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Happy Family Floater Mediclaim Plan

Oriental Health Insurance

3/5 based on 24 User Reviews
Happy Family Floater Health Policy offered by Oriental Insurance covers medical expenditures incurred by the whole family under a single sum assured. The family comprises of Self, Spouse, Children, Parents, and Parents-in-laws. There are two plans available in Family Floater– Silver and Gold. With this plan, you can claim for medical costs owing to any ailment/ injury/ accident that necessitates hospitalization.
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Highlights of Oriental Individual Mediclaim Plan

  • One sum insured for the whole family including parents and parents-in-laws
  • No pre-policy medical test for individuals up to the age of 60 years
  • Based on the benefits, policy is available in two options – Silver & Gold
  • Personal Accident Cover and Life Hardship Survival Benefit available at extra premium
  • If you do not prefer the TPA services, you can get additional 5% discount on the premium

Scope of cover

Family Floater Plan

Entry Age

For children : 91 days

Adults :

Minimum : 18 years

Maximum : 65 years

Number of Members Covered

Maximum Members : 7

Maximum Adults : 4

Maximum Children : 4

Sum Insured

Silver: 1 lakh to 5 lakh
Gold: 6 lakh to 10 lakh


discount

Family Discount


Policy Periods Available

1 year


Pre-Policy Medical Check-up

Above 60 years


Important Features

Day Care Treatments

Covers about 24 day-care procedure that does not require a minimum of 24 hours hospitalization.

No-Claim Benefits

You are entitled to a no-claim bonus of 5% up to a maximum of 20% on the premium if you renew the policy without any break.

Organ Donor Cover

You can claim for hospitalization, nursing home charges, surgery, medicines, drugs, pathological tests, and so forth during an organ transplant.

Pre Hospitalization

The insurance company will compensate you for the medical expenses related to your hospitalization 30 days before the hospitalization.

Post Hospitalization

The insurance company will pay you for the medical expenses related to your hospitalization 60 days post hospitalization.

Restore Benefits

Does not offer any restore benefit.

Good to Have Benefits

OPD Expense Cover

You cannot claim for any OPD treatments.

Daily Hospitalization Allowance

In Gold Plan, you get a daily hospital cash up to 0.1% of sum insured per day to a maximum for ten days. The maximum liability is restricted to 1.5% of the sum insured.

Health Check-up

Complimentary health check-up is not available in this plan.

Home Hospitalization/ Domiciliary Hospitalization

You can claim for the costs towards a treatment at home, provided it satisfies the defined conditions.

  • Silver: 10% of sum insured up to a limit of Rs. 25,000
  • Gold: 10% of sum insured up to a limit of Rs. 50,000

Non- Allopathic Treatment Expense Cover

This plan does not cover costs arising out of non-allopathic treatment.

Emergency Ambulance

Under this benefit, you can claim for the ambulance charges as per the below:

  • Silver: Rs.1,000 per illness up to a maximum of Rs.3,000 or 1% of sum insured
  • Gold: Rs.2,000 per illness up to a maximum of Rs.6,000 or 1% of sum insured

ATTENDANT ALLOWANCE

In Gold plan, you can claim Rs.500/- per day of hospitalization per illness up to ten days. The maximum liability is limited to payment for 15 days of hospitalization.

TREATMENT FOR RABID ANIMAL BITE

Under this benefit, you can claim the reasonable expenses up to Rs.5,000/- incurred for immunization injections.

Terms & Conditions

Room Rent / Room Category

The plan has pre-determined limits for room rents and is equal to:

  • 1% of sum insured per day
  • ICU expenses not to exceed 2% of the sum insured per day

Co-Payment

Gold plan does not have any co-payment clause. However, Silver plan has a 10% co-payment.

Waiting Period

Cooling Off Period

A 30 days cooling off period for all claims except any arising out of accidental injuries.

Specific Illnesses

The policy covers some specific diseases/treatments only after 24 months. These include Cataract, Hysterectomy, Myomectomy for Fibroids, and so forth.

Pre-Existing Illnesses

You can claim for any pre-existing conditions after 48 months from the policy start date.

Add-on Covers

Day Care Treatments

At an added premium, you can opt for the below cover.

LIFE HARDSHIP SURVIVAL BENEFIT

At an extra premium, you can also opt for this benefit in Gold Plan.

  • Plan A: 15% of sum insured payable to anyone who survives 180 days from the hospital discharge date
  • Plan B: 25% of sum insured payable to any person who survives 270 days from the hospital discharge date

Value Adds

Eye-cover

This plan does not provide any compensation towards eye cover.

Maternity Cover

This plan does not cover maternity costs.

Dental Coverage

This policy does not cover for any cosmetic/corrective dental treatment.

Recovery Benefit

This plan does not offer any recovery benefit.

Critical Illness Cover

This policy does not provide any additional cover for critical illness.

FREE LOOK PERIOD

For any reason, should you decide not to proceed with the policy, you can return the same and request for a refund within 15 days from the date of receipt of the policy document.

Permanent Exclusions

The Plan will not cover any liabilities towards the treatments of following conditions-

  • whose signs or symptoms first occur within 30 days of the policy period
  • attempted suicide
  • use of alcohol or drug
  • AIDS
  • pregnancy, childbirth, miscarriage, and abortion
  • Congenital disease
  • infertility and in vitro fertilization.
  • hospitalization out of war, riot, strike and nuclear weapons

Review of Oriental Happy Family Floater Mediclaim Plan

If you are looking to buy a health plan mainly to cover your entire family including your parents and parents-in-laws, Oriental’s Happy Family Floater plan is one to consider. With some decent benefits on offer like personal accidental cover and survival benefit, the policy is tailor-made to provide comprehensive health cover. When you weigh the pros and cons of both Silver and the Gold plan, the latter scores the brownie point.

**Reviews and ratings are based only on Benefits and Conditions. Things like Claim Settlement Ratio, Hospital Network have not been covered under product ratings. These are covered under Company ratings.

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