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Oriental Health Insurance Claims Procedure

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Cashless Treatment

Customer Service

Medical Coverage

Claim Experience

To make health insurance claims with Oriental Insurance, the customer will be required to visit the insurance provider’s website and login using the unique user ID and password provided by the company. Then enter the “Claim” tab and you will gain access to the claim forms where you will have to enter the policy number against which the claim is intimated. The form must then be submitted online following which the company will receive your intimation. The intimated claim forms can be viewed via “My Intimated Claims”, but individuals will have to personally pay a visit to an office of the Oriental Insurance Company for the submission of the detailed claim form along with other necessary documents as it serves as an evidence for the registration of claims with the company. The claim will appear on the user’s homepage only after registration with the company is complete.

Claims must be sent to the company in writing, be it in the form of e-mails or letters. Letters can be sent to the registered office at Oriental House, A-25/27, Asaf Ali Road, New Delhi – 110002. In case a customer wishes to contact the company for information related to claims, calls can be made to 011-43659595.

Incurred Claim Ratio for Oriental Health Insurance:

The Incurred Claim Ratio of an insurance company is one of the main indicators of its performance and it helps prospective customers to get a better sense of the company’s reliability. The Incurred Claim Ratio for Oriental Health Insurance is as follows:

For 2015-16:

Net Earned Premium (in lakhs INR) Net Claims Paid (in lakhs INR) Incurred Claims Ratio (Percentage)
235960 270132 114.48

For 2014-15:

Net Earned Premium Net Claims Paid Incurred Claims Ratio
Rs.200,410 lacs Rs.234,517 lacs 117.02%

It is crucial to note that the Incurred Claim Ratio of a company is not the only parameter against which it must be judged as there could be factors that may not be taken into consideration when computing the same. A comprehensive comparison of insurance policies and the record of the companies that provide these policies must be checked before choosing one.

How to Make Claims?

  1. In Case of Cashless Treatment:

    • Procedure to File a Claim (Planned / Emergency Hospitalisation):

      Claim forms in case of cashless treatment must be pre-authorised by the network hospital / day care centre / nursing home. Insured individuals can claim Third party Accident once the TPA receives the relevant medical details from the network provider / insured individual. The insurance company will look at the medical information and determine whether or not that particular individual is eligible for claims.

      Should the company find the information satisfactory, a guarantee of payment or pre-authorisation letter will be sent to the day care centre / nursing home / hospital. This letter will contain details regarding the guaranteed sum that the customer will receive. If the insured individual cannot for whatever reason furnish the requisite medical information as requested by the TPA, the TPA will determine whether or not pre-authorisation can be provided to the customer. The TPA will notify the customer in writing if it does not accept pre-authorisation and the insured individual will have to undergo treatment based on the advice of his / her treating doctor / medical practitioner. After treatment, the claim papers can be submitted in full to the TPA to facilitate the reimbursement of claims. The claim documents must be sent to Oriental House, A-25/27, Asaf Ali Road, New Delhi – 110002.

  2. In Case of Reimbursement of Treatment Expenses:

    • Procedure to File a Claim:

      The customer must provide the insurance company with details regarding the particulars of the policy number, the insured individual’s name in whose name the claim is going to be made, nature of injury / illness, and the name and contact details of the nursing home / hospital / medical practitioner.

    • Documents Required:

      The customer will have to submit certain documents for the claims process to be initiated by the Oriental Insurance Company. These documents include a copy of the claim form along with a Xerox of premium and policy receipt, medical treatment report / hospital discharge report, original test reports (EGG / Sonography / X-Rays, etc.), medical recovery report, employer’s leave certificate, information regarding medical expenses such as cash memos / original bills / prescriptions, registration number of the nursing home / hospital (in case the nursing home / hospital is not registered, a certificate from the treating doctor must be provided and said certificate must contain details regarding the number of beds in the treatment facility, availability of qualified 24/7 staff / nurses and doctors and fully equipped operation theatre in the nursing home / hospital), and first information report from the police containing all details about the accident.

    • Claims Process:

      The TPA must be intimated about the claim within seven days after the date on which the insured individual was hospitalised. The final claim documents must be sent along with cash memos / original bills from the hospital and other documents that are mentioned in the claim form before the completion of 30 days from the date on which the insured individual was discharged from the hospital. Any other information or documents requested by the TPA / company must also be provided to the TPA / company to ensure easy facilitation of claims. The documents can be sent to the registered office at:

      Oriental House, A-25/27, Asaf Ali Road, New Delhi – 110002.

This Insurance Company has not partnered with BankBazaar.com. For more details, please visit its website/branch office. The trademarks, logos and other subject matters of intellectual property belong to their respective owners.

GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

Oriental Health Insurance Claims Procedure Reviews

Page 1 of 5 1 2 3 4 5
  • Oriental Insurance Health Insurance
    "Good service"
    0.5 5.0/5 "Blown Away!"
    I have a health insurance policy with Oriental Insurance, i never had any claim Experience with this policy , this policy cover accidental claim and i pay premium on yearly basis ,and it use to get auto debited my account, so far I did not face any issues till date.
    Was this review helpful? 0
    , mumbai
    Reviewed on Dec 30, 2018
  • Oriental Insurance Health Insurance
    "Good Policy"
    0.5 4.0/5 "Great!"
    I have a health insurance policy with Oriental insurance from last 3 years, i pay a premium of more than Rs 10000 for this insurance policy. There was no claim experience so far with this insurance. This policy has a coverage value of Rs 5 lacs.
    Was this review helpful? 0
    , ghaziabad
    Reviewed on Dec 29, 2018
  • Oriental Insurance Health Insurance
    "Good policy"
    0.5 5.0/5 "Blown Away!"
    My health insurance policy was taken with Oriental. My total family has been covered in this policy. Within 5 hours, they have processed the claim and the settlement amount was satisfied and they have provided me a cashless treatment facility even though the list of hospital list was not much good. Coverage value of the policy is 5 lakhs.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 21, 2018
  • Oriental Insurance Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have been using my health insurance with Oriental bank insurance, i took mediclaim with this institution, they have tie up with many hospital and they have shared me those hospital location, and this insurance company is not dealing directly, they have agent involve with me and those agent are not good, like for 1,00,000 claim i get that 80% easy but for 20% i am struggling lot.
    Was this review helpful? 0
    , kolkata
    Reviewed on Dec 19, 2018
  • Oriental Insurance Health Insurance
    "Very good health insurance policy"
    0.5 5.0/5 "Blown Away!"
    Past 7 years i have been renewing the health insurance policy with Oriental company. My entire has been covered by this policy. I pay the premium amount of Rs. 10000 per year. They are offering a coverage amount of Rs. 10 lakhs. So many hospital has tie up with oriental insurance. I had no claim experience till now.
    Was this review helpful? 0
    , new delhi
    Reviewed on Nov 28, 2018
  • Oriental Insurance Health Insurance
    "Excellent"
    0.5 4.0/5 "Great!"
    I have a health insurance policy with Oriental which was provided by company.It is for entire family and policy coverage for per person is 2.5L.There is no claim experience. They have good network of hospital for the cashless facility. They cover all types of minor, major diseases and critical illness.
    Was this review helpful? 0
    , chennai
    Reviewed on Nov 17, 2018
  • Oriental Insurance Health Insurance
    "Satisfied health insurance policy"
    0.5 5.0/5 "Blown Away!"
    They have provided the very good services. They have not deducted any un-respected amount. I can use the policy upto 85000. I had a claim experience with oriental insurance in the year of 2016. I'm paying the premium of Rs. 16000 per day for my family. The customer care people also given a proper response. The hospital list was good and the cashless treatment also available.
    Was this review helpful? 2
    , mumbai
    Reviewed on Aug 01, 2018
  • Oriental Insurance Health Insurance
    "Best policy"
    0.5 5.0/5 "Blown Away!"
    I have my health insured with Oriental insurance from last 9 years, it is a family coverage which covers dependents and spouse. I have a coverage value of Rs 50 lakhs for this insurance policy. I pay a premium of Rs 25000 and i have no claim experience so far from this insurance.
    Was this review helpful? 0
    , ghaziabad
    Reviewed on May 31, 2018
  • Oriental Insurance Health Insurance
    "Good Policy"
    0.5 4.0/5 "Great!"
    I have my health insured with Oriental insurance from last 7-8 years, i am happy with the coverage value of this insurance policy. My claim experience was good with this insurance and the coverage is up to 3-4 lakhs. I am not aware of the premium amount as my company pays it.
    Was this review helpful? 0
    , kolkata
    Reviewed on May 11, 2018
  • Oriental Insurance Health Insurance
    "Good Policy"
    0.5 4.0/5 "Great!"
    I have my health insured with Oriental insurance from last 4-5 years and it is a good policy to use. I have a coverage value of Rs 3-4 lakhs for this insurance policy. I have no claim experience with this insurance policy. A premium of Rs 15000 has to be paid for this insurance policy.
    Was this review helpful? 0
    , gurgaon
    Reviewed on May 07, 2018
  • Oriental Insurance Health Insurance
    "Claim process is smooth"
    0.5 5.0/5 "Blown Away!"
    My health insurance is with Oriental insurance. Six months back I had a claim for my spouse and I had claim 33 to 35K. I submitted the documents and and I got the reimbursement soon. I got 99% of the claim amount. A very easy and smooth process. The medical coverage is for four lakhs.
    Was this review helpful? 0
    , vadodara
    Reviewed on Mar 01, 2018
  • Oriental Insurance Health Insurance
    "Good policy to use"
    0.5 4.0/5 "Great!"
    I have a health insurance policy with Oriental Insurance from last 5 years, this policy has to be renewed every year and i pay a premium of Rs 11000 for this insurance. I have not taken any cashless treatment and i do not have claim experience so far with this insurance. I have a coverage of Rs 3 lakhs which is satisfactory for this insurance.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Feb 05, 2018
  • Oriental Insurance Health Insurance
    "Good policy to use"
    0.5 4.0/5 "Great!"
    I have a health insurance with Oriental Insurance from last 7 years and it is one of the good insurance policy to use. This policy has to be renewed every year and i pay a premium of Rs 14000. I do not have claim experience and i have not taken any cashless treatment. I have a coverage of Rs 3 laksh which is satisfactory.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 29, 2018
  • Oriental Insurance Health Insurance
    "Best insurance policy"
    0.5 5.0/5 "Blown Away!"
    I have taken a Health insurance with Oriental Insurance.I pay my premium amount through online and is 9000 annually.I have claim experience once they had covered 100% cashless treatment.Net banking is good and efficient to use.This policy is meant for individuals too.
    Was this review helpful? 0
    , chennai
    Reviewed on Jan 24, 2018
  • Oriental Insurance Health Insurance
    "Good policy"
    0.5 5.0/5 "Blown Away!"
    I have a Heath Insurance with Oriental insurance.Its been 7 months since i have taken the policy .The premium amount is 9300 paid annually.I pay it through an ECS payment.I have claim experience for four times they had covered 100% of the bill amount.
    Was this review helpful? 1
    , hyderabad
    Reviewed on Dec 06, 2017
  • Oriental Insurance Health Insurance
    "Good Policy to hold"
    0.5 5.0/5 "Blown Away!"
    I'm using this health insurance policy with ORIENTAL INSURANCE for the last 10 years. I pay a premium of around Rs. 10000 annually. I have a claim experience which is good and quick. I feel this is a very secured and good policy to have that's why I renew this policy every year.
    Was this review helpful? 0
    , kolhapur
    Reviewed on Oct 16, 2017
  • Oriental Insurance Health Insurance
    "Good policy to use"
    0.5 4.0/5 "Great!"
    The Oriental health insurance policy has been given by my company., This policy covers 2members which is myself and my spouse. This policy has the coverage of Rs,1laksh. I never had any claim experience with this policy. The coverage is good and I am satisfied with the policy.
    Was this review helpful? 0
    , dibrugarh
    Reviewed on Oct 07, 2017
  • Oriental Insurance Health Insurance
    "Safe health insurance policy"
    0.5 4.0/5 "Great!"
    Holding a Oriental health insurance policy for more than 5 years. I never had any claim experience with the policy. This policy covers 3 members which is myself, my spouse and my children. I pay around Rs.11,000 to renew the policy every year. I am happy holding this policy with oriental insurance.
    Was this review helpful? 0
    , chennai
    Reviewed on Oct 04, 2017
  • Oriental Insurance Health Insurance
    "Good health policy"
    0.5 4.0/5 "Great!"
    Having a Oriental health insurance policy for more than 4 years. This policy covers 4 members, that is myself my parents,my spouse and my children. The customer service is good with policy. They give intimation to renew the policy very year before the due dates. I never had any claim experience with this policy so far. I pay Rs.18,000 to renew the policy every year.
    Was this review helpful? 0
    , new delhi
    Reviewed on Sep 02, 2017
  • Oriental Insurance Health Insurance
    "Good policy to use"
    0.5 5.0/5 "Blown Away!"
    I got the Family Health Benefit medical card which was provided by my company . I use this card for almost 3 years. This policy covers almost 4 members that is myself and my family. My company pays around Rs.1,50,000 every year to renew this policy. I never had any claim experience so far. I am happy holding this health insurance policy from oriental health insurance.
    Was this review helpful? 0
    , visakhapatnam
    Reviewed on Aug 22, 2017
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