| 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
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| 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. |
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| 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
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| d. | Pre Existing Coverage | After 4 consecutive years of policy being renewed on time | ||||||||||||
| 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:
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| 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.
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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).
Review Oriental Individual Mediclaim Insurance insurance brochure to understand coverage details.
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Review Oriental Individual Mediclaim Insurance insurance policy wordings which explains the terms and conditions.
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