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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 6 1 2 3 4 5
    • 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
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance with Oriental Insurance from last 1 year, i am not aware of the premium amount as my company pays it. I am happy with the coverage value of this insurance policy and they cover Rs 3 lakhs. I have no claim experience so far with this insurance.
      Was this review helpful? 0
      , bangalore
      Reviewed on May 03, 2018
    • Oriental Insurance Health Insurance
      "Best policy"
      0.5 5.0/5 "Blown Away!"
      I have my health insured with Oriental Insurance from last 2 years, i am not aware of the premium amount as my company pays it. I have a coverage of Rs 2.5 lakhs for this insurance. My claim experience was good as they covered 85% and it was a cashless treatment.
      Was this review helpful? 0
      , bangalore
      Reviewed on Apr 28, 2018
    • Oriental Insurance Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insurance with Oriental insurance from last 4-5 years and it is a good insurance policy to use. This policy has to be renewed every year and i pay a premium of Rs 7000-8000 for this insurance. I have a coverage of Rs 3 lakhs for this insurance and i do not have claim experience.
      Was this review helpful? 0
      , new delhi
      Reviewed on Apr 02, 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
      "Claim procees should be better"
      0.5 3.0/5 "Satisfactory"
      I am using this Oriental Insurance for 5 years. The claim experience was average because I had to go to the doorstep and to submit all the documents. The claim process was very lengthy. In cashless service, they gave a good response. I am paying 6000 rupees per year to renew the policy.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jan 04, 2018
    • Oriental Insurance Health Insurance
      "Good policy"
      0.5 4.0/5 "Great!"
      I have taken a Health Insurance with Oriental Insurance.The policy is taken long back,the premium amount is paid annually 25,000.I don't have claim experience so far.The total policy coverage is six lakhs.The online site is very useful to get the scheme details.
      Was this review helpful? 1
      , bhubaneshwar
      Reviewed on Dec 07, 2017
    • 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 use"
      0.5 4.0/5 "Great!"
      I have Oriental health Insurance policy for past 6years. This policy was provided by my company. The customer support is good with the Oriental health insurance company. This policy covers 4 members in my family. I can claim up up to Rs,2lakhs as the medical coverage.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Nov 07, 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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