Oriental Individual Mediclaim Policy

With the increase in health problems, medical costs are also increasing. And at the same time, it is getting difficult to manage financial stress. Oriental Mediclaim Insurance is the one-stop solution to all such problems.

It is a unique and basic health insurance cover, specially designed to take care of all your medical expenses related to the Hospitalization/Domiciliary hospitalization of the policyholder in the following conditions:

• Sudden illness
• Accident
• Surgery to treat any disease that arises during the policy period.

The comprehensive health insurance plan provides coverage on hospitalization expenses, domiciliary costs, organ donors,s and much more for individuals between the age of 18 to 65 years for treatment in India. The sum insured option ranges from Rs. 1 lakh to Rs. 10 lakhs. You can also include your family under the same policy. Let's discuss the plan in detail.

Eligibility of Individual Mediclaim Policy

**Last Updated on May, 2021

Key Features of Individual Mediclaim Policy

• The pre-existing diseases are covered after four renewals consecutively.
• The plan offers amazing discounts such as a family discount of 10% if more than one member is covered under the plan.
• There is no provision for the medical examination for persons up to the age of 55 years.
• The insured person is provided with a lump sum amount at the time of hospitalization. The money can be used for meeting additional expenses or for compensating for the income loss during the entire period of hospitalization. This plan provides a daily cash allowance in case of more than 2 days of hospitalization.
• The ambulance charges are also covered under this plan that involves the transportation of the policyholder from one hospital to another for medical treatment.
• Get the free look period of 15 days from the date of the policy receipt to renew the terms and conditions.
• They offer you an option of a grace period that is of 30 days for the payment of renewal premiums.
• Options for personal accidents are also available for sum insured from Rs. 2 lakhs to Rs. 10 lakhs.
• This plan also covers the hospitalization expenses incurred for the organ donor treatment of the policyholder.

Coverage Details of Individual Mediclaim Policy

**Last Updated on May, 2021

Hospitalization Benefits

**Last Updated on May, 2021

Waiting Period

The expenses incurred on the following discussed diseases/surgeries manifested after the starting of the first policy, are not payable during the waiting period specified below:

**Last Updated on May, 2021

Sample Premium Rates

This graph illustrates the premium rates payable by an individual for choosing coverages at the different sums insured and at different ages. Let's understand this with the help of a graph that represents the Oriental Health Insurance Premium chart.

Premium Rates of Oriental Individual Mediclaim Policy at different age and different sums insured.

Exclusions

Here are the major exclusions which are covered under this plan:

• Self-inflicted injuries
• Suicidal attempt
• Venereal diseases treatment
• Sexually transmitted diseases, HIV, AIDS treatment
• Health issues arising because of military, air, and naval operations
• Hospitalization because of the Breach of law with criminal intent
• Nuclear war/explosion
• Adventurous sports/hazardous activities
• Complications related to pregnancy and childbirth
• Health diseases due to nuclear radiations or from nuclear waste
• Overdosage of Alcohol/drug/substance abuse

Claim process of Oriental Individual Mediclaim Policy

There are two claim processes offered by Oriental Individual Mediclaim Policy: Cashless and Reimbursement Process.

Cashless Claim

In case of an emergency or planned hospitalization, follow these steps for a smooth and quick claim experience:

• Fill the claim application form completely which is required to be approved by the network hospital.
• After approval, your documents and all related information will be verified by the insurer.
• Determine the eligibility to get the claim benefit.
• After completing the entire process, a pre-authorization letter will be sent to the hospital enlisted with your insurer. The form mentions the amount required to be paid by the insurer.
• All the documents are required to be sent to the Oriental Insurance Registered office or you can send them via mail.

Reimbursement claim

• For a reimbursement process, third-party administrators will be informed within a week of your hospitalization.
• Information such as details of the insured members, policy number, details of the hospital, injury type, and the name of the doctor is required to process the claim.
• Submit the documents related to the claim along with the medical bills/receipts within 30 days of getting discharged from the hospital to the TPA division or Oriental Insurance Company.