The PNB-Oriental Royal Mediclaim Policy is a health insurance plan that is exclusively catered towards employees and account holders of Punjab National Bank (PNB). The plan can be extended to cover the proposer’s immediate family, i.e., his/her spouse and two children. By way of this policy, insured members can eliminate or reduce expenses that they might have to incur due to an unplanned hospitalisation or medical emergency.
Eligibility for the PNB – Oriental Royal Mediclaim Policy
In order to be eligible to subscribe to this plan, one must ensure that he/she meets the eligibility criteria that is set by the insurance company.
- Policy coverage is available for both adults (proposer and spouse) and their dependent children.
- Any member under the age of 80 years can be enrolled under this policy.
- The coverage can be extended to dependent children between 3 months to 26 years of age.
- Female children will be covered until they are legally wed. Post this, the policy coverage will cease to exist.
- Male children will be provided a risk cover until they attain the age of 26 years, provided he is a student or is dependent on the proposer.
Sum Insured and Premium
The sum insured is the maximum amount of money that the insurer is liable to pay in case one meets with a certain eventuality. The premium, on the other hand, is what the insured member pays to the insurer in order to enjoy the policy’s coverage. Certain particulars related to your sum insured and premium rates are listed in the table below.
||Rs.1 lakh – Rs.5 lakh
||Rs.1,749 – Rs.6,830
Features of PNB Oriental Royal Mediclaim Policy
- This policy is available on a family floater basis and the cover can be extended to one’s spouse and 2 dependent children.
- Insured members can avail cashless hospitalisation facility in all hospitals that fall within the insurer’s network.
- Pre-hospitalisation expenses will be covered for 30 days prior to the actual date of hospitalisation.
- Post-hospitalisation expenses will be covered for 60 days after discharge from the hospital.
- In-patient hospitalisation and day-care procedures are also covered by the insurer.
- In order to avail the protection from this plan, one will have to pay the premium in advance, before the risk cover can commence.
- Claim documents will have to be submitted within a period of seven days from the date of discharge.
- The policy can be cancelled at any time by providing the insurer a 30-day notice.
- The policy will only cover treatments and hospitalisation that occur within India.
- The policy is issued for a 1 year period, after which the insured member will have to renew it on a yearly basis.
Benefits of PNB Oriental Royal Mediclaim Policy
|Room, Boarding, and Nursing Expenses
||Up to 1% of the sum insured or Rs.5,000 per day, based on whichever is the lesser of the two
||Up to 2% of the sum insured or Rs.10,000 per day, based on whichever is the lesser of the two
||Up to 1% of the sum insured or Rs.1,000, based on whichever is the lesser of the two
|Other Expenses Covered
||Insurer covers consultant, medical practitioner, and surgeon’s fees. In addition, charges for oxygen, chemotherapy, medicines, blood, anaesthesia, etc. are covered as per the limits of the sum insured
||Insurer will reimburse incidental expenses which are incurred by the insured when hospitalised, up to a maximum of Rs.1,000 during the entirety of the policy term
|Reimbursement of Funeral Expenses
||Up to Rs.1,000 will be reimbursed by the insurer
||Up to a maximum of Rs.25,000 or 10% of the sum insured
Exclusion Criteria under the PNB Oriental Royal Mediclaim Policy
- Pre-existing ailments and diseases for the first 3 policy years.
- Certain other specific illnesses, as mentioned in the policy brochure, have a waiting period between 1 and 3 years.
- Any disease/injury caused due to a war or nuclear activity.
- Cosmetic procedures, naturopathy treatments, alternative medicine, dental treatments, eye surgery, cost of lenses/spectacles, circumcision, inoculation, etc.
- General debility, convalescence, congenital diseases, conception procedures, sterility, venereal diseases, psychiatric disorders, drug- or alcohol-related disorders.
- Treatments undertaken in a nature care clinic, convalescent home, and other such establishments.
- Hospitalisation as a result of AIDS, HIV, STDs, HTLD – III, LAV, etc.
- Expenses incurred for diagnostic purposes without undergoing active treatment, referral fee, and doctor/attendant fees during the pre- and post-hospitalisation period.
- Non-medical expenses, expenses incurred on vitamins and tonics.
- Hospitalisation expenses as a result of pregnancy, miscarriage, caesarean delivery, etc.
- Weight-loss treatments, Ayurvedic treatments, non-prescribed drugs, hormone replacement therapy, sex change, etc.
Cost of ambulatory devices, equipment used in the treatment of CPAP, CAPD, etc.
- Treatment due to the member participating in hazardous activities.
- Service charges that are levied by the hospital, which are not directly payable to the government.