WBSAMB / CEO / 62 / 2025 - 26

Providing Family floater medical group health insurance for 694 Nos of employees and 1972 nos Dependent (Spouse+ Parents+Children (maximum Two nos)) are to be covered policy with cashless facility covering .Rs. 7,50,000.00 / per family including critical illnesses, pre-existing conditions, etc and also provide the Premium of the Policy for one insured family in Rupees ......

1- Family Floater:- Self+ Spouse+ Parents+ Dependent Children up to age of 30 years (Dependent children (maximum Two nos) with any kind of disability should be covered on providing the supporting document for the same) 2- Pre-existing diseases to be covered from day one 3- Pre & Post Hospitalization: 30 days pre-hospitalization and 60 days post-hospitalization. 4. No Sub-limit, Capping or Co-payment on any type of illness/surgery, including Robotic surgery. 5- Room rent ceiling will be 1% of the sum Insured & for ICU 2% of the sum Insured. 6. Ambulance Charges: Up to ₹2,500/- per hospitalization for emergency transportation. 7- Day Care Treatments: To be covered. 8. OPD (Domiciliary Treatment)- to be covered with the following terms and conditions: Medical expenses incurred in case of the any diseases which need domiciliary treatment as may be certified by the attending medical practitioner and/or medical officer shall be deemed as hospitalisation expenses and reimbursed to the extent of 100% subject to the overall limit of OPD limit as Rs. 30,000/- (excluding GST) excluding Sum Insured limit per family [primary member] 9. Animal Bite Claims: Payable even without hospitalization, as per IRDAI guidelines.

10. No Age Limit for dependent parents for existing employees as well as new entrants also. 11. Cashless Hospitalization Facility as per SBD 13. Pan-India Coverage: No deduction on approved claim amount due to geographical limits, as employees are located across India. 14. Coverage of All Diseases and related surgeries including viral diseases, except cosmetic surgery and gender change treatments. 15. Critical Illness Coverage. 16. Coverage of Non-Medical Expenses. 17. Corona Coverage. 18. Cataract surgery sublimit not applicable. 19. Maternity benefit up to ₹75,000/- with waiver of 09 months waiting period for maternity benefit. 20. Baby cover from day one & expenses covered with in maternity limits 21. External TPA is mandatory to run the policy. 22. Weekly Help Desk to be conduct by provider at Head Office. 23. Introduction of single point of contact by the provider who will be coordinate with Hospital, Insured and Insurer throughout the claim journey (Cashless and Reimbursement) Claims

The regular employees and their dependent family members of West Bengal State Agricultural Marketing Board and 18 Zilla Regulated Market Committees (ZRMCs) / 4 Regulated Market Committees (RMCs) of West Bengal

Category A :- Age Group (0 year to 25 year)

Category B :- Age Group (26 year to 45 year)

Category C :- Age Group (46 year to 55 year)

Category D :- Age Group (56 year to 65 year)

Category E :- Age Group (66 year to 75 year)

Category F :- Age Group (76 year to 85 year)

Category G :- Age Group (86 & Above)