Oriental Insurance Plans

Oriental Individual Mediclaim Insurance

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The policy covers reasonable and customary charges in respect of Hospitalisation and / or Domiciliary Hospitalisation for medically necessary treatment only for illness / diseases contracted or injury sustained by the Insured Person(s) during the policy period, upto the limit of Sum Insured (SI)

Key features of Oriental Individual Mediclaim Insurance plan

  • Room Rent: Covered upto 1% of Sum Insured as a daily limit.
  • Co - pay: Option of Voluntary Copay of 10% or 20% with premium reduction.
  • Restoration Benefit: NIL Restoration benefit.

Oriental Health Insurance Review

Oriental Health Insurance
Oriental Health Insurance sum insured
1 lac − 20 lacs options available
Incurred Claims Ratio *
108.80%
Oriental Health Insurance tenure options
1 year
Claims Settlement Ratio **
99.48%
List of network hospitals
4,300+ hospitals
Number of policies issued *
1,250,812
Maximum family floater coverage
Self, Spouse + dependent (children + parent)
Number of lives covered *
30,325,000
* As per IRDAI report for 2018-19   |   ** As per NL25 data published on the Insurance Company website
Oriental health insurance is a popular health insurance among Indians with the option of availing quality treatment at more than 4300+ leading hospitals across the country. They have an incurred claims ratio of 108.00%, and also covered 303.25 lac lives during the same year 2018-19, as per the data provided by IRDAI.
Why Should One insure themselves through Oriental Insurance Health Insurance plans?
  • Wide Range Of Health Insurance Products From Individual Plans to Family Floater Schemes with Sum Insureds ranging from ₹1 lacs to ₹20 lacs.
  • Covers Hospitalisation Treatment including coverage for Covid 19 Expenses.
  • Tax benefit: Premium paid by any mode other than cash is eligible for tax relief as provided under Section 80-D of the Income Tax Act.
Oriental Insurance Health Insurance is today one of the leading Government Owned general insurance players in India with a lot of focus on both retail and group insurance products. Today the Oriental Insurance health insurance premium is one of the most competitive in the market across all their plans apart from being competitive in their benefit structure. They are also one of the players who have built a strong hospital network across India with a current strength of 4,300+ and growing. Most of the customer’s Oriental Insurance health insurance reviews have been positively influencing the growth of their business year on year.

Oriental Individual Mediclaim Insurance benefits

  • Salient Features
  • Benefits
  • Eligibility Criteria

Salient Features Oriental Individual Mediclaim Insurance

  • Maximum Entry age for any member, is 65years however, this can be extended upto 70 years. In such case, an additional premium of 10% (including on all future renewals) will be charged on applicable rates, including on Optional PA cover
  • Lifelong renewals allowed
  • Family discount of 10% (including on PA cover) if more than one person is covered under the policy
  • Option of voluntary co-payment of 10% / 20% with corresponding premium discount of 10% and 20% respectively on SI of ₹.2.00 lacs and above. Voluntary co-payment does not apply on PA section
  • In case of fresh covers, 50% of the Pre-insurance medical check-up cost reimbursable, subject to acceptance of the Proposal

Benefits of Oriental Individual Mediclaim insurance policy.

Hospitalisation Benefits
Expenses covered Limits of Covered Expense
a. Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing Home Not exceeding 1 % of the Sum Insured per day
b. Intensive Care Unit (ICU) expenses as provided by the Hospital/Nursing Home Not exceeding 2% of Sum Insured per day
Note : Number of days of stay under ‘a’ and ‘b’ above should not exceed total number of days of admission in the hospital. Admissibility of all related expenses (c and d), except for medicine / pharmacy bills and body implants, shall also be as per the entitled category vis-à-vis room rent.
c. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees As per the limits of the sum insured
d. Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances. Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, cost of prosthetic devices like Pacemaker implanted during surgical procedures, relevant laboratory / diagnostic tests, X-ray, and similar expenses As per the limits of the sum insured
e. Ambulance service charges Rs.2,000/- OR 1% of the sum insured whichever is less per hospitalization subject to aggregate expenses not exceeding Rs. 4000/- under the policy
f. Daily Hospital Cash Allowance 0.1% of the sum insured per day subject to maximum of 6 days per insured person during the entire policy period. Deductible of 2 days shall apply for each hospitalization.
Pre and Post hospitalization expenses Medical expenses incurred 30 days prior to hospitalisation and upto 60 days post hospitalisation
a. In case of Ayurvedic / Homeopathic / Unani treatment, Hospitalisation expenses are admissible only when the treatment is taken as an in-patient, in a Government Hospital or a hospital associated with a Medical College.
b. Relaxation to 24 hours minimum duration for hospitalization as defined below, is allowed in
  • Day care procedures / surgeries (specified in the policy) where such treatment is taken by an insured person in a hospital / day care centre (but not the outpatient department of a hospital)
  • Or any other day care treatment as mentioned in clause 3.5 and for which prior approval from Company / TPA is obtained in writing.
Domestic Hospitalisation **
a. Surgeon, Medical Practitioner, Consultants, Specialists Fees, Blood, Oxygen, Surgical Appliances, Medicines & Drugs, Diagnostic Material and Dialysis, Chemotherapy, Nursing expenses. 20% of the Sum Insured subject to maximum Rs.50,000 per Insured person during the entire policy period.
b. Treatment for Dog bite (or bite of any other rabid animal like monkey, cat, etc.) Maximum Rs.5,000 per incident, actually incurred on immunisation injections. This will be part of Domiciliary hospitalisation limits as given above.

For the purpose of this section the conditions for domiciliary hospitalisation benefit shall not apply.
Other Coverages / Benefits
a. Donor Expenses (under Hospitalisation Expenses) Hospitalisation expenses incurred for donating an organ by the donor (excluding cost of organ) to the insured person, during the course of organ transplant, will also be payable. However, overall liability of the Company will be limited to the Sum Insured of the insured person.
b. Voluntary Co pay (Optional) i. If the insured opts for a co-payment of 10% or 20%, he is eligible for a corresponding premium discount of 10% and 20% respectively. This option is available only for insured person(s) having Sum Insured of Rs 2 lacs and above. Co-payment cannot be opted on selective basis. All insured persons under a policy have to compulsorily opt for the same (except for insured persons with Sum Insured below Rs.2lacs, where co-payment option is not available.), and the co-payment percentage has to be uniform across all insured persons. ii. Co-payment is applicable on each and every claim, which means the insured shall bear 10% / 20% (as opted by him) of each and every admissible claim.
c. Personal Accident (PA) covering death and permanent disability (50% & 100%) – Optional Cover subject to Additional premium Sum Insured in multiples of Rs. 2,00,000 upto Rs. 10,00,000 per insured person above 18yrs.

However for persons below 18 years of age maximum coverage of Rs.4 lacs is allowed
Benefits covered under PA Amount payable
Accidental Death 100 % of CSI
Loss of two entire limbs, or sight of two eyes or one entire limb and sight of one eye 100 % of CSI
Loss of one entire limb or Sight of one eye 50 % of CSI
Permanent Total Disablement resulting in totally and absolutely disabling the person insured from engaging in any employment or occupation whatsoever 100 % of CSI
The overall liability in the event of one or more of the eventualities (listed above) occurring shall be restricted to the CSI.
d. Pre Existing Coverage After 4 consecutive years of policy being renewed on time

Eligibility Criteria of Oriental Individual Mediclaim Insurance

Eligibility Criteria
Policy Term 12 months
Age of Insured Between the age of 18 to 65 years for treatment taken in India
Sum Insured (₹) Minimum sum insured is ₹ 1,00,000 and thereafter in multiples of ₹50,000 thereafter, up to ₹ 5,00,000 / 6,00,000 / 7,00,000 / 8,00,000 / 9,00,000 / 10,00,000
Pre Policy Medical Check Up No medical examination for persons upto the age of 55 years
Free Look Period A period of 15 days from the date of receipt of the policy to review the terms and conditions of the policy and return the same, if not acceptable.
Grace Period 30 days is allowed for payment of renewal premium
Family Definition Family consists of the proposer and any one or more of the family members as mentioned below:
  • Legally wedded spouse
  • dependent Children (i.e. natural or legally adopted) between the age 3months to 18 years. However male child can be covered upto the age of 25 years if he is a bonafide regular student and financially dependent on the proposer. Female child can be covered until she gets married. Divorced and widowed daughters, are also eligible for coverage under the policy, irrespective of age. If the child above 18 years is financially independent or if the girl child is married, he or she shall be ineligible for coverage in the subsequent renewals.
  • Parents / Parents-in-law (either of them). (iv) Unmarried siblings, if financially dependent on the proposer.
Pre Policy Health Check up Any person beyond 55 years of age proposing to take insurance cover has to submit following medical reports from listed Diagnostic Centre or any other medical report(s) required by the company in case of fresh proposal or in case of renewal where there is a break in policy period. The cost shall be borne by the insured.
  • Physical Examination
  • Urine(Microalbumin Urea)
  • Glycocylated Haemoglobin
  • Ultrasonography (Whole Abdomen And Pelvis)
  • X Ray Both Knees (Anteposterior And Latrel)
  • Complete Eye Test Including Fundus Etc
  • Stress Test (Tmt)

Oriental Insurance Health Insurance FAQ’s

The premium paid on a health insurance policy is eligible for deduction under Section 80D of the Income Tax Act. So save with your policy now!

A deductible is a cost-sharing requirement. It states that the insurer will not be liable for a specified amount in case of indemnity policies. This is applicable for a specified number of days/hours in case of hospital cash policies which apply before any benefits are payable by the insurer. Remember that a deductible does not reduce your sum insured.

In planned hospitalization the treatment is planned well in advance. The intimation of such hospitalization and authorization from us has to be taken minimum 3 days prior to the date of hospitalization. E.g. Cataract, pace maker implantation, total knee replacement etc are examples for which the hospitalisation can be planned.The insured person should at least 3 days prior to admission to the hospital approach the network provider for hospitalization for medical treatment.

In emergency hospitalization the patient is admitted to the hospital in an emergency situation, for e.g. Severe abdominal pain, accident, heart attack etc. In such event, we should be intimated within 48 hours of admission to the hospital.

You should carry the health card provided by the company with this policy, along with a valid photo identification proof (voter id card / driving license / passport / pan card / any other identity proof as approved by the company).

Brochure

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Proposal form

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Policy wordings

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CIN: U66000KA2018PTC117713 | IRDAI Web aggregator License Code Number: IRDAI / INT / WBA /53/ 2018, Valid till 07/08/2022
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