting Physician (Non Surgical) 1.00 0.80 0.70 0.60
Surgeon (Excluding Specialist in Plastic Surgery) Lithotripsy, Dentist
3 and similar extra corporal method of treatment)
2.00 1.60 1.40 1.20
4 Surgeon (Plastic Surgery & Anaesthetists) 3.00 2.40 2.10 1.80
Excess: 0.25% of the AOY limit subject to a minimum of Rs.1,000/- and a maximum of Rs.1,00,000/-

CATTLE INSURANCE POLICY

GST TAX EXTRA RATES per mille
Schedule of Rates Non Scheme (Direct Finance) Scheme (Govt.Subsidy)

Category 1 Yr. 3 Yr. 1 Yr. 3 Yr.

Cattle/Buffalow 4.00 10.20 2.25 4.80
Sheep/Goat 5.00 12.75 2.75 6.21
Cattle with PTD 5.00 12.75 2.75 6.21
Risk Covered : Death due to Accident and Disease/illness. Condition: NO TAG, NO CLAIM. If No Tag, Claim will not be paid
Exlusion : Policy will not cover Death Claim during First 15 days from Inception of Policy. All Claims are payable on 80% Basis.
 OVERSEAS MEDICLAIM POLICY - PREMIUM CHARTS
(Charts Prepared by : Gulshan Rai, Asstt. Manager, UIIC, DO AGRA, Mobile : 9868338009, Email : gulshanrai@uiic.co.in)

OMP - PREMIUM RATE CHART - BUSINESS & HOLIDAY GST EXTRA OMP - PREMIUM RATE CHART - BUSINESS & HOLIDAY GST EXTRA
PLAN A-1 (EXCLUDING USA/CANADA) SUM INSURED US $ 50,000 PLAN A-2 (EXCLUDING USA/CANADA) SUM INSURED US $ 1,00,000
AGE GROUP 160% 175% 200% AGE GROUP 160% 175% 200%
6 Months- 51-55 56-60 61-65 6 Months- 41-50 51-55 56-60 61-65
Days of Travel 41-50 Yrs. 66-70 Yrs. 71-75 Yrs. Days of Travel 66-70 Yrs. 71-75 Yrs.
40 yrs Yrs. Yrs. Yrs. 40 yrs Yrs. Yrs. Yrs. Yrs.
1 - 4 days 336 380 393 399 639 699 799 1 - 4 days 436 463 508 534 854 934 1067
5 - 7 days 381 402 432 456 729 797 911 5 - 7 days 484 504 522 544 870 951 1048
8-14 days 495 633 642 661 1057 1156 1321 8-14 days 599 661 691 729 1166 1276 1458
15-21 days 601 643 691 714 1143 1250 1428 15-21 days 638 696 745 785 1256 1374 1570
22-28 days 683 724 740 792 1268 1386 1584 22-28 days 734 804 823 876 1401 1532 1751
29-35 days 767 841 908 914 1462 1599 1828 29-35 days 894 908 978 1005 1609 1760 2011
36-47 days 851 995 1005 1096 1754 1918 2192 36-47 days 1026 1162 1181 1236 1977 2163 2472
48-60 days 1054 1099 1240 1358 2174 2377 2717 48-60 days 1119 1253 1271 1410 2256 2468 2820
61-75 days 1440 1527 1613 1639 2622 2868 3278 61-75 days 1512 1619 1730 1907 3050 3336 3813
76-90 days 1802 1821 1985 2016 3226 3529 4033 76-90 days 1911 2163 2366 2450 3920 4288 4900
91-120 day 2270 2424 2619 2721 4353 4761 5441 91-120 day 2622 2720 3074 3345 5352 5853 6690
121-150 days 2601 2638 2816 2984 4774 5221 5967 121-150 days 3187 3541 3930 4280 6849 7491 8561
151-180 days 3188 3544 3878 3903 6245 6830 7806 151-180 days 4000 4456 4758 5180 8287 9064 10359

OMP - PREMIUM RATE CHART - BUSINESS & HOLIDAY GST EXTRA OMP - PREMIUM RATE CHART - BUSINESS & HOLIDAY & CFT GST EXTRA
PLAN A-3 (EXCLUDING USA/CANADA) SUM INSURED US $ 2,50,000 PLAN B-1 (INCLUDING USA/CANADA) SUM INSURED US $ 50,000
AGE GROUP 160% 175% 200% AGE GROUP 160% 175% 200%
6 Months- 51-55 56-60 61-65 6 Months- 41-50 51-55 56-60 61-65
Days of Travel 41-50 Yrs. 66-70 Yrs. 71-75 Yrs. Days of Travel 66-70 Yrs. 71-75 Yrs.
40 yrs Yrs. Yrs. Yrs. 40 yrs Yrs. Yrs. Yrs. Yrs.
1 - 4 days 522 534 540 563 900 985 1125 1 - 4 days 544 653 667 685 1096 1199 1370
5 - 7 days 550 583 602 617 987 1080 1234 5 - 7 days 617 690 699 717 1147 1255 1434
8-14 days 629 720 769 789 1263 1382 1579 8-14 days 880 951 962 980 1568 1715 1960
15-21 days 679 761 819 853 1365 1493 1706 15-21 days 944 1078 1087 1094 1751 1915 2189
22-28 days 786 850 897 908 1453 1590 1817 22-28 days 1089 1221 1235 1248 1996 2184 2495
29-35 days 908 914 1072 1145 1832 2004 2290 29-35 days 1343 1588 1593 1597 2555 2795 3194
36-47 days 1099 1199 1240 1280 2049 2241 2561 36-47 days 1588 1819 1822 1824 2918 3192 3648
48-60 days 1268 1347 1444 1457 2332 2550 2915 48-60 days 2160 2909 2931 2945 4711 5153 5889
61-75 days 1722 1790 1982 2116 3386 3703 4232 61-75 days 3176 4263 4270 4283 6853 7495 8566
76-90 days 2007 2462 2710 2800 4481 4901 5601 76-90 days 3819 5174 5183 5191 8305 9083 10381
91-120 day 2902 3730 3922 4091 6545 7159 8181 91-120 day 4581 6125 6134 6143 9829 10751 12287
121-150 days 3524 4413 4981 5141 8225 8996 10281 121-150 days 5352 6987 7001 7015 11223 12275 14029
151-180 days 5092 5246 5992 6143 9829 10751 12287 151-180 days 6263 7710 7731 7742 12388 13549 15485

OMP - PREMIUM RATE CHART - BUSINESS & HOLIDAY GST EXTRA OMP - PREMIUM RATE CHART - BUSINESS & HOLIDAY & CFT GST EXTRA
PLAN B-2 (INCLUDING USA/CANADA) SUM INSURED US $ 1,00,000 PLAN B-3 (INCLUDING USA/CANADA) SUM INSURED US $ 2,50,000
AGE GROUP 160% 175% 200% AGE GROUP 160% 175% 200%
6 Months- 51-55 56-60 61-65 6 Months- 41-50 51-55 56-60 61-65
Days of Travel 41-50 Yrs. 66-70 Yrs. 71-75 Yrs. Days of Travel 66-70 Yrs. 71-75 Yrs.
40 yrs Yrs. Yrs. Yrs. 40 yrs Yrs. Yrs. Yrs. Yrs.
1 - 4 days 699 727 811 820 1313 1436 1641 1 - 4 days 717 746 824 848 1356 1483 1695
5 - 7 days 726 770 846 899 1439 1574 1799 5 - 7 days 780 818 903 917 1468 1605 1835
8-14 days 953 1082 1092 1191 1905 2083 2381 8-14 days 999 1176 1196 1261 2018 2207 2523
15-21 days 1039 1213 1301 1393 2229 2438 2786 15-21 days 1077 1277 1391 1442 2307 2523 2884
22-28 days 1111 1390 1611 1697 2715 2970 3394 22-28 days 1178 1483 1726 1751 2802 3065 3503
29-35 days 1439 1789 1866 1901 3042 3327 3802 29-35 days 1451 1821 1987 1999 3199 3498 3998
36-47 days 1783 2142 2335 2421 3874 4237 4842 36-47 days 1805 2325 2487 2543 4068 4450 5085
48-60 days 2423 336 3397 3511 5617 6144 7022 48-60 days 2724 3542 3632 3795 6072 6641 7590
61-75 days 3543 5240 5381 5410 8656 9468 10820 61-75 days 3901 5551 5642 5736 9177 10038 11472
76-90 days 4393 5419 5491 5652 9044 9892 11305 76-90 days 4708 5637 5789 5828 9324 10198 11655
91-120 day 5899 6999 7076 7197 11515 12595 14394 91-120 day 6280 7396 7877 8470 13552 14823 16940
121-150 days 6914 7820 8908 9950 15920 17413 19900 121-150 days 7975 8801 9974 10073 16116 17627 20145
151-180 days 8817 9534 11687 11701 18721 20476 23401 151-180 days 9873 9991 11724 11815 18904 20676 23630

OMP - PREMIUM RATE CHART - BUSINESS & HOLIDAY GST EXTRA OMP - PREMIUM RATE CHART - CFT WORLDWIDE GST EXTRA
PLAN B-4 (INCLUDING USA/CANADA) SUM INSURED US $ 5,00,000 PLAN E-1 CFT WORLDWIDE SUM INSURED US $ 1,00,000
AGE GROUP 160% 175% 200% AGE GROUP

6 Months- 51-55 56-60 61-65 18 Yrs 41-60

Days of Travel 41-50 Yrs. 66-70 Yrs. 71-75 Yrs. Days of Travel 61-70 Yrs.
40 yrs Yrs. Yrs. Yrs. to 40 yrs Yrs.
1 - 4 days 996 1550 1634 1655 2648 2897 3310 Annual 2800 3850 7172
5 - 7 days 1107 1603 1667 1693 2709 2963 3387
8-14 days 1171 1705 1732 1816 2905 3178 3632
15-21 days 1265 1790 1869 1907 3050 3336 3813 OMP - PREMIUM RATE CHART - CFT WORLDWIDE GST EXTRA
22-28 days 1453 1869 1961 2147 3435 3757 4294 PLAN E-2 CFT WORLDWIDE SUM INSURED US $ 5,00,000
29-35 days 1788 2487 2601 2633 4213 4608 5267 AGE GROUP
18 Yrs
Days of 41-60 61-70
36-47 days 2096 2840 3145 3178 5085 5561 6356 to 40
Travel Yrs. Yrs.
yrs
48-60 days 3437 4229 5342 5429 8687 9501 10858 Annual 4230 4750 8180
61-75 days 5036 5744 6342 8083 12932 14145 16165
76-90 days 6091 7906 9068 9261 14818 16207 18523 NB: Pre-Acceptance Health Check-up is waived upto the age of 70 Years for all slabs of
91-120 day 7348 9798 10990 12078 19325 21137 24156 Sum Insured (Max. US $ 5,00,000)
121-150 days 8864 12670 13818 15162 24258 26533 30323
151-180 days 11366 15961 18232 19111 30577 33444 38221 In case of age > 75 Years, the proposal should sent to RO for approval with loading