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  • Oriental Health Nagarik Suraksha Policy

    Health Insurance
    • Premiums as low as Rs12/day for coverage of Rs.4 Lakhs*
    • 10,000+ hospitals for cashless treatment
    • Claim up to Rs. 55,000 deduction under section 80D**

    Nagarik Suraksha Policy is a health insurance policy that provides reimbursement of hospitalisation expenses arising from an accident. It also offers cover for accidents that might lead to death, loss of limbs or permanent partial/total disablement.

    Eligibility Criteria of Nagarik Suraksha Policy

    The policyholder is required to keep certain age limits in mind while deciding whether to purchase the Nagarik Suraksha Policy or not.

    Minimum age at entry
    • 5 years for family package
    • 18 years for individual or group cover
    Maximum age at entry 70 years

    Sum Insured and Premium

    Sum Insured

    The total sum of money from which hospital expenses and accident cover can be claimed is referred to as the sum insured.

    Minimum Sum Assured Rs.1 lakh
    Maximum Sum Assured Rs.5 lakh

    Premium

    The periodic instalment of money that is paid to the insurer by the insured is called the premium. The premium is generally decided by the insurer based on the sum insured and policy term chosen by the policyholder.

    Minimum term of the policy 1 year
    Maximum term of the policy 4 years

    *Premiums vary based on age, location, plan term, and other factors.

     

    Features of Oriental Health Nagarik Suraksha Policy

    • The policy is available only to Indian nationals.
    • The policy is divided into two sections. The first section deals with the claims made with regard to personal accidents.
    • If the policyholder loses his life solely because of an accident within 12 months of the occurrence of the event, the sum insured will be provided to the nominee or legal representatives of the policyholder.
    • If the insured person loses both his eyes or any two of his/her limbs, he will be eligible to claim 100% of the sum insured, provided it is a cause of an accident that occurred within 12 months prior to the disability.
    • The policyholder can claim 100% of the sum insured if he/she loses one eye and one hand/foot, provided the loss was a direct cause of an accident that occurred within 12 months prior to the disability.
    • If a certain accident was the sole and direct cause of loss or sight of one eye and irrecoverable loss of a hand/foot within 12 months of its occurrence, the insured can claim 50% of the sum insured.
    • A certain amount of the sum insured will be provided to the policyholder in the event that any permanent disability or injury disallows him/her from being employed.
    • A partial cover is offered to the insured if any accident leads to any kind of physical separation or injury which amounts to 40% of disablement of the insured person.
    • Section-II lists out the specifications of reimbursement of hospital bills resulting from the medical or surgical treatment solely arising from an accident. The percentage of the sum insured that can be claimed for each medical condition is specified in the policy.
    • The total liability of the insurer cannot exceed the sum insured opted by the policyholder.

    Benefits of Oriental Health Nagarik Suraksha Policy

    Free-look period A 15-day free-look period is offered to the policyholder to review the policy. If he/she is unsatisfied with the policy, he/she may return the policy. On return, the company is liable to refund the premiums paid unless any claims were made. This is applicable only for individual policies.
    Cumulative Bonus Each claim-free year will reward the policyholder with a 5% increase in the compensation payable as reimbursement of hospital expenses.
    Funeral Expenses 2% of the sum insured or Rs.2,500, whichever is lesser, can be reimbursed for carriage of dead body and/or funeral expenses.
    Education Fund On the death of the policyholder, the dependent children will be provided with an education fund along with the sum insured. The amount is generally equal to 10% of the sum insured. In the case of one dependent child, the maximum amount offered is Rs.5,000 and in the case or more than one dependent child, the maximum amount offered is Rs.10,000.
    Loss of employment In the event that the policyholder suffers a disablement due to which he/she can no longer be employed, the insurer will provide an additional 1% of the sum insured along with the total sum insured. This is applicable only to individual policyholders.

    Exclusions of Oriental Health Nagarik Suraksha Policy

    • Claims for more than one of the benefits listed out in the policy, during the same period for a disablement caused by the same accident.
    • Any additional payment for disablement after a claim has already been made under Section-I.
    • Any payment, if more than one claim has been made under the same section, which crosses the total sum insured of the policy within 12 months of the first claim.
    • Self-injury, suicide, or any injury resulting from an attempt to commit suicide.
    • Any injury caused by drugs, liquor or other intoxicating substances.
    • Any injury suffered as a result of mounting/dismounting from an aircraft other than when one is a passenger.
    • Death or disablement due to childbirth, pregnancy, venereal disease, or insanity.
    • Any illness resulting from HIV/AIDS or HIV-related illness or a mutant variation or derivative of HIV/AIDS.
    • Any injury or disablement resulting from an activity that amounts to breach of law.
    • Any condition that existed before the date or receipt of the insurance policy, whether the policyholder was aware of the same or not.
    • Complications resulting from pre-existing conditions.
    • Circumcision and plastic surgery unless required for the treatment of injury.
    • Vaccination, cosmetic, or aesthetic surgeries or change of life.
    • Expenses incurred on spectacles, contact lens, or hearing aids.
    • Convalescence, rest cure, run down condition, or general debility.
    • External congenital defects or disease and sterility.
    • Laboratory or diagnostic examination and X-Ray unless required for the treatment of the injury.
    • First-aid or OPD that is unrelated to the hospitalisation.
    • Tonics and vitamins unless prescribed by the physician for the treatment of the injury.
    • Naturopathy or yoga therapy.
    • Dental surgery or treatment unless hospitalisation is necessary.
    • Pre- and post-hospitalisation expenses.
    • Any injury resulting from war, rebellion, civil commotion, invasion, etc.
    • Any injury resulting from any activity ordered by the government or person of authority.
    • Any injury resulting from nuclear weapons/materials.

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