Incurred Claim Date*

Paid Claims*

Outstanding Claims*

Incurred Claim*

Policy Run Days*

Premium Paid at Inception*

Premium as on Date*

Earned Premium*

Annualised Claims*

Incurred Claims Ratio(%) *

Earned Claims Ratio(%) *

Formulas:
1. Incurred Claims = Paid Claims + Outstanding Claims
2. Policy Run Days = Incurred Claim Date - Policy Start Date + 1
3. Earned Premium = (Premium as on Date / 365) × Policy Run Days
4. Annualised Claims = (Incurred Claims / Policy Run Days) × 365
5. Incurred Claim Ratio = Incurred Claims / Premium as on Date
6. Earned Claims Ratio = Annualised Claims / Premium as on Date

Proposed Insurer

Proposed TPA

No of Employees at Inception *

No of Dependents at Inception *

Total Lives at Inception *

No of Employees at Expiry

No of Dependents at Expiry

Total Lives at Expiry

No of Employees at Renewal

No of Dependents at Renewal

Total Lives at Renewal