Oriental Health Insurance

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

There are two ways to make a 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.

• 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 team will communicate the reasons.

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 csd@orientalinsurance.co.in.

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

• Thumbs-Up

• 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