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Oriental Health Insurance

Oriental Health Insurance Co. Ltd. (IRDA Reg. No 556) Is one of the oldest and trusted insurance companies in India.

It has evolved since it was established in 1947, thus catering to newer clients and newer needs. It has its ever growing customer base. Its underwritten premium currently stands at over Rs.7,282 crores.

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.

Plans Offered by Oriental Insurance

Individual Mediclaim Health Insurance

The health insurance policies by Oriental offers coverage against medical expenses on an individual basis. Given below are details of coverage offered.

  • This plan offers basic coverage in the range of INR 50,000 and INR 5,00,000 for individuals between age 3 months and 80 years.
  • In-patient hospitalization expense cover, pre and post hospitalization expense cover, etc. are the benefits provided in this plan.

In case you wish to cover yourself or your family under Individual Mediclaim Health Insurance, please click here.

Personal Accident Policy

Personal Accident Disability Plan by Oriental covers incidences like death or disability due to accident within 12 months from the time of accident.

  • This is a benefit plan which offers coverage in case of accident depending on the plan chosen from the table of benefits.
  • Permanent or partial disability, accident related death, etc. are covered under this plan.

Know all the terms and conditions under this policy before you buy this plan. Contact Coverfox for more details.

Janata Personal Accident Policy

This benefit plan is available for any occupation risk group. The compensation paid and coverage offered is as follows:

  • This plan offers coverage in the range of INR 25,000 to INR 5,00,000 for individuals between age 10 years and 80 years irrespective of age and profession.
  • Death, total disability, permanent partial disability, etc. are covered under this plan.

Before buying this plan know all the terms and conditions under which compensation or benefits are offered. Contact Coverfox for more details.

Nagrik Suraksha Policy

This personal accident disability plan offers compensation for only two conditions namely permanent or temporary disability.

  • This is a personal accident plan which offers coverage in case of permanent or temporary disability.

Note: For any claims under this policy the disability should be more than 40%.

If you want to buy this plan, know all the details about the terms conditions and exclusions, contact Coverfox for any assistance.

Happy Family Silver Plan

This is a family floater coverage

  • This is a family floater plan which offers coverage to the entire family in the range of INR 1,00,000 and INR 5,00,000.
  • Dependents between age 3 months and 25 years and adults above age 18 years can be covered under this plan.
  • A maximum of two members can be covered under this plan.
  • Basic coverage like pre and post hospitalization expense, ambulance charges, etc. are covered under this plan.

Happy Family Gold Plan

  • This is a family floater plan which offers coverage to the entire family in the range of INR 2,00,000 and INR 10,00,000.
  • Dependents between age 3 months and 25 years and adults above age 18 years can be covered under this plan.
  • A maximum of two members can be covered under this plan.
  • In addition to silver plan, the gold plan offers daily cash allowance, add-on coverage for personal accidents, etc. are benefits provided in this plan.

Talk to a Health Insurance Advisor

Understand all the benefits of Oriental Health Plans

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• One of the oldest health insurance companies in India, Oriental Insurance has an evolved model to cater to the newer needs and audience.

• Holds an excellent standing amongst its customers for settling claims and have a very low claim rejection record.

• Provides you deductions on your premium by offering various capping limits. Oriental health insurance fairs okay in terms of the pricing of their products.

Claim process at Oriental Insurance

There are two ways to make claim under a Health Insurance Policy: on cashless basis and on reimbursement basis. In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form. In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for the claim on reimbursement are obtained after hospitalization.

Oriental Health Insurance has a well-defined claim processing system.

Cashless Service: seeking Pre-Authorization

  • Complete the pre-authorization form available at the hospital’s insurance/TPA Desk.
  • Send the completed form via email or fax.
  • Approved letter will be sent by the claim management team. Remember that the claim management team could send an inquiry to the hospital or you before authorization.
  • In case the authorization is rejected, initiate the treatment and file for reimbursement claim.

Reimbursement Claim: Claim Submission

  • Complete the necessary form and submit along with required documents, as per the policy terms and conditions.
  • Necessary documents include discharge summary, prescriptions, bills etc.
  • Approved letter will be sent by the claim management team. Remember that you will be answerable to any queries raised by the claim management team before the letter is issued.
  • In case the claim is rejected, the reasons will be communicated by the team.

In case of any emergencies, you need to inform Oriental Insurance within 24 hours of the admission. In case of planned emergencies, the notification has to reach the company 48 hours prior to the hospitalization. The claim intimation can be done via Oriental Insurance's toll free number 1800-118-485. The same could also be emailed to .

Note: If you are a Coverfox customer, you can directly reach out to us for all your claim-related issues and queries.

Frequently Asked Questions

- I am looking to buy Oriental Insurance Company’s Family Floater plan. What are the key points I should be considering?

Happy Family Floater Health Insurance Policy is available in two plans- Silver and Gold Plan. Silver plan offers coverage between Rs. 1 – 5 lakhs and Gold Plan offers cover between Rs.6-10 lakhs. Also, 10% co-payment applies in Silver Plan which is not the case in Gold Plan. For details on terms and coverage, please refer to the Policy Wordings.

- Is Personal Accident covered in Family Floater Plans?

Personal Accident - Available in Silver and Gold plans

  • In Silver up to Rs.5 lakhs.
  • In Gold up to Rs.10 lakhs.

- Do I have to undergo a pre-policy medical check-up?

Pre acceptance medical examination is not required if the beneficiaries are below 45 years of age.

- What are the major exclusions in Oriental Health policy?

Any pre-existing disease, any expense incurred during first 30 days of cover except injury due to accident, all expenses incurred in respect of any treatment relating to pregnancy and child birth. Treatment for Cataracts, Benign prostatic hypertrophy,Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma,Bronchitis, All Psychiatric or Psychosomatic disorders are excluded from the scope of the cover. For detailed list, please refer the Policy Wordings.

- Which all hospitals are covered under Oriental Insurance's cashless network?

Cashless services are available at a network hospital. To locate a Oriental Insurance network hospital near you, click here.

Review of Oriental Insurance Company Limited


  • Competitive pricing
  • Exceptional claim settlement record and ratio

Could be better…

  • Absence of No Claim Bonus for claim-free years
  • 4 years of waiting period for pre-existing conditions
  • Network of affiliated hospitals for cashless settlement could be stronger
Leave a rating!
2.3 (3 votes)