Oriental Health Insurance

Investing in a health insurance plan is almost like adding a couple of years to your life. Why? Because your health insurance plan covers all your medical expenses and you can live a stress-free life! One reliable name in this space is Oriental Insurance.

One of the oldest and trusted insurance companies in India.

The company offers health insurance plans that let you cover up to 7 family members, have a lifelong renewal benefit and also cover pre-existing diseases post a waiting period of 4 years. With Oriental Insurance, you wouldn’t have to worry about a thing during any unforeseen circumstances.

Features of Oriental Health Insurance

  • No. of members- Oriental Health Insurance plan covers maximum 7 members of your family with up to 3 children and 4 adults.
  • Lifelong Renewal – Oriental Health Insurance offered are lifelong renewable, hence it saves you from the financial burden and stress caused by a medical emergency and keeps you well prepared to handle any situation.
  • Pre & Post hospitalization cover- The plan covers medical expenses for 30 days prior to hospitalization and 60 days post hospitalization only for related medical expenses.
  • Health Check-ups – Offers health check-up for insured after every 4 continues claim-free year.
  • Pre-existing diseases- Pre-existing diseases are covered after 4 years of waiting period
  • Co-payment- The insured has to pay 10% of the claim amount as co-payment.
  • Claim Settlement Ratio - The incurred claim settlement ratio of Oriental Health Insurance for F.Y. 2017 - 18 is 113.86%.

Benefits of 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.

Plans offered by Oriental Health Insurance

Note: All information regarding benefits and exclusions has been sourced from the official website of Oriental Health Insurance.

Individual Mediclaim Health Insurance

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

Benefits and Features Of Individual Mediclaim Health Insurance

What is Covered?- Hospital admission of minimum 24 hours.
- Related medical expenses incurred 30 days prior to hospitalization.
- Related medical expenses incurred within 60 days from date of discharge.
- Specified / Listed procedures requiring less than 24 hours hospitalization (day care).
- Dental Treatment arising out of accident.
- Ambulance Charges, Donor Expenses, Domiciliary Treatment.
- Ayurvedic, Unani and Homeopathic treatment in Govt. Hospitals/ Colleges.
- Daily Hospital Cash.
- PA as optional cover.
- Voluntary co-pay option.
- Family Discount.
- Entry Load.
Waiting Period- Initial waiting period: 30 days for all illnesses (not applicable on renewal or for accidents).
- Pre-existing diseases: Covered after 48 months.
Cashless Facility- Cashless services of admissible expenses in Network
Renewal Benefits- Grace Period of 30 days.
- Policy is ordinarily renewable.
- Adjustment of premium on renewal in lieu of OMP policy.
- Health Checkup Benefit For every block of 3(three) claim free policy years for the insured persons up to 0.75% of average Sum Insured, subject to maximum Rs.3000/- per insured person.

Exclusions

Major Exclusions- War and war like operations.
- Circumcision, sex change surgery, cosmetic surgery & plastic surgery.
- Substance abuse, self-inflicted injuries.
- STDs and HIV/AIDS.
- Any hospital admission primarily for investigation / diagnostic purpose.
- Pregnancy (except ectopic), infertility, congenital/genetic conditions & stem cell
- Treatment outside India.
- Correction of eyesight, cosmetic dental surgeries.
- Any kind of admission fees, registration fees levied by the hospital.

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

Group Mediclaim Policy

Benefits and Features Of Group Mediclaim Policy

Sum AssuredMinimum sum insured is Rs 50,000/- and in multiples of Rs 25,000/- upto Rs 2, 00,000/- . Beyond the Sum Insured of Rs. 200000/- in multiples of Rs. 50000/- upto Rs 500000/-.
Group DiscountThe Group Discount depending upon total number of insured persons (families) at inception of the policy is allowed at the following scale.
Maternity BenefitThis is an optional cover, which can be obtained on payment of 10% of the total basic premium for all the insured persons under the policy. New born child shall be covered from day one up to the age of 3 months and expenses incurred for treatment taken in hospital as in patient shall only be payable within the specified sum insured of Rs 50,000/- under Maternity benefit extension.
Cashless FacilityYes
In-patient ExpensesYes, patient has to be admitted for a minimum of 24 hours.
Pre/Post Hospitalization ExpensesUpto 30 and 60 days.

The Group Mediclaim Policy is for any Group/Association/ Institution/ Corporate Body of more than 50 persons/families, provided it has a central administration point. Each insured individual should cover all eligible members under one group policy only.

Exclusions

Major Exclusions- War and war like operations.
- Circumcision, sex change surgery, cosmetic surgery & plastic surgery.
- Substance abuse, self-inflicted injuries.
- STDs and HIV/AIDS.
- Any hospital admission primarily for investigation / diagnostic purpose.
- Pregnancy (except ectopic), infertility, congenital/genetic conditions & stem cell
- Treatment outside India.
- Correction of eyesight, cosmetic dental surgeries.
- Any kind of admission fees, registration fees levied by the hospital.

Jan Arogya Bima Policy

Benefits and Features Of Jan Arogya Bima Policy
What is Covered?- Hospital admission of minimum 24 hours.
- Related medical expenses incurred 30 days prior to hospitalization.
- Related medical expenses incurred within 60 days from date of discharge.
- Specified / Listed procedures requiring less than 24 hours hospitalization (day care).
Waiting PeriodInitial waiting period: 30 days for all illnesses (not applicable on renewal or for accidents).
Specific waiting period for 1 year for listed diseases.
RenewalYes
PayoutReimbursement of covered expenses.

Exclusions

Major Exclusions- Any hospital admission primarily for investigation / diagnostic purpose.
- Pregnancy, infertility, congenital/genetic conditions.
- Treatment outside India.
- Circumcision, sex change surgery, cosmetic surgery & plastic surgery.
- Substance abuse, self-inflicted injuries, STDs and HIV / AIDS.
- War or war like operations or breach of law, etc.
- Any kind of admission fees, registration fees levied by the hospital.
- Pre-existing diseases.

Personal Accident Policy

Under this policy, you/your beneficiary will be entitled to compensation in the event of insured sustaining injuries, solely and directly from an accident caused by violent, visible and external means, resulting into death or disablement, be it temporary or permanent. Personal Accident Disability Plan by Oriental covers incidences like death or disability due to accident within 12 months from the time of accident.
**Benefits and Features Of Personal Accident Policy**
What is Covered?(a) If such injury shall within Twelve calendar months of its occurrence be the sole and direct cause to the death of the Insured, the Capital Sum Insured (CSI) stated in the Schedule.
(b) If such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the total and Irrecoverable loss of:
i) Sight of both eyes or of the actual loss by physical separation of two entire hands or two entire feet or of one entire hand and one entire foot, or of such loss of sight of one eye and such loss of one entire hand or one entire foot, the Capital Sum Insured in the Schedule.
ii) Use of two hands or two feet, or of one hand or one foot, or of such loss of sight of one eye and such loss of use of one hand or one foot, the Capital Sum Insured stated in the Schedule.
(c) If such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of:
i) the sight of one eye, or of the actual loss by physical separation of one entire hand or of one entire foot, fifty percent (50%) of the Capital Sum Insured stated in the schedule:
ii ) total and irrecoverable loss of use of hand or a foot without physical separation, fifty percent (50%) of the Capital Sum Insured stated in the Schedule.
NOTE: For the purpose of Clause (b) and Clause (c) above, ‘physical separation’ of a hand or foot means separation at or above the wrist and/or of the foot at or above the ankle respectively. **
(d) If such injury shall, as a direct consequence thereof, immediately, permanently, totally and absolutely, disable the Insured from engaging in any employment or occupation of any description whatsoever, then a lump sum equal to hundred percent (100%) of the Capital Sum Insured.
Worldwide CoverYes

Exclusions

Major Exclusions- Any payment, in case of more than one claim under the Policy, during any one period of insurance by which the maximum liability of the Company in that period would exceed the sum payable under sub-clauses (a) of this Policy.
- Payment of weekly compensation until the total amount shall have been ascertained and agreed.
- Payment of compensation in respect of Death, Injury or Disablement of the Insured (a) from intentional self-injury, suicide or attempted suicide, (b) whilst under the influence of intoxicating liquor or drugs (c) whilst engaging in Aviation or ballooning or whilst mounting into, dismounting from or traveling in any aircraft other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world, (d) directly or indirectly caused by venereal disease/s, or insanity, (e) arising or resulting from the insured committing any breach of law with criminal intent.
- Payment of compensation in respect of Death, Injury or Disablement of the Insured due to or arising out of or directly or indirectly connected with or traceable to: War, Invasion, Act of foreign enemy, Hostilities (whether war be declared or not), Civil War, Rebellion, Revolution, Insurrection, Mutiny, Military or Usurped Power, Seizure, Capture, Arrests, Restraints and Detainment of all kings, princes and people of whatever nation, condition or quality so ever.
- Payment of Compensation in respect of death of, or bodily injury or any disease of illness of the Insured:
- Directly or indirectly caused by or contributed by or arising from ionizing radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purpose of this exception, combustion shall include any self-sustaining process of nuclear fission.
- Directly or indirectly caused by or contributed by or arising from nuclear weapon material.
- Provided also that the due observance and fulfillment of the terms and conditions of this Policy (which conditions and all endorsements hereon are to be read as part of this Policy) shall so far as they relate to anything to be done or not to be done by the insured be a condition precedent to any liability of the Company under this Policy.
- Pregnancy Exclusion Clause: The Insurance under this Policy shall not extend to cover death or disablement resulting directly or indirectly caused by, contributed to or aggravated or prolonged by childbirth or from pregnancy or in consequence thereof.

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

Janata Personal Accident Policy

Under this policy, you/your beneficiary will be entitled to compensation in the event of bodily injury, resulting solely and directly from accident caused by outward violent and visible means and such bodily injury within the twelve calendar months of its occurrence be the sole and direct cause of:

Table Of BenefitsSum Insured Payable
A.Death100% of S.I.
B.Total and irrecoverable loss of sight of both eyes or loss of use of two hands or feet or loss of sight of one eye and loss of use of hand or foot.100% of S.I.
C.Total and irrecoverable loss of sight of one eye or loss of use of one hand or foot.100% of S.I.
D.Permanent total disablement due to accident100% of S.I.

Benefits and Features of Janata Personal Accident Policy

What is Covered?- Minimum sum insured of Rs.25,000/- per person per annum and the maximum sum insured is to be limited to Rs.5,00,000/- person per annum.
- The rate of premium is Rs.15/- for a sum insured of Rs.25,000/-. The sum insured shall be increased in multiples of Rs.25,000/- and premium is charged accordingly

Exclusions

Major Exclusions- Any existing disability.
- Death injury or disablement due to intentional self injuries, suicide or attempted suicide.
- Disablement or death under influence of liquor or drug.
- Death or disablement during racing, shooting, big game hunting, mountaineering, ice hockey, winter sports.
- Insanity.
- Breach of law with criminal intention.
- War group of perils.
- Nuclear group of perils.

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

  • 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 policy provides Personal Accident cover (Death/Permanent Total Disablement, Loss of Limb(s) & Permanent Partial Disablement) and reimbursement of Hospitalization Expenses to the insured/beneficiary.

Cumulative BonusCompensation payable under hospitalization reimbursement section is increased by 5% for each completed claim free period of 12 months during the period of insurance subject to maximum amount of such increase being not more than 20% of the sum insured, as specified in the schedule of insurance.
Funeral ExpensesExpenses incurred in the carriage of dead body of the Insured to his place of residence and funeral charges (death due to accident and the claim otherwise being admissible under the PA section of the policy) shall be reimbursed subject to maximum of 2% of the sum insured as specified in the schedule of insurance under PA section of this policy, or Rs. 2,500, whichever is less.
Education Fund If the Insured Person has one dependent child below the age of 23 years on the date of accident, an amount equal to 10% of original Sum Insured as specified in the PA section of the policy subject to maximum of Rs.5,000/-
- If the Insured person has more than one dependent child below the age of 23 years on the date of accident an amount equal to 10% of original Sum Insured as specified in the PA section of the policy subject to maximum of Rs.10,000/-

Exclusions

Major ExclusionsWar Risk: Bodily injury as a consequence directly or indirectly of war, invasion, act of foreign enemy, hostilities (Whether war be declared or riot) civil war, rebellion, revolution, insurrection, military or usurped power, confiscations nationalization, civil commotion or loot or pillage in connection herewith.
Confiscation: Any bodily injury to the Insured person due to confiscation, requisition or destruction by order of any government, public or local authority.
Nuclear Risk: Any bodily injury to the Insured person, consequential loss, legal liability, directly or indirectly caused by or contributed by arising from:
a) Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the Combustion of nuclear fuel.
b) The radioactive, toxic, explosive or the hazardous properties of any nuclear assembly or nuclear component.
  • 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

Features and Benefits of Happy Family Silver Plan

What is Covered?- 3 Plans - Silver, Gold & Diamond - Sum Insured (SI) Rs.2 to Rs.20 lakhs.
- Hospital admission of minimum 24 hours.
- Related medical expenses incurred 30 days prior to hospitalization & 60 days from date of discharge. Specified / Listed procedures requiring less than 24 hours hospitalization (day care).
- Cover for 11 critical illnesses on benefit basis.
- Daily Hospital Cash Allowance benefit of 0.1% of SI per day, max 10 days per illness limited to 1.5% of SI in a policy period - Gold and Diamond Plan.
- Attendant Allowance - Rs.500 & Rs.1000 per day of hospitalisation, in Gold Plan & Diamond Plan respectively, max 10 days per illness, limited to 15 days in a policy period - in respect of insured persons above the age of 90 days to 10 years. - Ambulance Charges - Rs 1000 to Rs.3000 per illness, limited to Rs.3000-Rs.8000 per policy period.
- Donor Expenses when insured is the Recipient.
- Organ Donor Benefit when insured is the Donor. Medical Second Opinion on reimbursement basis Maternity Expenses cover up to 2.5% of SI, in Diamond Plan New born Baby cover up to 2.5% of SI, in Diamond Plan Restoration of SI under 2 options-50% & 100%. Ayurvedic, Siddha, Unani and Homeopathic treatment. Optional Covers - Restoration of SI.
- Personal Accident, Life Hardship Survival benefit.
- Extension of policy covering SAARC countries.

Exclusions

Major Exclusions- Any hospital admission primarily for investigation / diagnostic purpose.
- Pregnancy (covered in Diamond Plan), infertility, external congenital/genetic conditions.
- Circumcision, sex change surgery, cosmetic surgery & plastic surgery.
- Refractive error correction, hearing aids.
- Substance abuse, self-inflicted injuries.
- STDs and HIV / AIDS.
- War or war like operations or breach of law, etc.
- Any kind of admission fees, registration fees levied by the hospital.

This is family floater coverage

  • 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 Rs.2 lakh to Rs.10 lakh.
  • 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.

Reasons to buy Oriental Health Insurance Plans

One of the primary reasons to buy Oriental Health Insurance Plans is their excellent claim settlement ratio and superior customer support. They are one of the oldest and most trusted insurance providers in India.

Claims Process at Oriental Health Insurance

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.

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 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.

Oriental Health Insurance Network Hospitals

You can easily locate the preferred network hospital from the official website of Oriental Health Insurance. You need to enter the State, followed by the city of residence, and the entire list of hospitals will be displayed along with their address.

Oriental Insurance Mediclaim Renewal

In order to renew your Oriental Insurance Mediclaim Policy, simply visit the official website of the insurer and log in with your registered user ID and Password. Once logged in, select the online renewal option and make the payment via net banking/credit/debit.

Documents required to buy Oriental Health Insurance

  • KYC - Proof of Identity and Proof of Address
  • Proof of Age - Birth Certificate of each family member
  • Medical checkup/report in certain cases
  • Proof of Income for some policies

Oriental Health Insurance Customer Care Toll Free No

For all query/guidance, you can use the Toll free number: 1800118485 Or 011- 33208485 (Normal Charges Apply).

For any Issues related to the portal: Please contact - portal.support@orientalinsurance.co.in

Review of Oriental Health Insurance

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

Frequently Asked Questions on Oriental health insurance

How to pay Oriental health insurance premium?

What are the modes of payment available? - You can make the premium payment for Oriental Health Insurance via cash at the branch or do an online payment. Online payment can be made via net banking/credit or debit card.

How can I check policy status for Oriental health insurance?

If you are a registered policy holder, simply login to the e-Portal with your registered user ID and Password. Once logged in, you can check all the details of your policy.

What is the policy cancellation process for Oriental health insurance Plan?

You can cancel your existing Oriental Health Insurance Plan by submitting the policy documents at the nearest branch. The premium will be refunded post deduction of cancellation and other applicable charges.

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