Premium Table
                           Activ Assure
    Health Insurance
    Aditya Birla Health Insurance Co. Limited
    (A subsidiary of Aditya Birla Capital Ltd.)
      Health Insurance
      Aditya Birla Health Insurance Co. Limited
      (A subsidiary of Aditya Birla Capital Ltd.)
   Activ Assure - Premium Including GST
    Index
      Sr. No.                                                                               Page No.
                Table
      1         Gross Premium including GST -  Individual - Diamond Plan                    3
      2         Gross Premium including GST -  2 Adults - Diamond Plan                      3
      3         Gross Premium including GST -  2 Adults + 1 Child - Diamond Plan            4
      4         Gross Premium including GST -  2 Adults + 2 Children - Diamond Plan         4
      5         Gross Premium including GST -  2 Adults + 3 Children - Diamond Plan         5
      6         Gross Premium including GST -  2 Adults + 4 Children - Diamond Plan         5
      7         Gross Premium including GST -  1 Adult + 1 Child - Diamond Plan             6
      8         Gross Premium including GST -  1 Adult + 2 Children - Diamond Plan          6
      9         Gross Premium including GST -  1 Adult + 3 Children - Diamond Plan          7
      10        Gross Premium including GST -  1 Adult + 4 Children - Diamond Plan          7
      11        Optional Benefits                                                           8
      12        Discount & Loading                                                          9
                                                            Gross Premium including GST -  Individual - Diamond Plan
                                                                                       Sum Insured
   Age Band
               2 Lac    3 Lac     4 Lac     5 Lac     7 Lac     10 Lac    15 Lac    20 Lac    25 Lac     30 Lac     40 Lac      50 Lac      75 Lac      100 Lac    150 Lac      200 Lac
   5-24         3,439    3,887     4,457    5,197      5,781    6,387     8,193     8,655    9,036      10,194      12,520      13,689      15,305      17,080      18,231      20,237 
   25-35        4,058    4,641     5,382    6,371      7,123    7,919     10,153    10,746   11,245    12,751       15,772      17,286      19,384      21,364      22,862      25,465 
   36-40        4,589    5,284     6,171    7,366      8,263    9,216     11,811    12,522   13,119    14,921       18,531      20,336      22,849      24,998      26,787      29,907 
   41-45        5,170    5,989     7,038    8,451      9,507    10,628    13,624    14,459   15,160    17,285       21,537      23,664      26,622      28,963      31,072      34,740 
   46-50        7,692    9,040     10,775    13,118    14,857    16,709    21,408    22,787   23,941    27,444      34,469      37,974      42,851      46,008      49,481      55,538 
   51-55        9,062    10,706    12,814    15,697    17,815    20,066    25,708    27,379   28,783    33,055      41,604      45,866      51,800      55,408      59,632      66,997 
   56-60        11,107   13,183    15,852    19,522    22,197    25,042    32,079    34,197   35,964    41,369      52,190      57,575      65,068      69,341      74,687      84,011 
                13,493   16,054    19,343    23,756    27,062    30,578    39,171    41,791   43,978    50,649      63,991      70,640      79,896      84,926      91,521      103,028 
   61-65
                18,544   22,172    26,830    33,091    37,766    42,740    54,746    58,444   61,543    70,981      89,856      99,260      112,361    119,015    128,344    144,629 
   66-70
                23,207   27,847    33,809    42,038    48,014    54,360    69,608    74,329   78,272    90,348      114,501    126,515    143,251    151,444    163,362    184,170 
   71-75
                30,582   36,802    44,805    56,026    64,020    72,529    92,854    99,161   104,441   120,643    153,031    169,129    191,559    202,161    218,097    245,996
   75+
                                                             Gross Premium including GST -  2 Adults - Diamond Plan
                                                                                       Sum Insured
   Age Band
               2 Lac    3 Lac     4 Lac     5 Lac     7 Lac     10 Lac    15 Lac    20 Lac    25 Lac     30 Lac     40 Lac      50 Lac      75 Lac      100 Lac    150 Lac      200 Lac
   18-24        5,625    6,065     6,689    8,156    9,608      10,527    14,740    15,464    16,031    18,145      22,266      24,344      27,219      30,375      32,423      35,992 
   25-35        6,006    6,845     7,915    9,520    10,570    11,916    16,543    17,445    18,091    20,454       25,161      27,575      30,922      34,081      36,471      40,623 
   36-40        6,881    7,880     9,159    11,082    12,357    13,713    19,274    20,363    21,148    24,011      29,682      36,579      41,099      44,966      48,183      53,796 
   41-45        7,584    8,741     10,224    12,421    13,895    15,460    20,986    23,012    23,933    27,245     33,795      38,601      43,423      47,245      50,685      56,668 
   46-50        12,287   14,387    17,076    20,354    23,716    26,561    34,655    37,167    38,753    44,454     56,207      62,411      70,427      75,615      81,322      91,279 
   51-55        14,802   17,444    20,816    25,561    29,069    32,644    42,552    45,233    47,219    54,333     68,695      75,904      85,724      91,694      98,685      110,873 
   56-60        17,752   21,028    25,225    31,391    35,742    40,229    52,350    55,723    58,353    67,299     85,192      95,801      108,270    115,379    124,274    139,792 
                21,118   25,315    30,451    35,262    42,774    49,400    62,692    66,809    71,234    80,794     102,319    115,589    130,734    138,965    149,757    168,585 
   61-65
                31,379   37,571    45,424    56,044    63,987    72,958    93,762    100,036   104,464   120,987    153,310    172,476    195,239    206,803    223,014    251,310 
   66-70
                37,864   47,580    57,733    71,796    82,006    92,193    120,113   128,198   132,212   155,653    197,342    221,009    250,245    264,556    285,377    321,726 
   71-75
                49,310   62,959    76,609    95,794    108,036   117,248   158,784   164,578   168,379   207,053    262,706    294,518    333,578    352,040    379,793    428,374
   75+
                                                       Gross Premium including GST -  2 Adults + 1 Child - Diamond Plan
                                                                                       Sum Insured
   Age Band
               2 Lac    3 Lac     4 Lac     5 Lac     7 Lac     10 Lac    15 Lac    20 Lac    25 Lac     30 Lac     40 Lac      50 Lac      75 Lac      100 Lac    150 Lac      200 Lac
   18-24        7,488    8,290     9,524    11,273    12,869    14,334    18,751    19,745    20,930    23,072      28,500      30,881      34,529      38,531      41,129      45,657 
   25-35        7,584    8,666     10,034   11,865    13,742    15,758    19,628    21,377    22,778    24,989      30,853      33,815      37,919      41,792      44,723      49,814 
   36-40        9,059    10,403    12,104   14,436    16,771    18,824    23,767    26,192    27,935    30,739      38,102      45,770      51,426      56,265      60,291      67,314 
   41-45        9,514    10,986    12,848   15,432    17,967    20,196    23,855    28,407    30,332    33,408      41,503      46,856      52,709      57,348      61,524      68,786 
   46-50        14,318   16,780    19,925   22,785    28,717    30,368    38,417    44,308    47,360    52,302      65,318      72,908      82,272      88,334      95,001      106,632 
   51-55        17,150   20,222    24,125   28,905    34,981    38,983    49,545    53,540    57,273    63,428      79,426      87,095      98,363      105,214    113,234    127,220 
   56-60        20,066   23,772    28,496   34,325    41,912    47,284    59,978    64,106    68,846    76,425      96,055      107,040    120,973    128,916    138,854    156,192 
                23,029   27,581    33,150   37,465    48,395    53,789    67,373    73,939    80,864    88,316      111,334    125,190    141,594    150,508    162,196    182,587 
   61-65
                33,743   40,389    48,795   60,321    71,468    81,170    101,757   109,026   117,039   130,213    164,548    185,159    209,596    222,010    239,413    269,790 
   66-70
                41,851   52,583    63,761   79,406    94,175    102,364   133,849   145,356   147,646   172,087    217,740    244,335    276,658    292,480    315,499    355,684 
   71-75
                54,681   69,321    84,303   105,533   119,872   130,403   176,683   183,310   188,156   229,128    290,269    324,583    367,631    387,977    418,562    472,104
   75+
                                                     Gross Premium including GST -  2 Adults + 2 Children - Diamond Plan
                                                                                       Sum Insured
   Age Band
               2 Lac    3 Lac     4 Lac     5 Lac     7 Lac     10 Lac    15 Lac    20 Lac    25 Lac     30 Lac     40 Lac      50 Lac      75 Lac      100 Lac    150 Lac      200 Lac
   18-24        9,816    10,870    12,482   14,630    16,577    18,683    24,136    25,435    26,981    29,830      36,784      38,750      43,326      48,349      51,610      57,291 
   25-35        10,189   10,965    12,705   14,867    17,086    19,331    25,819    26,329    27,812    30,919      38,263      41,937      47,026      51,829      55,465      61,779 
   36-40        10,562   12,150    14,148   16,713    19,259    21,848    27,500    29,871    31,577    35,186      43,692      51,578      57,951      63,405      67,940      75,855 
   41-45        10,965   12,677    14,826   17,665    20,384    23,144    27,646    32,148    34,011    37,893      47,126      52,764      59,356      64,579      69,280      77,458 
   46-50        16,644   19,269    23,192   26,057    31,728    33,962    42,989    51,987    55,005    61,234      75,802      84,929      95,837      102,897    110,664    124,212 
   51-55        19,500   22,998    27,433   32,379    39,349    42,993    54,594    61,389    64,982    72,525      90,159      98,287      111,003    118,733    127,785    143,569 
   56-60        22,516   26,677    31,961   37,789    46,479    50,994    65,381    72,364    76,948    86,072      107,560    118,984    134,471    143,300    154,348    173,620 
                25,337   29,598    36,421   40,265    52,629    56,992    71,586    81,683    88,463    97,371      122,271    136,936    154,880    164,630    177,414    199,720 
   61-65
                35,467   42,443    51,242   63,451    74,312    86,076    107,358   114,946   122,941   136,969    172,656    194,321    219,967    232,995    251,259    283,139 
   66-70
                44,820   55,416    67,155   83,745    99,198    110,322   141,486   151,575   159,845   181,423    229,123    257,583    291,658    308,338    332,604    374,969 
   71-75
                58,500   72,801    88,485   110,884   130,182  140,416   187,266   200,684   203,956   240,627    304,396    341,164    386,409    407,796    439,943    496,221
   75+