Oriental Health Insurance Review

Introduction of Oriental Health Insurance Review

Our today’s topic is Oriental Health Insurance Review. Oriental health insurance provides a wide range of insurance options to the rural and urban populations of India. The company has spread its presence across the country with 31 regional offices and over 1800 operating offices. The company has a claim settlement ratio of nearly 84%.

Here are the advantages, benefits, types of health insurance schemes and a general overview of Oriental Health Insurance discussed in brief.

About Oriental Health Insurance

  1. Oriental Health Insurance Company has over 4300 network hospitals.
  2. The Incurred Claim Ratio is nearly 114.
  3. Lifetime renewability facility.
  4. Waiting period is 4 years.

Features of Oriental Health Insurance

  1. Availability of cashless treatment in network hospitals. When you gat hospitalized is any of the network hospitals, you can enjoy this facility.
  2. No initial screening or individuals ageing upto 55 years. If a pre-existing illness prevents you to get compressive insurance coverage, check the plans offered by Oriental Health Insurance. This is a big reason for Oriental Health Insurance success over others.
  3. The health plans are tailor made after considering the particular needs of various individuals. To fulfill the insurance expectations, Oriental offers comprehensive covers.
  4. In case of hospitalization, you get daily cash according to your sum insured.
  5. Oriental has formulated plans to offer the maximum sum insured to their customers.
  6. Oriental Health Insurance plans are loaded with discounts and who doesn’t like it? Enjoy attractive discounts on premiums, which make investing worthy.
  7. Oriental offers very simple, quick and hassle-free claim settlement to its buyers.
  8. You can enjoy the insurance benefits lifelong if, you are covered by any Oriental Health Plan. Lifetime renewability is available no matter how old you get.
  9. Last but not the least. If you have not so good experience with Oriental Health Insurance, you can switch to another insurance provider of your choice very easily.

Advantages

  1. In-patient hospitalisation costs like Boarding expenses, Room rent, Nursing charges, ICU charges, OT charges, cost of Medicines are covered.
  2. Pre-hospitalization costs cover for upto 30 days prior to get admission in hospital.
  3. Post-hospitalisation costs cover for upto 60 days.
  4. Daily cash benefit is available for non-medical expenses.
  5. Domiciliary treatment costs for upto a specific time period are covered.
  6. It also cover day care procedures.
  7. In case of Organ transplant, Organ donor charges are covered according to the selected plan.
  8. Maternity coverage for infant and mother is available.
  9. Convalescence coverage is also offer in selected policies.
  10. Tax deduction benefit on premium payments are offered under Section 80D of the Income Tax Act, 1961.

Health Insurance Plans by Oriental Health Insurance

Oriental Individual Mediclaim Plan

I. Sum assured – Rs. 50,000 – Rs. 5 Lakhs.
II. Pre-existing disease cover – 4 years.
III. Medical test – mandatory for individuals over the age of 45 years.
IV. Pre and post-hospitalization costs – 30 days and 60 days respectively.

Features

I. Hospitalization costs incurred due to sudden illnesses, diseases, or accidents are covered.
II. Applicants aged upto 80 years are eligible to avail of this scheme.
III. Cashless facility for ailment in-network hospitals through dedicated Third Party Administrators desk.

Coverage

I. Room rent, Boarding expenses, and Nursing expenses to the quantum of 1% of the sum insured or Rs. 5,000/day(whichever is less).
II. Intensive Care Unit expenses upto 2% of the sum insured or Rs. 10,000/day(whichever is less).
III. Other expenses like Surgeon, Anesthetist, Medical practitioner, and Consultants fees.
IV. Expenses incurred due to Anesthesia, Blood, Oxygen, OT charges, Medicines, and Drugs.
V. Surgical procedures like pacemaker, Diagnostic test, and X-ray tests.
VI. Expenses due to Ambulance services are covered upto 1% of the sum insured or Rs. 2,000(whichever is less).
VI. Domiciliary treatment expenses shall be reimbursed for 3 days subject to a maximum limit of 20% of the basic sum insured.

Exclusions

I. Any expenses towards newly incepted diseases within 30 days waiting for period post commencement of plan.
II. Claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports or activities.
III. Medical expenses incurred due to Obesity, Hormone replacement therapy, Sex change, Genetic disorders, Stem cell implantation, etc.
IV. Expenses towards Naturopathy, Experimental Medicines, Acupressure, Acupuncture, etc.
V. Expenses towards the treatment of Nuclear, War, or Invasion injuries.
VI. Treatments for Cataract, Benign Prostatic hypertrophy, Hernia, Fistula of Anus, Asthma, Bronchitis, etc.

Oriental Happy Family Floater Plan

I. Sum assured – Rs. 1.5-10 Lakhs.
II. Pre-existing disease cover – 4 years.
III. Medical test – mandatory for individuals over the age of 60 years.
IV. Pre and post hospitalization cost – NA.

Features

I. Single sum insured for entire family residing in India.
II. Attractive discounts on premiums.
III. Available in 2 variants, Gold Plan and Silver Plan.

Gold Plan

I. The sum insured amount ranges between Rs. 6-10 Lakhs on a floater basis.
II. Daily cash allowance cover as per sum insured limit.

Coverage

I. Expenses incurred for room rent, boarding, and nursing expenses are covered upto 1% of the sum insured per day.
II. ICU expenses are covered upto 2% of the sum insured per day.
III. Expenses towards Surgeon, Anesthetist, Consultant fees are covered against the limit of sum insured.
IV. Cost of purchasing Blood, Oxygen, OT charges, Medicines and Drugs, X-ray, Dialysis, Chemotherapy, pacemaker, Artificial limb, etc are covered.
V. Ambulance expenses are covered upto Rs. 2,000/illness or 1% of the sum insured or Rs. 6,000(whichever is less).
VI. Daily hospital cash is available upto 1% of the sum insured per day for upto 10 days.
VII. For domiciliary treatments, upto Rs. 50,000 is allowed for the surgeon, consultant fees, medicines, drugs, etc.

Silver Plan

I. The sum insured amount ranges between Rs. 1-5 Lakhs on a floater basis.
II. 10% mandatory co-pay attached with this plan.
III. Daily cash allowance cover as per sum insured limit.
IV. Personal accident cover is available under this scheme.

Coverage

I. Expenses towards Room rent, Boarding and Nursing expenses, etc are covered upto 1% of the sum insured per day.
II. ICU expenses are covered upto 2% of the sum insured per day.
III. Expenses incurred for Surgeon, Anesthetist, Consultants are covered against the limit of the sum insured.
IV. Cost of purchasing Blood, Oxygen, OT charges, Medicines and Drugs, X-ray, Dialysis, Chemotherapy, pacemaker, Artificial limb, etc are covered.
V. Ambulance expenses cover upto Rs. 1,000/illness or 1% of the sum insured or Rs. 3,000(whichever is less).
VI. For domiciliary treatments, upto Rs. 25,000 allow for the surgeon, consultant fees, medicines, drugs, etc.

Exclusions

I. Any expenses towards newly incepted disease within 30 days waiting for period post commencement of plan.
II. Claim towards the ailment of any disease or accidental injury suffered during dangerous sports or activities.
III. Medical expenses during Obesity, Hormone replacement therapy, Sex change, Genetic disorder, Stem cell implantation, etc are not covered.
IV. Cost of Naturopathy, Acupressure, Acupuncture is not covered.
V. Expenses for treatment of injuries in events such as nuclear accidents, war, or invasion.
VI. Treatment for Cataract, Benign prostatic hypertrophy, Fistula of Anus, Piles, Asthma, Bronchitis, Dental treatment, etc are not included for coverage.

Oriental Overseas Mediclaim Plan

I. Sum assured – Rs. 50,000 – Rs. 5 Lakhs.
II. Pre-existing disease cover – 4 years.
III. Medical test – no medical tests required.
IV. Pre and post hospitalization cost – NA.

Features

I. Complete protection cover for medical expenses on trips outside India.
II. Coverage for both in-patient and out-patient expenses.
III. Cashless service available with overseas partner M/s Coris International.
IV. Plan category available depending on the requirements of the traveler.
V. Coverage for students undertaking studies abroad.

Oriental Group Mediclaim Plan

I. Sum assured – NA.
II. Pre-existing disease cover – 3 years.
III. Entry age – 3 months – 75 years.
IV. Pre and post-hospitalization costs – 30 days and 60 days respectively.

Coverage

I. Expenses incurred for Room rent, Boarding, and Nursing expenses are covered upto 1% of the sum insured or Rs. 5,000/day(whichever is less).
II. ICU expenses cover upto 2% of the sum insured or Rs. 10,000/day (whichever is less).
III. Expenses related to Anesthetist, Medical practitioner, Consultant fees are covered.
IV. Cost of purchasing Blood, Oxygen, OT charges, Medicines and Drugs, X-ray, Dialysis, Chemotherapy, pacemaker, Artificial limb, etc covered.
V. Ambulance charges cover upto 1% of the sum insured or Rs. 2,000(whichever is less).
VI. In the case of Organ transplant, Donor charges cover as per the limit of the sum insured.
VII. For domiciliary hospitalization, expenses shall be reimbursed for 3 days subject to a maximum limit of 20% of the basic sum insured.
VIII. Cover of Maternity and newborn child can be availed on the payment of 10% of the total basic premium for all the insured persons.

Exclusions

I. Claim towards the ailment of any disease or accident during dangerous sports or activities.
II. Medical expenses during Obesity, Hormone replacement therapy, Sex change, Genetic disorder, Stem cell implantation, etc are not covered.
III. Cost of Naturopathy, Acupressure, Acupuncture not covered.
IV. Expenses for treatment of injuries in events such as nuclear accidents, war, or invasion.
V. Treatment for Cataract, Benign prostatic hypertrophy, Fistula of Anus, Piles, Asthma, Bronchitis, Dental treatment, etc are not included for coverage.

Jan Arogya Plan

I. Sum assured – Rs. 5,000/annum.
II. Pre-existing disease cover – NA.
III. Eligibility age – 5 – 70 years.
IV. Pre and post-hospitalization costs – 30 days and 60 days respectively.

Features

I. The policy covers reimbursement of both hospitalizations, domiciliary hospitalization.
II. Affordable premiums to pay.
III. Valid yearly and renewable.
IV. Free look period of 15 days to have time and review acceptability of the terms and conditions.

Coverage

I. The expenses like Room rent, Boarding, and Nursing costs can reimburse.
II. Surgeon, Anesthetist, Consultants fees covered under the scheme.
III. Blood, Oxygen, OT charges, Medicine and Drugs, X-ray, Dialysis, pacemaker, cost of Artificial limbs covered.
IV. The maximum liability for all consolidated claims could be Rs. 5,000/person.

Exclusions

I. Claim towards the ailment of any disease or accident during dangerous sports or activities.
II. Medical expenses during Obesity, Hormone replacement therapy, Sex change, Genetic disorder, Stem cell implantation, etc are not covered.
III. Cost of Naturopathy, Acupressure, and Acupuncture not covered by this scheme.
IV. Expenses for treatment of injuries in events such as nuclear accidents, war, or invasion.
V. Treatment for Cataract, Benign prostatic hypertrophy, Fistula of Anus, Piles, Asthma, Bronchitis, Dental treatment, etc are not included for coverage.

Health Of Privileged Elders(HOPE) Plan

I. Sum assured – Rs. 1-5 Lakhs.
II. Pre-existing disease cover – the plan only covers critical illnesses.
III. Eligibility age – 60 years and above.
IV. Pre and post hospitalization cost – NA.

Coverage

I. Accidental injury – 100% of sum insured.
II. Knee replacement – 70% of sum insured.
III. Cardiovascular disease – 50% of sum insured.
IV. Chronic renal failure – 50% of sum insured.
V. Cancer – 50% of sum insured.
VI. Hepato Biliary disorder – 50% of sum insured.
VII. Chronic obstructive lung disease – 20% of sum insured.
VIII. Stroke – 20% of sum insured.
IX. Benign prostrate – 15% of sum insured.
X. Ophthalmic disease – 10% of sum insured.
XI. Orthopaedic disease – 15% of sum insured.
XII. Room rent, boarding, and nursing expenses can avail upto 1% of the sum insured or Rs. 5,000/day(whichever is less).
XIII. ICU expenses allow upto 2% of the sum insured per day.
XIV. Rs. 1,000 can avail for emergency Ambulance service.

Exclusions

I. Noninfective Arthritis.
II. Cataract.
III. Benign prostatic hypertrophy.
IV. Surgery of Gall bladder and Bile duct excluding Malignancy.
V. Surgery of Genitourinary system excluding malignancy.
VI. Calculus diseases.
VII. Joint replacement due to degenerative condition.
VIII. Age-related Osteoarthritis, Osteoporosis.
IX. Claim towards the ailment of any disease or accident during dangerous sports or activities.
X. Medical expenses during Obesity, Hormone replacement therapy, Sex change, Genetic disorder, Stem cell implantation, etc are not covered.
XI. Cost of Naturopathy, Acupressure, Acupuncture not covered.
XII. Expenses for treatment of injuries in events such as nuclear accidents, war, or invasion.

Pravasi Bharatiya Bima Yojana Plan

Features and Coverages

I. Sum assured ranges upto Rs. 10 Lakhs.
II. Add on the benefit of a family floater plan of Rs. 50,000 for the policy holder’s family residing in India(self+spouse+2 dependent children upto the age of 21 years).
III. Rs. 30,000 as legal expenses reimbursement which the policyholder has incurred towards filling any legal suit in the country of employment. It is certified by the ministry of the country against foreign employers.
IV. Maternity benefit expenses to the policyholder woman emigrant is upto a maximum limit of Rs. 25,000.

Exclusions

I. Pre-existing diseases shall not be covered till 2 years post commencement of the policy.
II. Claim towards the ailment of any disease or accident during dangerous sports or activities.
III. Medical expenses during Obesity, Hormone replacement therapy, Sex change, Genetic disorder, Stem cell implantation, etc are not covered.
IV. Cost of Naturopathy, Acupressure, Acupuncture not covered.
V. Expenses for treatment of injuries in events such as nuclear accident, war, or invasion.
VI. Treatment for Cataract, Benign prostatic hypertrophy, Fistula of Anus, Piles, Asthma, Bronchitis, Dental treatment, etc are not included for coverage.

How to register a claim with Oriental Health Insurance

planned or emergency hospitalization cashless claim

In case of cashless treatment, the claim form must be authorized by the network hospital. The insurance provider will check the medical information and analyze whether the claim is eligible or not. If satisfied, the insured person would get the cashless treatment facility and the hospital will settle the bills with the insurance provider directly.

Emergency hospitalization reimbursement claim

In case of emergency hospitalization, the insurance provider or third-party administrator must be informed within 24 hours of admission. The insured person must fill out the claim form and submit it with all the original medical documents within 15 days of discharge. According to the terms and conditions, the insurance provider will either approve or cancel the claim reimbursement. In case of disapproval, the insured person will be informed of the reasons for claim rejection.

Documents required to claim

I. Duly signed and filled up the claim form with a photocopy of the policy and premium receipt.
II. Discharge details.
III. Medical treatment reports.
IV. All Cash memos, bills, prescriptions.
V. Original copies of tests like x-ray, ECG, etc.
VI. In case of accident, first information report containing accident details.

Contact

Call – 1800 118 485(Toll-free) / 011 33208485.

E-mail – [email protected] / [email protected]

Address – Mr. Thomas T. Oommen, DGM, Customer Service Department, Oriental House, A-25/27, Asaf Ali Road, New Delhi-110002.

Leave a Comment