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Oriental Oriental Happy Family Floater insuranceThe Policy covers reasonable and customary charges in respect of Hospitalisation and / or Domiciliary Hospitalisation for medically necessary treatment only for Illnesses / diseases contracted / suffered or Injury sustained by the Insured Person(s) during the Policy Period, upto the limit of Sum Insured, as detailed in the Policy Terms and conditions. The benefits under this Policy are available under three plans, viz Silver, Gold & Diamond as opted by the Insured in the proposal form.
The Policy covers reasonable and customary charges in respect of Hospitalisation and / or Domiciliary Hospitalisation for medically necessary treatment only for Illnesses / diseases contracted / suffered or Injury sustained by the Insured Person(s) during the Policy Period, upto the limit of Sum Insured, as detailed below:
Rs 100,000 - 20,00,000
99.48%
108.80%
1,250,812
30,325,000
4,300+ hospitals
Self, Spouse + dependent (children + parents)
1 year
* As per IRDAI report for 2020-21 | ** As per NL25 data published on the Insurance Company website
| Name | Corona Rakshak Policy, Oriental insurance |
|---|---|
| Product Type | Individual/ Floater |
| Category of Cover | Benefit based |
| Sum insured | Rs 50,000/- (Fifty Thousand) to2,50,000 (Two and half Lakh) (in the multiples of fifty thousand) |
| Policy Period | Three and half months (3 ½ months), six and half months (6 ½ months) and nine and half months (9 ½ months) i.e, 105 days, 195 days and 285 days respectively. |
| Eligibility | Policy can be availed by persons between the age of 18 years and 65 years. Proposer with higher age can obtain policy for adult members of the family, without covering self. |
| Coverage | COVID Cover:Lump sum benefit equal to 100% of the Sum Insured shall be payable on positive diagnosis of COVID, requiring hospitalization for a minimum continuous period of 72 hours. The positive diagnosis of COVID shall be from a government authorized diagnostic centre |
| Sl No | Type of Claim | Prescribed Time limit |
|---|---|---|
| 1. | COVID Cover | Within thirty days of date of discharge from hospital following positive diagnosis for COVID. |
Documents to be submitted for claim:
The claim is to be supported with the following documents and submitted within the prescribed time limit.
Covid-19 CoverThe Company shall not be liable to make any payment under the policy, in respect of any expenses incurred in connection with or in respect of:
The role of TPA begins after policy issuance by insurance company.
The entire process followed in current TPA allocation exercise was duly uploaded on company’s portal and was kept in public domain for any representation, observation, grievance and objection for redressal by specially constituted Appellate Committee. You can access the notice on the noted url: url
A claim is registered, processed and finally paid within 30 days of the receipt of the last necessary document by the TPA/Insurer, as per terms and conditions of the policy. Exception is made for settlement and final payment for 45 days in case a claim warrants an investigation.
Insurance companies have tie-up arrangements with several hospitals which are called network hospitals. Under a health insurance policy, a policyholder can take treatment in any of the network hospitals without having to pay the hospital bills as the payment is made to the hospital directly by the insurance company. TPA helps in organizing cashless treatment to the member. However, expenses beyond the limits or sub-limits as per terms and conditions of the insurance policy or expenses not covered under the policy have to be paid by customer directly to the hospital. Preauthorization, however, is not available if treatment is taken in a nonnetwork hospital.
Preauthorization is facilitated by TPA at network Hospitals.
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