Oriental Health Claim Settlement Ratio
  • CSR of the company
  • Claim process
  • Importance of CSR
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Oriental Health Insurance Claim Settlement Ratio

The claim ratio, or claim settlement ratio, tells us about the percentage of claims that are settled by the insurance company out of the total number of claims raised. The higher the claim ratio of an insurance company, the better the chances of your claim being settled. This ratio gives you an idea as to how reliable the health insurance company can be in case you need to make a claim.

Every year the Insurance Regulatory and Development Authority (IRDAI) releases all life insurers' claim settlement ratios. The Oriental health claim ratio is 90.18%.

In the following sections we will discuss the types of claims Oriental Health Insurance Company offers.

Health Insurance Claim Settlement Ratio

Why Is Claim Settlement Ratio Important?

When buying an insurance policy, you need to check various aspects before deciding which insurance company is right for you. You have to find out about the various policies and covers offered by the insurance company. You need to know how their customers review them in terms of services and customer relationship management. However, many people ignore the need to check the claim settlement ratio, which is a huge mistake. Here are two reasons why checking claim settlement ratio is important:

1. Measure the insurer’s reliability

Buying a policy is a big investment plan. You have to pay a good number of premiums over a long duration to avail of the benefits offered by the policy. So, if your claim is rejected for some reason in the future then that can seriously hurt your financial planning. The settlement ratio is a very reliable measurement indication that helps you know if a certain insurer is trustworthy or not. A favorable ratio indicates that the insurer is right for you.

2. Gives assurance about your dependent’s financial future

Checking the claim settlement ratio is important to ensure the financial security of your family. The last thing any family can endure after suddenly losing a family member is the rejection of an insurance claim. It is your job as a policyholder to make sure that your family does not have to go through that trouble. With the help of the settlement ratio, you can make the right decision when buying a policy.

Types Of Oriental Health Insurance Claims

There are two types of health insurance claims you can choose from

  • Cashless Claim
  • Reimbursement Claim

Cashless Claims

Cashless claims in health insurance is a mode of claim settlement where the policy holder does not have to pay cash for treatment and the settlement of the bills is taken care of directly between the hospital and the insurance company. Oriental Health Insurance cashless claim settlement helps in paying off the hospital bill instantly, upfront. Cashless claims are gaining popularity every day, and more and more people getting health insurance policies are availing this feature for the comfort it offers.

Status of Oriental Health Insurance Claim Settlement Ratio - 2021-22

Financial Year 2021-22
Age Analysis of Number of Claims Paid (%)< 3 months3 months to 6 months6 months to <1 year1 year to <3 year3 years to <5 years5 years
Claims Settled 90.185.682.171.440.290.2

Oriental Health Insurance Cashless Claim Procedure

If you are undergoing treatment at a network hospital, then you can avail cashless claims. The steps to file cashless claims are given below:

Step 1: Find a network hospital in the city where you can avail the medical treatment.

Step 2: Then you must inform the Oriental Insurance Company in case of an emergency and before hospital admission for planned hospitalization.

Step 3: Show your cashless health card and a photo ID proof at the network hospital.

Step 4: Get the pre-authorization form from the hospital, fill it and submit it to the hospital authority.

Step 5: Then, the hospital cross-checks the customer's identity and then sends a pre-authorization form to Oriental Health Insurance Company /Insurer’s TPA.

Step 6: The insurer or the third-party administrator checks and approves the coverage. If the health insurance claim is approved, the medical expenses will be taken care of by Oriental Health Insurance Company.

Health Insurance Companies

Reimbursement Claims

In this type of claim, you can visit any hospital, not just those under your insurer’s cashless network. Here, you get your treatment done at the hospital, pay out of your pocket, and then apply for a reimbursement for the expenses with your insurer. At the time of making the claim, the customer needs to submit all hospital bills, prescriptions, and medical documents. These will need to be approved by Oriental Health Insurance Company before the claim is processed, meaning that it can take slightly more time to get through.

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Oriental Health Insurance Reimbursement Claim Procedure

Reimbursement claims can be filed in both network and non-network hospitals. You can follow the reimbursement claim process as given below:

Step 1: On getting admitted to any network or non-network hospital, intimate Oriental Insurance Company about the hospitalization as soon as possible.

Step 2: The customer can get reimbursement claim form from the insurer or download it from Oriental Insurance Company website.

Step 3: Provide the required details while filling the form.

Step 4: On getting discharged, pay the hospital bills and collect all original bills, documents, and reports.

Step 5: Sign all documents and send them to the Oriental Health Insurance Company along with the claim form. If all the information is correct, Oriental Health Insurance Company will settle the claim as per the policy terms and conditions.The payment will be done in the policyholders bank account

Oriental Health Insurance Claim Settlement Ratio: FAQs

1. What percentage of CSR is considered the best to buy a plan from a company?

A claim settlement ratio of more than 85% is a good sign, making the insurer trustworthy. But insurance companies having a high CSR of more than 90-95% is a better option.

2. What is the formula to calculate Oriental Claim Settlement Ratio?

Claim Settlement Ratio or CSR can be calculated by taking the total number of insurance claims settled by the insurer and dividing it by the total number of insurance claims received by the insurer.

Let’s consider the claims settled by the company are 89 and the claims filed by policyholders are 100 in a year,then the CSR of that insurance company will be:

CSR=Total no. of insurance claims settled successfully / Total no. of insurance claims filed by the policyholders

=89/100
=89%

Explore other Oriental Health Insurance Plans

Oriental Health Insurance offers a wide range of health insurance plans to fulfill the medical needs of individuals, families, and senior citizens.

A comprehensive policy that is designed to secure the healthcare needs of a family. The plan comes in 4 variants and the SI goes up to 50 lacs.

Unique Features

  • Covers SAARC countries
  • Midterm inclusion allowed
  • Assisted Reproduction Treatment

Happy Family Floater Policy (Pros)

  • New Born Baby Cover
  • Maternity Expenses Cover
  • Modern Treatments
  • Plastic Surgery Due To Injury
  • Family Floater Benefits

Happy Family Floater Policy (Cons)

  • No Gender Treatments
  • No Global Coverage
  • No Alcoholism Cover
  • No War Injury Cover
  • No Obesity/Weight Cover

Happy Family Floater Policy (Other Benefits)

  • Zone Wise Rates
  • Non-TPA Discount 5.5%
  • 10% Discount on Online Renewal
  • Waiver of Proportionate deduction
  • Dental Treatment Covered

Happy Family Floater Policy (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 1 L to 50 L
  • Waiting Period - 30 Days

A plan for individuals and families covering domiciliary hospitalization, and daycare treatment. The plan also offers many discounts and other add-on benefits.

Unique Features

  • Option of voluntary co-payment
  • Mental Illness coverage
  • No Medical examination required

Mediclaim Insurance (Individual)(Pros)

  • 10 % Family Discount
  • Daily Hospital Cash
  • Air Ambulance Cover
  • Personal Accident Cover
  • Lifetime Renewals

Mediclaim Insurance (Individual)(Cons)

  • No Suicide Cover
  • Co-Payment in Many Injuries
  • No Alcoholism Cover
  • No War Injury Cover
  • No Obesity/Weight Cover

Mediclaim Insurance (Individual)(Other Benefits)

  • Spouse Cover
  • Non-TPA Discount 5.5%
  • 10% Discount on Online Renewal
  • Family Cover
  • Dependent Child Covered

Mediclaim Insurance (Individual)(Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age -65 Years
  • SI - 10 L to 50 L
  • Waiting Period - 30 Days

The policy focuses on securing the health of PNB account holders/employees and their families. The SI goes up to 10 lacs and covers 116 day care procedures.

Unique Features

  • Teleconsultation/Telemedicine covered
  • No Pre-medical check-up
  • Funeral Expenses covered

OBC-Oriental Mediclaim Policy

A medical expenses covering policy for the account holders of Oriental Bank of Commerce (OBC) and covers individuals and family. The SI is up to 10 lacs.

Unique Features

  • Teleconsultation/Telemedicine covered
  • 116 Day Care procedures
  • Coverage for funeral expenses

Oriental Happy Cash-Nischint Rahein

The policy offers Daily Cash Benefit during hospitalization. It also provides a 25% extra daily cash benefit for female policyholders at no additional premium.

Unique Features

  • Convalescence benefits
  • Lifelong renewal
  • Coverage for AYUSH

Happy Cash-Nischint Rahein (Pros)

  • Daily Cash Benefit
  • Day Care Treatment Cover
  • Parents-in-law Cover
  • Pre-Existing Disease Cover
  • Hospitalization Cover

Happy Cash-Nischint Rahein (Cons)

  • No Suicide Cover
  • No Unproven Treatment Cover
  • No Biological Injury Cover
  • No War Injury Cover
  • No Obesity/Weight Cover

Happy Cash-Nischint Rahein (Other Benefits)

  • Spouse Cover
  • Inpatient Expenses Cover
  • Acute Condition Cover
  • Ambulance Cover
  • Dependent Child Covered

Happy Cash-Nischint Rahein (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - NA
  • Waiting Period - 30 Days

Oriental Aarogya Sanjeevani Policy

Covers hospitalization charges for the individual and family members. It is a standard plan that covers many illnesses and annual medical checkups.

Unique Features

  • All daycare expenses covered
  • Cover parents and parents in law
  • Lifelong renewal with no exit age

Aarogya Sanjeevani Policy(Pros)

  • Domiciliary Expenses Covered
  • 5% Cumulative Bonus
  • Dental surgery Expenses
  • Ambulance Charge Cover
  • 5.5% Non-TPA Discount

Aarogya Sanjeevani Policy(Cons)

  • No Dietary Supplements Cover
  • No War Injury Cover
  • No Biological Injury Cover
  • No Rheumatism Cover
  • No Obesity/Weight Cover

Aarogya Sanjeevani Policy(Other Benefits)

  • Spouse Cover
  • Dependent Child Cover
  • 50% Medical Checkups Covered
  • Daycare Treatment Covered
  • ICU Cover

Aarogya Sanjeevani Policy(Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age -65 Years
  • SI -5 L to 20L
  • Waiting Period - 30 Days

Oriental Jan Arogya Policy

It provides health insurance coverage to the financially constrained sections of society at very nominal premiums ranging between Rs. 50 to 70.

Unique Features

  • Avail benefit up to Rs 5k
  • Domiciliary Hospitalization
  • In-patient hospitalization covered

Oriental Jan Arogya Policy(Pros)

  • Room Expenses Covered
  • Artificial Limbs Covered
  • Dental surgery Expenses
  • Pre-existing condition Cover
  • Maternity Covered

Oriental Jan Arogya Policy(Cons)

  • No Suicide Cover
  • No Maternity Cover
  • No Dietary Supplement Cover
  • No War Injury Cover
  • No Obesity/Weight Cover

Oriental Jan Arogya Policy(Other Benefits)

  • Pre- Hospitalization
  • Post-Hospitalization
  • Ambulance Cover
  • Cost of Organ Covered
  • Naturopathy Cover

Oriental Jan Arogya Policy(Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age -70 Years
  • SI -Rs 5000
  • Waiting Period - 30 Days

Oriental Pravasi Bharatiya Bima Yojana

The policy safeguards the Indian emigrant workers who intend to emigrate or have done so. The policy provides a Sum Insured of 10 lacs.

Unique Features

  • Cover against HIV/AIDS
  • Female Maturity benefit
  • Personal Accident Cover

Pravasi Bharatiya Bima Yojana(Pros)

  • Air Ambulance
  • Permanent Disability Cover
  • Dead Body Carriage Expenses
  • Legal Expenses Covered
  • Mental Illness Cover

Pravasi Bharatiya Bima Yojana(Cons)

  • No Suicide Cover
  • No Unproven Treatment Cover
  • No Biological Injury Cover
  • No War Injury Cover
  • No Obesity/Weight Cover

Pravasi Bharatiya Bima Yojana(Other Benefits)

  • Oral chemotherapy
  • Nursing Expenses
  • Robotic surgeries
  • Deep Brain stimulation
  • AYUSH Cover

Pravasi Bharatiya Bima Yojana(Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 60 Years
  • SI - 10 L
  • Waiting Period - 30 Days

Oriental Super Health Top-up

Oriental Super Top-up policy is an add-on policy that is designed to provide coverage to the insured and his family in case their base coverage is exhausted.

Unique Features

  • Advanced surgeries covered
  • No Pre-acceptance till 55 years
  • AYUSH treatment covered

Super Health Top-up (Pros)

  • Organ Donor Benefit
  • Day Care Treatment Cover
  • Room Boarding Expenses
  • Newborn Baby Cover
  • SAARC Countries Cover

Super Health Top-up (Cons)

  • No Suicide Cover
  • No Unproven Treatment Cover
  • No Biological Injury Cover
  • No War Injury Cover
  • No Obesity/Weight Cover

Super Health Top-up (Other Benefits)

  • Maternity Cover
  • Nursing Expenses
  • Pre- Hospitalization
  • Post -Hospitalization
  • ICU Charges Covered

Super Health Top-up (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 3L to 5L
  • Waiting Period - 30 Days

Oriental Health of Privileged Elders

Designed to offer health insurance coverage to senior citizens aged 60 years and above and comes out with a compulsory co-payment of 20%.

Unique Features

  • Discount on Voluntary Co-payment
  • Loading for new entrants
  • Telemedicine expenses

Health of Privileged Elders(Pros)

  • Domiciliary Expenses Covered
  • Eye Surgery Cover
  • Dental surgery Expenses
  • Parental Chemotherapy Cover
  • Orthopedic Diseases Cover

Health of Privileged Elders(Cons)

  • No Arthritis Cover
  • No Upper Respiratory Cover
  • No Biological Injury Cover
  • NoRheumatism Cover
  • No Obesity/Weight Cover

Health of Privileged Elders(Other Benefits)

  • No Claim Bonus
  • Accidental Injury
  • Knee Replacement
  • Chronic Renal Failure
  • Cancer Charges Covered

Health of Privileged Elders(Eligibility Criteria)

  • Entry Age - 60 Years
  • Max Entry Age -NA
  • SI -1 L to 5L
  • Waiting Period - 30 Days

Oriental Overseas Mediclaim Policy (E & S)

Coverage for medical expenses of various ailments to the policyholders residing outside of India for study and employment.

Unique Features

  • Accidental cover
  • Mental health cover
  • Permanent Total Disablement

Overseas Mediclaim Policy (E & S)(Pros)

  • Spouse Cover
  • Ambulance Cover
  • Permanent total disablement
  • Air Ticket Covered
  • Serious Injury Covered

Overseas Mediclaim Policy (E & S)(Cons)

  • No Pre Existing Disease Cover
  • No Dental Cover
  • No Cosmetic Surgery Cover
  • No War Injury Cover
  • No Obesity/Weight Cover

Overseas Mediclaim Policy (E & S)(Other Benefits)

  • Repatriation of Remains
  • Medical Evacuation
  • Legal Coverage
  • Contingency Insurance
  • Medical Expenses Benefits

Overseas Mediclaim Policy (E & S)(Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age -65 Years
  • SI - US $ 5,000
  • Waiting Period - 30 Days

Oriental Dengue Kavach Policy

Specially designed to offer coverage on detection of Dengue Fever without any sub-limit/ co-payment. The plan comes with a coverage of up to Rs. 20,000.

Unique Features

  • One premium irrespective of age
  • Family Discount up to 5%
  • Free-look period available

Oriental Dengue Kavach Policy(Pros)

  • Spouse Cover
  • Dependent Child Covered
  • 5% Online Discount
  • Parent In-law Cover
  • No Medical Checkup

Oriental Dengue Kavach Policy(Cons)

  • No Suicide Cover
  • No Maternity Cover
  • No Dietary Supplement Cover
  • No War Injury Cover
  • No Obesity/Weight Cover

Oriental Dengue Kavach Policy(Other Benefits)

  • Pre- Hospitalization
  • Post-Hospitalization
  • Ambulance Cover
  • Divorced Daughter Cover
  • Easy Claim Processing

Oriental Dengue Kavach Policy(Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age -70 Years
  • SI -Rs 10000- Rs 20000
  • Waiting Period - 30 Days

Oriental Overseas Mediclaim Policy (B & H)

A combination of travel and health insurance that contains health benefits and offers coverage against loss during travel abroad.

Unique Features

  • Hijack distress allowance
  • Financial Assistance Emergency
  • Flight Delay Allowance

Overseas Mediclaim Policy (B & H)(Pros)

  • Loss of Limb Cover
  • Loss of Eye Covered
  • Permanent total disablement
  • Room Rent Covered
  • Serious Injury Covered

Overseas Mediclaim Policy (B & H)(Cons)

  • No Suicide Cover
  • No Maternity Cover
  • No Dietary Supplement Cover
  • No War Injury Cover
  • No Obesity/Weight Cover

Overseas Mediclaim Policy (B & H)(Other Benefits)

  • Repatriation of Remains
  • Medical Evacuation
  • Annual Multi-Trip Insurance
  • Contingency Insurance
  • Medical Expenses Benefits

Overseas Mediclaim Policy (B & H)(Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age -65 Years
  • SI -NA
  • Waiting Period - 30 Days

Oriental Critical Illness Policy

A plan that covers 22 critical illnesses including kidney and lung failure. The policy covers spouse, dependent child, parents-in-law and unmarried siblings.

Unique Features

  • Personalized Health Advice
  • Two plan options to choose from
  • Coverage of up to 50 Lakhs

Critical Illness Policy(Pros)

  • Open heart replacement Cover
  • Cancer Cover
  • Benign brain tumor Covered
  • Bone marrow transplant
  • Loss of speech Covered

Critical Illness Policy(Cons)

  • No Coronary Syndromes Cover
  • No Other stem-cell transplants
  • No Angioplasty Cover
  • No Angina Pectoris Cover
  • No Coma Cover

Critical Illness Policy(Other Benefits)

  • Permanent paralysis of limbs
  • 10% Buying Online Discount
  • 10% Family Discount
  • Third Degree Burn Covered
  • Loss of Limbs Cover

Critical Illness Policy(Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age -65 Years
  • SI - Upto 20 Lakh
  • Waiting Period - 90 Days

Oriental Corona Kavach

Available on both an individual and family floater basis, it protects the policyholder from the expenses incurred due to COVID-19 treatment.

Unique Features

  • Road Ambulance Charges covered
  • Pre & Post hospitalization
  • AYUSH Expenses covered

Oriental Mediclaim Insurance Policy (Group)

It is a group health insurance plan that covers hospitalization and maternity expenses. The plan also covers low-claim discounts.

Unique Features

  • Mental Illness Cover
  • HIV Cover
  • Newborn baby expenses

Mediclaim Insurance Policy (Group) (Pros)

  • Diabetes Cover
  • Daily Hospital Cash
  • AYUSH Cover
  • Hernia surgery Cover
  • Psychiatrist Cover

Mediclaim Insurance Policy (Group) (Cons)

  • No Suicide Cover
  • No Gender Change Cover
  • No War Injury Cover
  • No Drug Abuse Cover
  • No Obesity Cover

Mediclaim Insurance Policy (Group) (Other Benefits)

  • Pre- Hospitalization
  • Post- Hospitalization
  • Indemnity Cover
  • Inpatient Cover
  • Daycare procedures Covered

Mediclaim Insurance Policy (Group) (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - NA
  • Waiting Period - 30 Days

Oriental Insurance Bank Saathi Policy - Group

A group health insurance product for the Bancassurance partners of the company. Prosper can include family and the Sum Insured goes up to 25 lacs.

Unique Features

  • ICU covered
  • Assisted Reproduction Technique covered
  • Newborn baby covered

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Naval Goel

Reviewed By : Naval Goel

Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.