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Oriental Health Insurance

Headquartered in New Delhi, Oriental Insurance Company Ltd. is a market leader in providing insurance solutions. Apart from health insurance products, they also offer motor insurance, personal accident insurance, shopkeeper, householder and Nagrik insurance services. They have over 1,800 branches in the country with 30 regional offices.

Features & Benefits of Oriental Health Insurance

  • Comprehensive policies - Oriental Insurance offers a number of attractive plans to suit various needs. The health plans provide good coverage against illnesses and also come with added benefits, discounts and rider options.
  • Cashless network hospitals - Equipped with a wide range of cashless network hospitals, Oriental offers good quality services to consumers without any hassles.
  • Easy online purchase - A prospective buyer can instantly get an insurance quote online by providing a few simple details. If satisfied with the quote, payment can be made online without any inconvenience by following a few steps.
  • Hassle-free claim settlement - All claims can be made easily through the toll-free number or online. The customer needs to provide a few basic details and initiate the claim process. Claims can be either cashless claims or reimbursement claims.
  • Daily allowances - In the event of hospitalization, a certain fixed sum of money will be given to the policyholder for a fixed period of time to take care of the daily expenses incurred.
  • Free health check-up - Oriental Insurance offers customers the benefit of availing complimentary health check-ups after the completion of three claim free years.
  • Easy Renewal- Oriental Insurance offers the customer the ease of renewing policies online at the click of a button. This gives policyholders the added benefit of convenience and allows them to renew policies with ease.

Plans provided by Oriental Health Insurance

Plan Name Plan Basis(individual, family, etc) Sum Insured (Min and Max)
Mediclaim Policy Individual Min: Rs.1 lakh Max: Rs.10 lakh
Group Mediclaim Policy Group Min: Rs.2 lakh Max: Rs.5 lakh
Health of Privileged Elder(HOPE) Individual Min:Rs.1 lakh Max:Rs.5 lakh
Happy Family Floater Policy 2015 Group Silver - up to Rs.5 lakh Gold - up to Rs.10 lakh Diamond - up to Rs.20 lakh
Jan Arogya Bima Policy Individual and Group Ranging around Rs.5,000

*Premiums may vary depending upon factors like age, location, term of the plan and prevailing taxes/GST.

Mediclaim Policy

The Mediclaim Policy is an individual policy that offers comprehensive coverage, covers hospitalization and pre-hospitalization expenses, consultation charges and comes with a wide range of discounts and benefits.

Unique Features of Mediclaim Policy

  • A total of 1% of the premium per day can be availed towards nursing charges, boarding and room charges
  • This policy covers ICU charges. A total of 2% of the sum insured can be used towards this on a daily basis during hospitalization
  • The other expenses that will be covered include specialist fees, expenses incurred towards Surgeons, anaesthetists, medical practitioners, and consultants
  • Other charges that may be covered are blood, oxygen, operation theatre charges, X-ray, artificial limbs, pacemaker, diagnostic tests, dialysis, radiotherapy, medicine and drugs, surgical appliance, etc
  • The other benefits offered include ambulance charges, daily hospital allowance, pre-hospitalization and post-hospitalization charges
  • In-patient expenses incurred towards Unani, Homeopathic and Ayurvedic treatment will be covered under the policy
  • A sum of Rs.5,000 will be provided towards any kind of animal bites such as dog, monkey, rabbit, etc

Plan Details

Entry Age Until 65 years
Plan Basis Individual
Sum Insured Range Min: Rs.1 lakh Max: Rs.10 lakh
Co-Payment 10% or 20%
Discounts Family discount of 10%, voluntary co-payment discount of 10 to 20%

Group Mediclaim Policy

The Group Mediclaim policy is an enhanced version of the Individual mediclaim policy that is designed for families. It offers good coverage and benefits.

Unique Features of Group Mediclaim policy

  • A maximum sum of Rs.5,000 can be utilized per day towards nursing, boarding and room related expenses
  • A total sum of Rs.10,000 can be utilized for ICU expenses on a daily basis
  • Ambulance fee can be availed up to a maximum of Rs.2,000 to transport the person from their home to the hospital in question
  • Charges towards specialist, surgeons, operation theatre, medicines, dialysis, etc will be taken care of
  • All donor related expenses will be covered

Plan Details

Policy Term 1 year
Entry Age 18 years
Plan Basis Group
Sum Insured Range Min: Rs.2 lakh Max: Rs.5 lakh
Premium Shall be payable in advance
Medical Screening A must for for aged above 45

Health of Privileged Elder (HOPE)

The HOPE policy is specifically designed for the older generation and covers certain specified illnesses such as accidental injury, cancer, knee replacement charges, renal failure and cardiovascular diseases, etc.

Unique Features of Health of Privileged Elder (HOPE)

  • The diseases covered under this policy include Ophthalmic diseases, orthopaedic problems, benign prostate, stroke, chronic obstructive lung diseases, Hepato-biliary disorders, cancer, chronic renal failure, cardiac related problems, accidental injury and knee injury
  • All charges incurred towards ambulance fee will be reimbursed up to a maximum of Rs.1,000
  • ICU charges, room charges and nursing expenses will be taken care of under the policy
  • Fees given to specialist, consultants, medical practitioners, anaesthetists and surgeon related expenses will be covered
  • A no claim bonus discount of 5% will be provided to policyholders every year, extending up to a maximum of 20%, at the time of renewal

Plan Details

Policy Term 1 year
Entry age Those above 60 years
Plan Basis Individual
Sum Insured Range Min:Rs.1 Lakh Max:Rs.5 lakh
Premium Payable in advance
Co-Payment 20%
No Claim Bonus 5% to 20%

Happy Family Floater Policy 2015

Specially designed for families, this policy offers protection for the policyholder, the spouse and dependent children. Policyholders can choose go for the Silver, Gold or Diamond plan.

Unique Features of the Happy Family Floater Policy 2015

  • The Diamond plan offers a higher coverage and sum assured amount, when compared to the Silver and Gold plans
  • Room charges and nursing charges under all the three options with variations on the maximum upper limit
  • Expenses related to surgeons, consultants and specialists will also be taken care of under the policy
  • A maximum of 2% of the sum insured can be used per day as ICU charges under the Silver and Gold plan. In the Diamond plan, a maximum of Rs.10 lakh can be used per day towards ICU charges
  • Transportation charges such as ambulance fee and daily allowances will be provided. Apart from this, the other provisions include attendant allowance, maternity expenses, newborn baby cover, donor expenses, pre and hospitalization expenses

Plan Details

Entry Age Between 18 to 65 years
Plan Basis Group
Sum Insured Range Silver - up to Rs.5 lakh Gold - up to Rs.10 lakh Diamond - up to Rs.20 lakh
Premium Shall be payable in advance
Co-Payment 10% for Silver plan

Jan Arogya Bima Policy

The Jan Arogya Bima Policy is a health insurance plan that is designed to benefit the economically weaker sections of society.

Unique Features of Jan Arogya Bima Policy

  • This health insurance policy offers good coverage at comparatively lower premiums
  • The premium amount payable is Rs.70 for an adult and Rs.50 for a dependent
  • Policyholders can avail benefits up to a maximum of Rs.5,000

Plan Details

Entry Age Between 3 months to 70 years
Plan Basis Group
Sum Insured Range Rs.5,000
Premium Rs.70

Checklist before Buying Oriental Health Insurance

  • Keep all documents ready such as ID proof, etc
  • Before making a purchase decision read through all the plans and examine what suits personal needs
  • Choose the right sum insured amount and premium
  • Some of the factors to be considered before making a purchase include the plan basis, premium, entry age, number of benefits such as claim settlement ratio, etc

Documents Required for Purchasing Oriental Health Insurance

  • ID and address proof
  • Medical certificate, if asked

Reasons to choose Oriental Health Insurance

Online purchase & renewal
Wide range of benefits
24/7 customer support
Cashless network hospitals

Incurred Claim Ratio of Oriental Health Insurance

Incurred claim ratio basically refers to percentage of claims that are successfully solved by the insurance company in a given financial year.

Year Incurred Claim Ratio
2015-16 114.48%

Extra Benefits from Oriental Insurance

Mobile app services All insurance related processes such as purchase, renewal, claim initiation, etc, can be made through the app
Complaint redressal All complaints or issues faced by the customer can be lodged as a formal complaint on their website through the ‘In Your Service’ option

Oriental Insurance Renewal

The Oriental Health insurance policy can be renewed online. Following are the steps to be followed for renewal:

  • Log on to the Oriental Insurance website
  • Click on the ‘renew online’ option and fill in policy details
  • Make the payment
  • A confirmation will be sent to your registered mobile number and email ID.

Oriental Insurance Network Hospitals for Cashless Treatment

Oriental Insurance provides pan India cashless hospitalization services. To locate the nearest empanelled hospital, log on to their website and click on the ‘Locator’ option. Then proceed to choose the ‘Network Hospital’ option. This will provide a detailed list of all the cashless hospital networks in India. The data will be available city-wise.

Claim Procedure for Oriental Insurance

Please follow the below steps to make a cashless claim:

  • Intimate the insurance provider and get approval
  • A health insurance card needs to be presented as proof to the TPA
  • Bills shall be paid by the insurance company to the concerned hospital

The following are the steps to make a reimbursement claim:

  • Fill in the claim form
  • All documents such as bills, invoices and discharge summary should be ready
  • Submit all documents
  • Reimbursements will be made in seven working days

Terms and Conditions of the Insurer

  • Reimbursement cannot be claimed for medical treatment undergone in a country outside India unless mandated by the insurance policy
  • The policy will expire if it is not renewed within the grace period
  • If the insurance company at any point of time acquires information that the policyholder has provided wrong information, misrepresented facts or has failed to reveal the truth; the insurance company may act as it regards fit and cancel the policy.
  • Reimbursement claims will not be settled unless there is enough documentary evidence provided