Oriental Health Insurance

Oriental Health Insurance
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About Oriental Health Insurance

Oriental health insurance is a part of Oriental General Insurance Co. Ltd. which promises to offer financial assistance against medical emergencies which includes hospitalization costs, health checkups, critical illness, etc. Apart from health insurance, the company deals in travel, motor, home, personal accident, business office/traders, engineering, marine, animals/ birds, aviation, agriculture, sericulture etc.

Highlights of Oriental Health Insurance Company

The Oriental Insurance company was formed at the time of independence of India i.e. in 1947 and was a subsidiary of Life Insurance Corporation of India. However, in 2003, the control of Oriental Insurance was given to the central government and from then, it started working as a public sector insurance company. Other necessary information about the company is stated below-

Number of Network Hospitals4300+
Suitability of policyAnyone (dependent child, spouse, parents, self)
Day Care Procedures116 treatments
Renewability of the PolicyLifetime
DiscountsUp to 10%-20%
Number of Offices1800+
Incurred claim ratio106.90
Pre-Policy Medical CheckupNot Required (for less than 55 years)

Table Data updated on 31-07-2020

What Are The Types of Oriental Health Insurance Plans?

To cater to the different needs of the customers, the company has come out with a wide range of health insurance plans:-

1. Oriental Super Health Top Up

A premium health insurance plan by Oriental Insurance Company that covers all the significant medical expenses associated with the required treatment.

Key Features

  • Expenses cultivating through inpatient treatment of an illness/disease are covered that generally consists- boarding room and nursing expenses during the course of treatment in a hospital/nursing home. A maximum of 1% of the deductible amount per day.
  • Transplantation of the organ in the insured’s body where coverage is reserved for in-patient hospitalization of donor and transplanting the same in the recipient body. The insured will receive 10% of the sum insured.
  • In-patient treatment at Ayurvedic, Yoga and Naturopathy, Unani, Siddha, and Homeopathic centres registered under government councils are reimbursed as per the specified limit.
  • Pre-hospitalization cost covered for 30 days before getting admitted to the hospital.
  • Post-hospitalization expenses coming after inpatient treatment are covered for 60 days after receiving discharge statements.

Eligibility Criteria

Minimum Age of entry18 years for adults
3 months for children
Maximum Age of entry65 years
Sum InsuredRs 3 lakhs to 30 lakhs
Deductibles: Rs 3 lakhs to 20 lakhs
Number members can be included6 members maximum (self, spouse, dependent children and parents)

Table Data updated on 31-07-2020

2. Pravasi Bhartiya Bima Yojana Policy

The policy is made to facilitate the people who are migrating to foreign countries for employment and have obtained a ticket for the same.

Key Features

  • In case of the death of the insured during the policy tenure in India or abroad, the plan will offer the required cover along with a sum of Rs. 10 lakhs.
  • Permanent disability arising during the period of living as an immigrant in abroad where disability resulted in the loss of employment due to the inability to engage in business activities. The company will pay Rs. 10 lakhs as compensation.
  • Hospitalisation cover for family members residing in India if the policy is taken on a floater basis. This is valid for death and disability of any member where Rs. 50,000 is a fixed amount for payment.
  • Hospitalisation of insured emigrants in an emergency on grounds of accidental injuries, sickness/disease, whether in India/any third country or in the country of employment.
  • Maternity benefits to female insured emigrants in case she conceives during the time abroad. For normal delivery, a maximum of Rs. 35,000 is provided and for caesarian operation, a maximum of Rs. 50,000.
  • The cost involved in the transportation of the deceased body of the insured (emigrant) to his home country if the death was reported from an accident. This may also include local burial.

Eligibility Criteria

Minimum Age of entry18 years for adults
3 months for children
Maximum Age of entry65 years
Sum InsuredRs 50 lakhs to 1 crore
Number members can be included6 members maximum (self, spouse, dependent children and parents)

Table Data updated on 31-07-2020

3. OBC-Oriental Mediclaim Policy

This policy contains medical benefits that become a blessing during emergencies that may make a person financially paralyzed. The OBC policy offers three options to its policyholders-

  • One Account-One Policy.
  • Multiple Accounts-One policies.
  • One Person-One Policy.

Key Features

  • Pre-hospitalisation expenses cover for the cost developing before the treatment of the illness/ injury.
  • Post-hospitalization expenses coming after getting treatment in a hospital and the issue of discharge are covered for 60 days.
  • Domiciliary hospitalization benefit where the insured can have the facility of a surgeon, medical practitioner, consultants, blood, oxygen, surgical appliances, medicines & drugs, diagnostic equipment and dialysis, chemotherapy and nursing at home.
  • AYUSH treatment facility where the insured can admit in centres of Ayurvedic, Unani, Siddha, and Homeopathic for inpatient treatment.
  • Daily Hospital Cash equal to Rs.200 per day whilst the course of hospitalization is given and up to Rs.1000 maximum can be availed once in a policy year.
  • Organ donor expenses arrived after transplantation of the organ in the recipient body is covered. Only in-patient treatment of donor(s) is included.

Eligibility Criteria

Minimum age of entry18 years for adults
3 months for children
Maximum age of entry79 years
Sum insuredRs 1 lakhs to 10 lakhs
Number members can be included6 members maximum (self, spouse, dependent children and parents)

Table Data updated on 31-07-2020

4. PNB Oriental Royal Mediclaim Insurance Policy

PNB Oriental Royal Mediclaim Insurance Policy focuses on securing the health of PNB employees and their families at an affordable rate of premium with no limitation on family inclusion. The policyholders can include their spouse, dependent child and widowed/divorced daughters.

Key Features

  • Daily hospital cash allowance is available only for the proposer of policy. The per-day limit would be Rs.200 whereas the total cash allowed is Rs.1000 in a policy period.
  • Organ donor expenses coverage for transplantation of organs where insured is the recipient. The insured must show that transplantation has been suggested by the doctor.
  • Post-hospitalization expenses that occur after getting treatment in a hospital and the issue of discharge are covered for 60 days.
  • Domiciliary hospitalization benefits where the insured can have the facility of the medical practitioner, consultants, blood, oxygen, surgical appliances, diagnostic equipment, medicines & drugs, surgeon and dialysis, chemotherapy and nursing at home.

Eligibility Criteria

Minimum Age of entry18 years for adults
3 months for children
Maximum Age of entry79 years
Sum InsuredRs 50 lakhs to 1 crore
Number members can be included6 members maximum (self, spouse, dependent children and parents)

Table Data updated on 31-07-2020

5. Mediclaim Policy (Individual & Family)

This health insurance policy is designed for individuals and their family members to wish to get promised coverage from unpredictable hospitalization and medical emergencies.

Key Features

  • Treatment taken at a licensed hospital unit or any nursing home for an illness/injury will be covered. All expenses associated with the treatment will get the required cover.
  • Pre and post hospitalization cost that occurs before and after the inpatient treatment of the same illness. For pre-hospitalization, the expenses occurring for 30 days are reimbursed whereas, for post-hospitalization, the expenses will be covered for 60 days. Insured must gather relevant evidence regarding the claim like reports, bills, etc.
  • Daily hospital cash benefit if the hospitalization exceeds more than 2 days and will be covered for 6 days maximum.
  • Under his plan, organ transplantation will be liable to get the cover. The plan will cover the organ cost along with the treatment.
  • Domiciliary hospitalisation which allows the insured to operate treatment at home only on the recommendation of a medical expert or due unavailability of the hospital bed. The insured can claim 20% of the sum insured or Rs 50,000 maximum per insured member.

Eligibility Criteria

Minimum Age of entry18 years for adults
3 months for children
Maximum Age of entry65 years
Sum InsuredRs 1 lakhs to 10 lakhs
Number members can be included6 members maximum (self, spouse, dependent children, unmarried siblings, and parents)

Table Data updated on 31-07-2020

6. Group Mediclaim Policy

TIf anybody wants to cover a target group, association, institution, corporate batch, can purchase Oriental Group Mediclaim. The cover can be bought for a group of 50 families or 50 persons or more. Also, the insured group must have one administrating person or body who can act on behalf of each member.

Key Features

  • The total value of in-patient hospitalization expenses popped up for a detected illness/injury will be covered.
  • Domiciliary hospitalization where treatment can be taken at home on the permission of a medical practitioner. The treatment must last for three days maximum to avail benefit
  • Pre-hospitalisation expenses that cover diagnostic tests, medicines, doctor consultation, etc appearing before going to a hospital are covered. Reimbursement of expenses is done for 30 days maximum ending on the date of admission.
  • Post-hospitalization costs up to 60 days are included once the insured is relieved from the treating hospital
  • Maternity expenses for the female insured members where normal child deliveries are paid out by the company.

Eligibility Criteria

Minimum Age of entry18 years for adults
3 months for children
Maximum Age of entry65 years
Sum InsuredRs 50,000 to 50 lakhs
Number members can be includedUnlimited (self, spouse, dependent children, parents, and parents-in-law)

Table Data updated on 31-07-2020

7. HOPE (Health of Privileged Elders)

Hope plan is designed to offer helpful health insurance cover to senior citizens aged 60 years and above. The plan offers coverage to specified disease only and it comes out with compulsory co-payment of 20%.

Key Features

  • The plan reimburses the cost of hospitalisation and domiciliary hospitalisation expenses for the specified diseases sustained by the insured persons. The company will settle the claim directly with the insured or the hospital.
  • The plan will also offer coverage against surgical treatment which includes treatment of an illness or injury, diagnosis and cure of diseases, correction of deformities and defects, performed in a hospital or daycare centre by an expert.
  • The plan will offer the required pre-hospitalization cover, 30 days before getting admitted to the hospital. Moreover, it also offers the needful post-hospitalisation cover under which all expenses associated with the treatment even 60 days after getting discharge will be liable to get the required cover.
  • The plan will be there to cover pre-existing diseases. The only clause is that the insured have to wait for 48 months to get the required cover.
  • The plan comes out with the cashless facility that means you can easily get the required cover at any network hospital without paying any single penny from the pocket.

Eligibility Criteria

Entry age 60 years and above
Medical examinationNo required
Sum InsuredRanges from Rs.1,00,000 to Rs.5,00,000
Co-payments20%
Policy period1 year

Table Data updated on 31-07-2020

8. Happy Family Floater Policy

Happy Family Floater Policy is for all the Indian citizens as well as SAARC country citizens who want to secure their families from future medical costs during inevitable hospitalization or medical issues.

  • Silver plan
  • Gold Plan
  • Diamond Plan

Key Features

  • In-patient hospitalization occurring during the time of treatment of any investigated illness in a hospital are covered.
  • Pre-hospitalization costs up to 30 days are given due payment on presenting valid proof such as medical reports, pharmacy bills, doctor’s certificate, diagnostic tests, etc.
  • Post-hospitalization costs are covered for a maximum of 60 days and will be settled only on submitting related reports/ bills/ tests/ doctor statements.
  • Daily hospital cash allowance up to Rs.1200 to Rs.2000 per day for the diamond plan and Rs.600 to Rs.1000 per day for a gold plan. The maximum period for which the service can be availed in the policy year is 10 days.
  • Domiciliary hospitalization coverage for the illness whose treatment exceeds 3 days of the time period and operated within the confinements of home.
  • Organ donor benefit where the insured member is the donor of the organ. Compensation equal to 10% of the sum insured is paid in a lump sum.

Eligibility Criteria

Minimum Age of entry18 years for adults
3 months for children
Maximum Age of entry65 years
Sum InsuredRs 2 lakhs to 20 lakhs
Number members can be included2 members minimum (self, spouse, dependent children, unmarried siblings, parents-in-law and parents)

Table Data updated on 31-07-2020

9. Overseas Mediclaim Policy (B&H)

Overseas Mediclaim Insurance Policy is a combination of travel insurance and health insurance that contains health benefits as well as loss/exigencies happening during travel.

Key Features

  • Sustenance of any physical injury that has visible and external traces on the body of the insured will be covered. The injury is eligible for compensation only if it has appeared from an accident. The injuries have caused the death or permanent disablement of insured
  • Loss of checked baggage like any article or property, valuable material will be incurred by the company and will pay for the total loss.
  • Any delay/respite made in scheduled delivery of checked baggage on the destination will be compensated by the Oriental Health Insurance Company. A delay must be more than 12 hours is admissible and the baggage is investigated by the international airline for a departing flight from India.
  • Loss of passport while travelling to a covered overseas destination will get coverage. The insured will receive reimbursement of real expenses incurred for acquisition of emergency travel documents as a replacement to the lost passport.

Eligibility Criteria

Minimum Age of entry18 years for adults
3 months for children
Maximum Age of entry65 years
Sum InsuredRs 50 lakhs to 1 crore
Number members can be included6 members maximum (self, spouse, dependent children and parents)

Table Data updated on 31-07-2020

10. Jan Arogya Bima Policy

The policy whose motive is to promote better health of people by providing basic medical facilities to every individual with distinguishing class and income.

Key Features

  • In-patient hospitalization covering expenses such as-
  • Loss of checked baggage like any article or property, valuable material will be incurred by the company and will pay for the total loss.
    • Boarding room expenses as provided by the hospital/nursing home.
    • Nursing expenses.
    • Surgeon, anaesthetist, medical practitioner, consultants and specialists fees.
    • Cost of a pacemaker, blood, operation theatre charges, surgical appliances, diagnostic materials and X-ray, dialysis, oxygen, chemotherapy, radiotherapy, anaesthesia, artificial limbs, medicines & drugs & cost of organs and similar expenses.
  • Pre-hospitalization costs up to 30 days are given due payment.
  • Post-hospitalization costs are covered for a maximum of 60 days and will be settled only when you submit related reports/ bills/ tests/ doctor statements.
  • Domiciliary hospitalization means medical treatment for a period exceeding three days for such illness /disease/injury which in the normal course would require care and treatment at a hospital but is actually taken while confined at home.

Eligibility Criteria

Entry age5 years to 70 years
Free look period15 days
Grace period30 days
Policy tenure1 year

Table Data updated on 31-07-2020

11. Oriental Happy Cash Policy

The Happy Cash Policy will keep you satisfied during the whole term of policy through a constant supply of cash during hospitalization that will not affect your pocket savings.

Key Features

  • Daily cash benefit for each day of hospitalization taken for the correction of illness and for a maximum time limit of 30 days to 60 days as chosen at the time of commencement.
  • Convalescence benefits for the treatment taken at home which lasts for 30/60 consecutive days. The company will return the admissible amount of treatment and insured have to declare an acceptable reason for home-based hospitalization.
  • Daily cash benefit period option where the insured can choose either 30 days or 60 days to avail the daily cash limit for any kind of hospitalization in the policy year.

Eligibility Criteria

Minimum Age of entry18 years for adults
3 months for children
Maximum Age of entry65 years
Sum InsuredRs 50 lakhs to 1 crore
Number members can be included6 members maximum (self, spouse, dependent children and parents)

Table Data updated on 31-07-2020

What Are The Benefits of Oriental Health Insurance?

  1. Incurred Claim Ratio- The claim incurred ratio is referred to the number of claims honoured and the total premium collected from its customers under Oriental Health Insurance. The ICR of Oriental insurance is 106.90 which shows the faith of customers and brand value of the company.
  2. Investment- The customer care team of Oriental Health Insurance Company has an online and offline grievance cell that is responsible for addressing customer queries and settling the claims. Customers can also reach them by dialling the specified number or writing an email.
  3. Comprehensive Coverage- The health insurance plans of Oriental provide a different value of sum insured ranging from Rs 1 lakhs to Rs 30 lakhs. The policyholder possesses complete freedom to choose the sum insured to deal with the medical requirements of the family.
  4. Coverage To Family- The policyholder can choose to involve family members under one sum insured and one premium applies to all the members. The eligible family members are spouse, children (divorced daughters), parents and parents in law who respect minimum age criteria.
  5. Number of Discounts- Almost each health insurance plan of Oriental Insurance carries this benefit and the percentage of discount is decided by the company. The policyholder can get a discount according to the number of members included in the policy with regard to the timely renewal of the policy.
  6. No Age Limitation- The company does not implement any restriction over the age of the policyholder. Anyone, whether it is a child of 3 months or a senior citizen of 65 years or a middle-aged person can take this policy for himself and his family.
  7. Tax Benefits- One cannot neglect the benefit of tax attached to the health insurance policy. Oriental Health Insurance will assist in tax savings and will decrease the total amount of annual income tax paid against the annual salary/revenue received from a job/business. A minimum of Rs. 30,000 to a maximum of Rs. 1.5 lakhs can be attained after purchasing health policy.

What Oriental Health Insurance Plans Doesn't Cover?

  1. Self-inflicted injuries or suicides.
  2. Injuries arousing out of the war, invasion, the act of a foreign enemy, hostilities, civil war, rebellion, revolution, insurrection, mutiny, etc
  3. Involvement of the person in criminal acts or breach of law that may invite injuries and even death.
  4. Engaging in any hazardous activities including speed contests or racing of any kind (other than on foot), adventure activities and sports that carry a sign of risk or involving a military/air force.

What is The Claim Process of Oriental Health Insurance?

Intimation of the claim

  1. The Oriental Insurance Company must be notified as soon as possible about filing the claim due to an illness or accident.
  2. The policyholder must first collect all the related information of the claim like policy number, ID card no., insured person name for whom claims registered, nature of disease/ injury, name and address of the attending medical practitioner/hospital/nursing home, etc.
  3. All these documents must be surrendered to the company/ TPA/ within the specified time limit. The mode of communication can be email or Fax or on the customer care number of Oriental Insurance.
  4. If a person has any sceptics about the process of notification of the claim can easily reach the customer service department of the company.
  5. All the above-reflected information must be delivered and conversed within 48 hours of admission to hospital and prior to the granting of the discharge.

The time limit for document submission

The company directs that all necessary documents must be acknowledged within 15 days after the claim intimation process has been done. The documents must be served in supplementary to Claim Information Letter.

Documents Required For The Claim Settlement Process

It is the responsibility of the policyholder to gather and submit all the documents to Oriental Insurance Company or TPA. The documents that you need to submit are mentioned below.

  1. Discharge certificate/card issued by the attending hospital/ nursing home
  2. Doctor's consultations reports/notes, prescriptions serving as the evidence of the disease detected.
  3. Hospital bills/cash memos.
  4. Summary of the medical history of the insured person analyzed by the hospital.
  5. Pathological and other reports from a pathologist/radiologist.
  6. Attending consultants/anaesthetists/specialist certificates concerning the disease.
  7. MLC/FIR/Post Mortem Report in case the injury is due to an accident.
  8. Previous policies details.
  9. Additional documents as on request.

The photocopies, as well as original, must be kept for approval of the claim by Third Party Administrator (TPA) or by the insurance company. The documents must be attested by the insured person.

Renewal Process Of The Oriental Health Insurance

The oriental health insurance policy must be renewed on a yearly basis to enjoy the benefit continuously. The company has come out with an online process which makes it completely easy to renew your plan from the comfort of your home. The process is mentioned below.

  1. Submit your request online by clicking on the “Renew Online” option displayed on the top of the menu bar of the website.
  2. Then, enter the policy number and click on the “Renew Now” button to proceed further.
  3. Again specify the policy details including personal details.
  4. Next is to deposit the premium value as reflected over the screen. The payment can be made with the debit or credit cards/ net banking etc.

FAQs

Oriental Health gives the option of a free look period of 15 days for the examination of the terms and conditions of the policy. During this period, the policyholder is free to cancel the policy if he/she is not in consensus with any of the clauses under the policy.

Yes, they are covered but the person has to wait to obtain the coverage for 36 months or maybe less. However, the policyholder has to confess about the diseases during the purchase of the policy. The company declines your claim for pre-existing diseases if you conceal true facts about your health during the proposal of policy.

The insured is not getting any bed in the hospital due to unavailability or the insured is not physically fit to move or step out of the home. The treatment should be under the vigilance and recommendation of Medical professional.

The cost of the organ, as well as the extraction of organs, is not covered under Oriental Health Insurance. While expenses incurred on in-patient treatment of organ donors are covered.

The health care is primarily for the cashless hospitalization of a particular disease where the insured is liberal from every hospital expenses arising during the in-patient treatment. The insured person or accompanying member can display the card to the hospital. The hospital will verify with the assigned TPA who will authorize the claim for cashless settlement.

Yes, they all are covered. However, the insured have to keep the policy active through timely payment of premium and have to wait for one or two years to receive a payout.

Page updated on 31-07-2020