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  • Oriental Health Insurance

    Oriental Health Insurance
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    Cashless Treatment

    Customer Service

    Medical Coverage

    Claim Experience

    The Oriental Insurance Company Ltd was incorporated at Bombay on 12th September 1947. The Company was a wholly owned subsidiary of the Oriental Government Security Life Assurance Company Ltd and was formed to carry out General Insurance business. ORIENTAL with its head Office at New Delhi has 30 Regional Offices and nearly 1800+ operating Offices in various cities of the country.


    Oriental Health Insurance at a Glance

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    Coverage for your most loved ones

    Total members covered

    Coverage for a maximum of 7 family members with up to 4 adults

    You get a choice of coverage tenure

    Pre and Post Hospitalization cover

    Medical expenses covered for 30 days before your hospitalization and 60 days for post hospitalization for related medical expenses

    The next best thing to having a doc in the family

    Health Check-ups

    Health check up undertaken once at the expiry of a block of every four continuous claim free underwriting years

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    * For a family health cover product.

    Critical Factors of the Plan

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    Not a paisa goes from your own pocket!

    Co-Pay

    10% co-payment of the claim amount has to be made by the insured

    You?re covered for any future medical expenses

    Life long renewable

    Plans are lifelong renewable and covers you for your entire lifetime.

    Get essential cover for existing ailments

    Pre-existing Diseases

    Any pre-existing condition will be covered after a waiting period of 4 year

    Hospital room rent determines your treatment bill

    Room Rent

    Room rent not exceeding 1 % of the Sum Insured or Rs. 5000 /- per day whichever is less.

    *These Features may be included as part of different products and are subject to the insurer's terms & conditions.

    Additional Features of Oriental Health Insurance

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    Good health offers multiple rewards

    Wherever family members are covered, a discount of 10% in premium is available.

    The world is your healthcare oyster

    Cashless facility for claim settlement available in network hospital

    *These add-ons may be included as part of different products and are subject to the insurer's terms & conditions.

    Overview

    Oriental Health Insurance Co. Ltd. was founded in 1947. Since its inception it has constantly attracted new and varied customers, which has facilitated its steady growth. Its underwritten premium currently stands at over Rs.7,282 crores.


    It functions as an entirely independent company whose board of members consist of the likes of T.A.Pai, B.D. Pande, K.R.Puri and other prominent personalities, who have achieved considerable levels of success in their respective fields.


    The company is based out of New Delhi and has a pan-India presence. It has over 30 regional offices, in addition to over 1,800 operating offices, serving a rural and urban client-base across India.


    Its operations are not limited to the domestic boundaries of India alone; it has representation in overseas markets like Nepal, Kuwait and Dubai as well.


    With the rising cost of healthcare in India, unfortunate, unpredictable events in the form of illnesses or accidents, can result in a requirement for hospitalisation. This can cause great strain on a person’s finances.


    Oriental Health Insurance Co. brings to its clients the following policies devised to meet the needs of individuals as well as provide affordable healthcare to their families.


    • Individual Mediclaim Health Insurance (for the proposer)
    • Happy Family Floater Policy (for the proposer and his/her family)
    • Oriental Bank Mediclaim Policy (for OBC’s account-holders)
    • PNB - Oriental Royal Mediclaim Insurance Policy (for PNB’s account-holders)
    • Jan Arogya Bima (low cost, low coverage plans for the financially constrained)
    • Nagrik Suraksha Policy
    • Janata Personal Accident Policy
    • HOPE - Health of Privileged Elders

    The salient features of each of the plans are provided below.

    Individual Mediclaim Health Insurance

    Sum Assured

    • Rs.50,000 to Rs.2 lakhs, in increments of Rs.25,000.
    • Rs.2 lakhs to Rs.5 lakhs, in increments of Rs.50,000.

    Cover

    • Hospitalisation expenses for a minimum stay of 24 hours (can be less than 24 hours when advanced methods of treatment are used or day care treatment involves administering general anaesthesia).
    • It includes the following:
      • Room expenses, including nursing charges, @Rs.5,000 or up to 1% of sum assured, whichever is lower, per day of hospital stay.
      • ICU expenses @Rs.10,000 or up to 2% of sum assured, whichever is lower.
      • Expenses for the following: Surgeon, Doctor, Anaesthetist, Consultant, Specialist Charges, Anaesthesia, Blood Oxygen, OT, Surgical and Diagnostic equipment, Medicines, Drugs, Dialysis, Radio/Chemotherapy, Prosthetic limbs or devices, Pacemaker, Laboratory Tests, Diagnostic Tests, X-Ray and other vital necessities.
      • Ambulance charges @ Rs.2,000 or 1% of the sum assured, whichever is lower.
      • Organ donor hospitalisation expenses.
      • Over 25 day care procedures.
      • Domiciliary Hospitalisation: Treatment, for a period beyond 3 days, provided at home in lieu of hospitalisation due to lack of space at the hospital or inability to transfer the insured person to a hospital.
      • Pre-hospitalisation expenses: Up to 30 days.
      • Post-hospitalisation expenses: Up to 60 days.
      • Pre-existing diseases: After completion of a 4 year waiting period from policy inception.

    Exclusions

    • Inpatient/day care treatment provided to the insured person as an outpatient.
    • Domiciliary hospitalisation does not include pre/post-hospitalisation cover and excludes certain ailments/injuries.
    • Claims made during the period when the policy is not in effect i.e. 30 days from policy inception.
    • Fallouts of war, terrorism, civil unrest, related events.
    • not forming part of admissible treatment.
    • Vitamins, tonics, circumcision, vaccinations, sex change or plastic surgery, dental procedures not forming part of admissible treatment.
    • Sight-correction surgery, glasses, contact lens, hearing aids etc.
    • Convalescence, congentinal ailments, birth defects, fertility treatment, STDs including HIV and related diseases, self-harm, psychiatric treatment, misuse of intoxicants. obesity.
    • Diagnostic tests which reveal ailments that are not treated during hospitalisation.
    • Maternity/Delivery/Termination and subsequent related illnesses.
    • Non-allopathic treatment.
    • Injuries from hazardous sports/hobbies
    • Hospitalisation expenses related to personal comfort e.g. toiletries, telephone use etc.
    • In case the claimant is already covered for the event that forms the basis of the claim by another policy, only a proportionate amount of liability will be borne.

    Benefits

    • Cashless facility, with TPA consent, at network hospitals.
    • Reimbursement of expenses, up to 1% of sum assured, for health checks after every 4 successive claim-free years.

    Eligibility

    • Medical screening required for persons over 45 years (50% of expenses will be reimbursed subject to a limit of 2)% of premiums if the person is accepted as a client).

    Happy Family Floater Policy

    As opposed to the individual policy, here the proposer and his/her family, which includes his/her spouse and dependent children, are covered under one plan.Under this, the amount chosen as sum assured is applicable to all members equally i.e. the amount is not per insured member.

    Cover

    Silver Plan
    • Room charges including nurses expenses up to 1% of the sum assured for each day of hospitalisation.
    • ICU charges up to 2% of the sum assured for each day of hospitalisation.
    • Charges for the following: Surgeons, Anaesthetists, Doctors, Consultants, Specialists, Blood,
    • Oxygen, Anaesthesia, Radio/Chemotherapy, Medicines, Drugs, X-Rays, Surgical Equipment,
    • Diagnostic Equipment, Prosthetic limbs and devices, Pacemakers, Dialysis up to sum assured.
    • Pre-existing diseases: Subject to a 4 year waiting period.
    • Treatment expenses for rabid animal bites : Up to Rs.5,000 for immunization.
    • Domiciliary Treatment: 10% of sum assured (overall limit of Rs.25,000).
    • Ambulance charges of Rs.1,000 per illness (overall limit of Rs.3,000 or 1% of sum assured, whichever is lower).
    • Add-on Cover on payment of additional premium: Personal Accident cover for sum assured up to Rs.5 lakhs, can include dependents.
    Gold Plan
    • Room charges including nurses expenses up to 1% of the sum assured for each day of hospitalisation.
    • ICU charges up to 2% of the sum assured for each day of hospitalisation.
    • Charges for the following: Surgeons, Anaesthetists, Doctors, Consultants, Specialists, Blood, Oxygen, Anaesthesia, Radio/Chemotherapy, Medicines, Drugs, X-Rays, Surgical Equipment, Diagnostic Equipment, Prosthetic limbs and devices, Pacemakers, Dialysis up to sum assured.
    • Pre-existing diseases: Subject to a 4 year waiting period.
    • Treatment expenses for any rabid animal: Up to Rs.5,000 for immunization.
    • Domiciliary Treatment: 10% of sum assured overall limit of Rs.50,000.
    • Ambulance charges of Rs.2,000 per illness (overall limit of Rs.6,000 or 1% of sum assured, whichever is lower).
    • Daily cash allowance for hospital stay (maximum 10 day): 0.1% of sum assured, per illness (overall limit of 1.5% of sum assured).
    • Attendant Allowance for hospitalisation of children between 3 years to 10 years (maximum 10 days): Rs.500 for each day of hospital stay, per illness (overall limit of 15 days).
    • Add-On Cover on payment of additional premium: Personal Accident cover for sum assured up to Rs.10 lakhs, can include dependents; Life Hardship cover for survival benefits.

    Sum Assured

    Silver Plan
    • Rs.1.5 lakhs.
    • Co-payment: 10%.
    Gold Plan
    • Rs.6 to Rs.10 lakhs.
    • Co-payment: Not applicable.

    Premiums

    Silver Plan
    • Proposer: Rs.1,320 to Rs.10,400.
    • Each family member: Rs.240 to Rs.7,970.
    • Add-On Cover - Personal Accident: Rs.60 to Rs.300.
    Gold Plan
    • Proposer: Rs.7,140 to Rs.23,640.
    • Each family member: Rs.1,290 to Rs.18,080.
    • Add-On Cover - Personal Accident: Rs.120 to Rs.600.

    Discounts

    • 5% discount on premiums if TPA services are not chosen

    Eligibility

    • Medical screening: Required for persons above 60 years.

    Oriental Bank Mediclaim Policy

    A health insurance policy extended to the customers (and employees) i.e. account-holders of Oriental Bank of Commerce.

    Cover

    • Hospitalisation for minimum of 24 hours.
    • Room charges including nurses expenses up to 1% of the sum assured or Rs.5,000, whichever is less, for each day of hospitalisation.
    • ICU charges up to 2% of the sum assured or Rs.10,000, whichever is less, for each day of hospitalisation.
    • Charges for the following: Surgeons, Anaesthetists, Doctors, Consultants, Specialists, Blood, Oxygen, Anaesthesia, Radio/Chemotherapy, Medicines, Drugs, X-Rays, Surgical Equipment, Diagnostic Equipment, Prosthetic limbs and devices, Pacemakers, Dialysis up to sum assured.
    • Domiciliary hospitalisation.
    • Ambulance charges: Lower of 1% of the sum assured or Rs.1,000 per illness.
    • Daily cash allowance for hospital stay: Actuals limited to Rs.1,000 over the policy term.
    • Pre hospitalisation expenses up to 30 days.
    • Post hospitalisation expenses up to 60 days.
    • Funeral Expenses: Actuals limited to Rs.1,000 over the policy term.
    • Pre-existing conditions subject to a waiting period of 3 years.

    Premium

    • Advance payment only.

    Benefits

    • Cashless Facility: At network hospitals.

    Renewability

    • Cover is valid for an insured member till 80 years of age.

    Policy Period

    • 1 year.

    Exclusions

    • Waiting periods apply for certain diseases/ailments as per the schedule.
    • Outcomes of war, terrorism and events of similar nature.
    • Ailments of or related to T-cell Lymphotropic Virus Types III or LAV or HIV.
    • Vitamins, tonics, circumcision, vaccinations, sex change or plastic surgery, dental procedures not forming part of admissible treatment.
    • Sight-correction surgery, glasses, contact lens, hearing aids etc.
    • Convalescence, congentinal ailments, fertility treatment, STDs including HIV and related diseases, self-harm, psychiatric treatment, misuse of intoxicants. obesity.
    • Maternity/Delivery/Termination and subsequent related illnesses.
    • Non-allopathic treatment.
    • Injuries from hazardous sports/hobbies.
    • Genetic defects, stem cell procedures.
    • Outpatient treatment.

    PNB - Oriental Royal Mediclaim Insurance Policy

    A health insurance policy extended to the customers (and employees) i.e. account-holders of Punjab National Bank.

    Cover

    • Hospitalisation for a minimum of 24 hours stay.
    • Room charges including nurses expenses up to 1% of the sum assured for each day of hospitalisation.
    • ICU charges up to 2% of the sum assured for each day of hospitalisation.
    • Charges for the following: Surgeons, Anaesthetists, Doctors, Consultants, Specialists, Blood,
    • Oxygen, Anaesthesia, Radio/Chemotherapy, Medicines, Drugs, X-Rays, Surgical Equipment, Diagnostic Equipment, Prosthetic limbs and devices, Pacemakers, Dialysis up to sum assured.
    • Ambulance charges on basis of actuals or Rs.1,000 or 1% of the sum assured, whichever is lower.
    • Pre-hospitalisation expenses up to 30 days.
    • Post-hospitalisation expenses up to 60 days.
    • Daycare treatment (subject to conditions).
    • Pre-existing conditions subject to a waiting period of 3 years.

    Eligibility

    • Entry Age: 79 years.
    • Maximum renewability age: Coverage is provided until the insured completes 80 years.

    Benefits

    • Cashless claims

    Policy Period

    • 1 year.

    Exclusions

    • Cover is effective for a certain number of treatments only after a certain period from policy inception.
    • Injuries/ailments resulting from war, terrorism and events of similar nature.
    • Vitamins, tonics, circumcision, vaccinations, cosmetic surgery including change of life, dental
    • procedures not forming part of admissible treatment.
    • Sight-correction surgery, glasses, contact lens, hearing aids etc.
    • General enervation, STDs , HIV , AIDS, HTLD-III, LAV and similar diseases, psychiatric treatment, misuse of intoxicants, obesity.
    • Pregnancy/termination and consequential ailments; reproductive-assistance treatment.
    • Non-allopathic treatment.
    • Self-harm or injuries resulting from involvement in dangerous activities.
    • Birth defects/genetic defects
    • Treatment availed as an outpatient.

    Jan Arogya Bima

    Cover

    • Inpatient hospitalisation.
    • Domiciliary hospitalisation.
    • Expenses of treatment for covered events/ailments/injuries.
    • Pre-hospitalisation up to 30 days.
    • Post-hospitalisation up to 60 days.

    Sum Assured

    • Rs.5,000 p.a. (for each insured member).
    • Sub-limits: None.

    Premium

    • Rs.70 upwards (men); Rs.50 upwards (women); Rs.50 (per dependent below 25 years).

    Eligibility

    • Entry Age: 5 years to 70 years
    • Children: 3 months to 5 years; subject to at least one parent being covered under this plan.

    Exclusions

    • Pre-existing conditions.
    • Claims during the 30 days immediately following policy inception (not applicable to accidental injuries).
    • Pregnancy/Delivery.
    • Cataracts, benign prostatic hypertrophy, hysterectomy, menorrhagia, fibromyoma, hernia, fistula, piles, sinusitis, asthma, bronchitis.
    • Psychiatric/psychosomatic disorders.

    Nagrik Suraksha Policy

    The health insurance offered by Oriental Insurance, known as the Nagrik Suraksha Policy, is a plan that offers policyholders the opportunity to provide for themselves and their family should they lose the ability to provide for them permanently or temporarily. This is a policy that will offer benefits like a cumulative bonus, cover for the cost of a child’s education or even cover for income lost as a result of an accident and a subsequent inability to work. It also covers accidental death and total or partial disability.

    Janata Personal Accident Policy

    The Janata Personal Accident Policy offered by Oriental Insurance is a plan that can offer a sum insured ranging from Rs. 25,000 to Rs. 5 lakhs. The premium that is payable for such a policy is limited to Rs. 15 for every Rs. 25,000 of the sum insured. The policy is one which provides accident benefits that will include covering the individual in case of an accident leading to a permanent disability or even death. This policy is offered to anyone between the ages of 10 years and 80 years and requires a proof of income only if the sum insured is above Rs. 2 lakhs.

    HOPE - Health of Privileged Elders

    The health insurance policy HOPE stands for Health of Privileged Elders and is a policy that can be taken by those who are above the age of 60 years. It offers a sum assured that can range from a minimum of Rs. 1 lakh to a maximum of Rs. 5 lakhs. To be able to take this policy, the policyholder will have to undergo a medical exam. The benefits that the policy will offer will range from cover for accidental injuries, knee replacements, cancer etc. The plan will also cover treatment in a hospital as well as domiciliary treatment up to a certain limit as defined by the policy for each condition.

    Oriental Health Insurance FAQs

    1. How much insurance cover do I need?
    2. Your insurance coverage depends upon a number of factors like age, way of life, city of residence, yearly income etc.


    3. What is the ideal age to get health insurance?
    4. A health insurance should be availed as soon as possible so as to avoid any medical emergency that may arise anytime and anywhere. Health Insurance takes care of hefty expenses that are made in case a sudden serious medical mishap strikes.


    5. What is meant by Family Package cover?
    6. Family Package cover refers to the family floater plan that covers the insurance needs of the full family namely, self, spouse, parents, children and parent-in-laws.


    7. What are the benefits of Family Package Gold scheme over the Silver Plan?
    8. Gold scheme has the following major benefits –

      • Daily Hospital Cash
      • Attendant Allowance for children aged between 3 months to 10 years

    9. Are there any sub-plans in the Family Welfare Package?
    10. Yes. The Family Welfare Package is available in two sub-plans namely, Plan Silver and Plan Gold.


    11. I have a Health Insurance scheme from my Employer, do I still need a personal Health Insurance policy?
    12. Yes. Your Employer-provided policy is usually non-transferrable, so it might be difficult when you change your job. Medical records too are maintained more proficiently in case a single health insurance policy is availed and then continued. Hence, it is advisable to have a private policy too in addition with the insurance scheme offered by your company.


    13. Is maternity/pregnancy covered as a part of Oriental Health Insurance Schemes?
    14. No. However, company provided group insurance schemes generally cover maternity expenses too.


    15. Will get any tax benefit on Oriental Health Insurance schemes?
    16. Yes. Tax exemption is available under section 80D of the Income Tax Act.


    17. What is the minimum entry age of Oriental Health Insurance Policy?
    18. The minimum age is 91 days.


    19. Can the sum-insured be changed?
    20. Yes. It can be changed on policy renewal at the end of annual terms.


    21. What is the maximum age of an applicant?
    22. Upper limit for the age of applicant for health insurance is 80 years.


    23. What are the documents required for applying for Oriental Health Insurance?
    24. A few basic documents like age proof, ID proof and residence proof. In some cases, a medical examination too may be required.


    25. Can I avail cashless hospitalization facility with this insurance?
    26. Yes. Cashless facility for claim settlement is available in various major hospitals of the nation.


    27. What is the range of sum insured that I can choose from?
    28. Sum insured varies between Rs.50000 to Rs.500000


    Examples of Network Hospitals in Major Cities

    CITY NAME OF HOSPITAL
    DELHI DHARAMSHILA CANCER HOSPITAL AND RESEARCH CENTRE
    MUMBAI ARYAN MEDICAL HOSPITAL AND ICU
    KOLKATA ADVANCE MEDICARE & RESEARCH INSTITUTE LTD
    BANGALORE APOLLO HOSPITAL
    CHENNAI AMMA HOSPITAL

    *Disclaimer - This is not an exhaustive list but an indicative representation of hospitals that form a part of the company's wider network.


    News About Oriental Health Insurance

    • Hike on Oriental Health Insurance Premium

      The state owned insurer Oriental Health Insurance has reportedly increased the rates of premium for its health insurance plans by 40%. The sudden spike in rates has incurred complaints from policyholders who own individual and family floater plans.

      People who haven’t made any claims over the past year have also encountered such hikes in the premium rates. The complaints have been reportedly more from policyholders who are in the senior citizen age group. The Insurance Regulatory and Development Authority of India allows revision of premium rates every three years and Oriental Insurance hasn’t been doing any such updates since 2009.

      The deferred rate changes have been brought in after careful calculation and adjusting of anomalies as per the insurer. The average increase of premium across insurers has been 25% per year as allowed by IRDAI. Compared to that, the 40% increase that has happened for Oriental Insurance is pretty standard as per the company. There were a few loopholes in the existing policy terminology which were being taken advantage of by policyholders who had floater policies active. Those loopholes have been sealed and now the insurer has a single premium table for all the members under a floater policy.

      15th April 2015

    • Qatar to have an Oriental Insurance Office!

      The public sector insurance player Oriental Insurance will soon be opening a new office in Qatar. As part of its overseas expansion plan, the insurance company has already opened offices in Dubai, Kuwait and Nepal.


      The company opened as many as 598 new branches all over the country in the year 2013-14, which is an exceptional achievement since almost all private players have been closing down many of their offices in the country.


      Private insurance players do not get much traction in small cities and as such public companies shoulder the responsibility of popularizing risk coverage and fulfilling insurance needs of the people. According to IRDA, Insurance Regulatory and Development Authority of India, around 700 insurance offices were shut down during the year 2013-14 while the number of new offices was just 150.


      28th January 2015

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