Oriental Health Insurance

Oriental health insurance is a product introduced by Oriental Insurance which promises you complete protection from medical emergencies such as hospitalization, health checkups, and critical illness, etc. Oriental Insurance company is 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 is given to the central government and from then it started working as a public sector insurance company.

Oriental health insurance incorporates the power of government. Oriental insurance is currently dealing with health insurance, travel, motor, home, personal accident, business office/ traders, engineering, marine, animals/ birds, aviation, agriculture. sericulture etc.

According to the latest statistics, Oriental health insurance is the most popular due to its purchase by the Indian population. Oriental health insurance has generated huge revenue and premium payment for the company.

Highlights of Oriental Health Insurance

Benefits Of Oriental Health Insurance

• Incurred Claim Ratio: The claim incurred ratio is referred to number of claim honoured and the total premium collected from its customers under Oriental Health Insurance. The ICR of Oriental insurance is 105.76% which shows the faith of customers and brand value of the company.
• Customer Service Values: The customer care team of Oriental Health Insurance company has online and offline grievance cell that is responsible for addressing customer queries and settling the claims. Customer can also reach them by dialing the specified number OR writing an email.
• Comprehensive Coverage: The health insurance plans of Oriental provides 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 in harmony to the medical requirements of the family.
• 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.
• Number of Discount: Almost each health insurance plan of Oriental Insurance carry this benefit and the percentage of discount is decided by the company. The policyholder can get discount according to the number of members included in the policy with regard to timely renewal of policy on the policy anniversary. A discount on the premium payment is given @ 5%, 7.5% or 10%.
• 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 age person can take this policy for himself and his family.
• Tax Benefits: One cannot neglect the benefit of tax attached to the health insurance policy. Oriental Health insurance policy will assist in tax savings and will decrease the total amount of annual income tax paid against the annual salary/ revenue receiving 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.

Types of Oriental Health Insurance

Oriental Super Health Top Up

A premium health insurance plan by Oriental that basically covers all the significant medical expenses that are sure to happen in the future.

What Medical Expenses are covered and discounts offered?

• Expense cultivating through inpatient treatment of an illness/ disease are covered that generally consists-
• Room, Boarding and Nursing Expenses during the course of treatment in a Hospital /Nursing Home. A maximum of 1% of the Deductible Amount per day.
• Intensive Care Unit (ICU) expenses up to 2 % of the Deductible Amount (mentioned in the Policy Schedule) per day.
• Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees.
• Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Diagnostic Material, and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs.
• 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 centers registered under government councils are reimbursed as per the specified limit.
• Pre-hospitalization cost covered for 30 days period before admission to the hospital.
• Post-hospitalization expenses coming after inpatient treatment are covered for 60 days after receiving discharge statement.
• Newborn baby expenses paid for a period of 90 days and the maximum coverage awarded is 5% of the Sum Insured. The days will start counting from the date of birth of the child.
• Maternity expenses that will include child delivery and up to 10% of the sum insured are available.
• 10% discount on including more than one member in a single policy is awarded.
• Loyalty discount amounting to 10% is given on the premium who at the inception of this policy is also covered under a base health insurance policy from Orient
• Staff discount on the premium @ 33% to the retired and present employees engaged in the operation of Oriental Health insurance company.
• Cancellation of room rent limit where insured will get relief from deductibles. However, an extra premium has to be submitted along with a basic premium.

Eligibility Criteria

Mediclaim Policy

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

What Medical Expenses are covered and discounts offered?

• Treatment taken at a licensed hospital unit or at any nursing home for an illness/ injury will be covered and the following expenses will be included-
• Room, Boarding and Nursing Expenses as provided
• Intensive Care Unit (ICU) expenses up to 2 % of the Deductible Amount (mentioned in the Policy Schedule) per day.
• Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees
• Anesthesia, Blood, Oxygen, Operation Theatre fee, Surgical Appliances, pharmaceuticals recommended by the medical expert, Diagnostic Material, and X-Ray, Chemotherapy, Radiotherapy, Dialysis, Pacemaker, Artificial Limbs
• Pre and post hospitalization cost appearing 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.
• Organ donor inpatient hospitalization expenses who is donating the organ for the transplantation process and the insured person is the organ recipient.
• 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.
• Dog’s bite or a bite of any other rabid animal will get the facility of treatment at home and a maximum of Rs 50,000 is provided with respect to an event.
• Personal Accident cover in case of death and permanent disability solely caused by an accident. An amount of Rs 4 lakhs maximum is offered.
• 10% to 20% discount on opting voluntary co-payment which means that the policyholder has admitted paying some percentage of the claim out of his pocket.

Eligibility Criteria

Jan Arogya 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.

What Medical Expenses are covered and discounts offered?

• In Patient hospitalization covering expenses such as-
• Room, Boarding Expenses as provided by the hospital/nursing home.
• Nursing Expenses.
• Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees.
• Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs & Cost of Organs and similar expenses.
• Pre-hospitalization cost up to 30 days is given due payment on presenting a valid proof for the same.
• Post-hospitalization cost covered for a maximum of 60 days and will be settled only on furnishing related reports/ bills/ test/ 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.

Pravasi Bharatiya Bima Yojana

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

What Medical Expenses are covered and discounts offered?

• On the death of the insured during the period insurance either in India or in another country will be covered and a sum of Rs 10,00,000 is provided.
• 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 member residing in India if the policy is taken on 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 emigrant 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 emigrant in case she conceives during the time in abroad. For normal delivery, a maximum of Rs 35,000 is provided and for caesarian operation, a maximum of Rs 50,000.
• Cost involved in the transportation of the deceased body of Insured (emigrant) to his home country if the death reported from an accident. This may also include local burial.
• The cost of air tickets will be borne by the company on permanent disability happened while living abroad with the status of the emigrant. The tickets purchased must be of economy class and payment will be provided for one way airfare to the International airport in India.
• Attendant airfare - In case of death/disability of the insured
• Legal expenses incurred in any litigation relating to emigrant’s employment

Eligibility Criteria

OBC-Oriental Mediclaim Policy

This policy contains medical benefits that become a blessing during emergencies that may 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

What Medical Expenses are covered and discounts offered?

• 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, nursing at home.
• AYUSH treatment facility where the insured can admit in centers of Ayurvedic, Yoga & Naturopathy, 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 is included.
• Ambulance availability for emergency transfer from home/ any place to a nearby hospital to avail the immediate treatment of the illness. Insured can get a maximum of Rs.1000 during a policy year and the claim is accepted by the company.
• Funeral Expenses arrived due to death of the insured during the term of the policy is covered and a lumpsum amount of Rs.1000 is paid with respect to approval of the claim.

Eligibility Criteria

PNB Oriental Royal Mediclaim

This plan 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, widowed/ divorced daughters.

What Medical Expenses are covered and discounts offered?

• 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 organ where insured is the recipient. The insured must show that transplantation has been suggested by the doctor.
• 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 the surgeon, medical practitioner, consultants, blood, oxygen, surgical appliances, medicines & drugs, diagnostic equipment and dialysis, chemotherapy, nursing at home.
• AYUSH treatment facility where the insured can admit in centers of Ayurvedic, Yoga & Naturopathy, Unani, Siddha, and Homeopathic for inpatient treatment.
• Ambulance service charges amounting to Rs.1000 during the policy period are admissible and payable.
• Funeral Expenses in case of demise of insured. A lumpsum amount of Rs.1000 is paid for the ceremony of the funeral for each insured person in a policy period.
• 116 Day Care Procedures that are completed within 24 hours are given due coverage.

Eligibility Criteria

Group Mediclaim Policy

If anybody wants to cover a target group, association, Institution, corporate batch, can purchase Oriental Group Mediclaim Policy. 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 and every member.

What Medical Expenses are covered and discounts offered?

• The total value of in-patient hospitalization expenses popped up for a detected illness/ injury will be covered through the payment of below-depicted expenses.
1. Room, Boarding and Nursing Expense up to 1 % of the Sum Insured or Rs. 5000 per day whichever is less.
2. I.C. Unit expenses not exceeding 2% of the Sum Insured or Rs. 10,000 /- per day whichever is less. (Room stay including I.C.U. the stay should not exceed the total number of admission days)
3. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees
4. Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during surgical procedure like a pacemaker, Relevant Laboratory / Diagnostic test, X-Ray, etc.
• Ambulance services for hassle-free transfer of the insured to the hospital. Oriental health will pay 1% of the sum insured or Rs 2000 per hospitalization, whichever is less.
• Domiciliary hospitalization where treatment can be taken at home on the permission of 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 after 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.
• Newborn baby expenses happening from day 1 and till the age of 3 months are covered. Company will pay for inpatient treatment of the child during the period.
• 10% to 25% discount on including members/ families more than 100/ 1000/ 5,000/ 15,000/ 25,000.
• No pre-policy check-up for policyholders under the age umbrella of 45 years.

Eligibility Criteria

Happy Family Floater Policy

This policy is for all the Indian citizens as well as SAARC country citizens who want to secure their families form future medical costs during inevitable hospitalization or medical issues.

• Silver plan
• Gold Plan
• Diamond Plan

What Medical Expenses are covered and discounts offered?

• In Patient hospitalization occurring during the time of treatment of any investigated illness in a hospital are covered. Expenses include-
1. Room, Boarding Expenses as provided by the hospital/nursing home.
2. Nursing Expenses/ Intensive Care Unit (ICU) up to 2% of the sum insured in silver and gold plan. While in the diamond plan, it is Rs 20,000 plus 1% of the Sum Insured.
3. Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees.
4. Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs & Cost of Organs and similar expenses.
• Pre-hospitalization cost up to 30 days is given due payment on presenting valid proof such as medical reports, pharmacy bills, doctor’s certificate, Diagnostic Tests, etc.
• Post-hospitalization cost covered for a maximum of 60 days and will be settled only on furnishing related reports/ bills/ test/ doctor statements.
• Daily Hospital Cash Allowance up to Rs 1200 to Rs 2000 per day for 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 sum insured is paid in lumpsum.
• Maternity Expenses if the insured becomes pregnant during the policy term where the company will cover child delivery expenses. The policy must remain active for a minimum of 24 months to get this coverage.
• New Born Baby expenses stating from the first day of birth and terminating on the completion of 90 days.
• Second Medical Opinion from the medical professional listed on the company panel. Insured can avail expert opinion for 11 serious diseases all over the world.
• Reloading of sum insured if the policyholder purchase sum insured between Rs.3 to 10 lakhs. The percentage of reloading is dependent on the type of plan opted- for Silver 50% or 100% of the Sum Insured and for Gold plan, it is 50% or 100% of the sum insured.

Eligibility Criteria

Overseas Mediclaim Policy (B&H)

This health plan is a combination of travel insurance and health insurance that contains health benefits as well as loss/ exigencies happening during travel.

What Medical Expenses are covered and discounts offered?

• 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 schedules delivery of checked baggage on the destination will be compensated by the Oriental health. 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 traveling 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

Oriental Happy Cash Policy

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.

What Medical Expenses are covered and discounts offered?

• 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 during the purchase of the policy.
• Convalescence benefit 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.
• A special advantage for females where daily cash limit will get increased without any requirement of submitting extra premium.
• Family discount of 5% and 7.5% no total premium paid if the policyholder extends the coverage to 2 family members and more than 2 members.
• Loyalty discount @ 10% on the gross premium where insured has to be constant in the renewal of the Oriental health policy.
• Staff Discount if the person is working with Oriental Insurance company in any profile. A discount of 33% is given on the total premium.

Eligibility Criteria

Claim Process of Oriental Health Insurance

Intimation of the claim

• The Oriental Insurance must be notified as soon as possible following the birth of claim due to an illness or accident.
• 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.
• All these documents knowledge 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.
• If a person has any skeptics about the process of notification of the claim can easily reach the customer service department of the company.
• 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.

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 Claim Settlement Process

It is the responsibility of the policyholder to gather and submit all the documents to Oriental Insurance company or TPA.

• Discharge certificate/ card issued by the attending hospital/ nursing home
• Doctor's consultations reports/ notes, prescriptions serving as the evidence of the disease detected.
• Hospital Bills / Cash Memos.
• Summary of Medical history of the insured person analyzed by the hospital.
• Pathological and other reports from a pathologist/radiologist.
• Attending Consultants / Anaesthetists / Specialist certificates concerning the disease.
• MLC /FIR /Post Mortem Report in case the injury is due to an accident.
• Previous policies details.
• 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

Oriental health insurance policy must be renewed on yearly basis to enjoy the benefit continuously.

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

Exclusions Of Oriental Health Insurance

• Self-inflicted injuries or suicides.
• Injuries arousing out of the war, invasion, the act of a foreign enemy, hostilities, civil war, rebellion, revolution, insurrection, mutiny, etc
• Involvement of the person in criminal acts or breach of law that may invite injuries and even death.
• 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.

Review of Oriental Health Insurance

The oriental health insurance has developed plans that carry all the basic as well as advanced needs of the policyholders. First, it is a government controlled insurance companies and second, it has bilateral ties with an international organization.

Also, the company has gained an impressive amount of customers through the selling of health insurance policies in India and outside India like Nepal, Kuwait, and Dubai. The incurred claim ratio is 105% which highlights the value of customer service and priority to customer happiness.

The online process of renewal and grievance notification is another feature provided by Oriental health insurance company. This feature has really boosted the trust of the policyholder in health insurance.

Oriental Health Insurance Claim Form

Click Here To Download

Contact Address

Oriental House, A-25/27, Asaf Ali Road, New Delhi - 110002
Phone No's :011-43659595
CIN :U66010DL1947GOI007158
Email: csd(at)orientalinsurance(dot)co(dot)in

FAQs

1. What is the free look period?

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 clause under the policy.

2. Are pre-existing diseases are covered under Oriental health insurance?

Yes, they are definitely covered but th3e 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.

3. What are the conditions under which a domiciliary treatment is offered?

The insured is not getting any bed in the hospital due to unavailability OR 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.

4. What kind of expenses are not covered in Organ Donor Expenses?

The cost of the organ, as well as the extraction of organ, is not covered under Oriental health insurance. While expenses incurred on in-patient treatment of organ donor is covered.

5. What are the benefits of having a health card issued by the company?

The health care is primarily for the cashless hospitalization of a particular disease where 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.

6. Are diseases like Cataract, hernia, Piles, Sinus, Joint replacement are included in the policy?

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.

Last updated on 14-06-2019

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