• PNB Oriental Royal Mediclaim Policy

    Health Insurance
    • Enjoy options to cover yourself, your spouse, kids and even your parents
    • Enjoy access to 10,000+ hospitals for cashless treatment
    • Reduce your taxable income by up to Rs. 50,000 deduction under section 80D**

    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.

    Policy tenure 1 year
    Sum Insured Rs.1 lakh – Rs.5 lakh
    Premium 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
    ICU Charges Up to 2% of the sum insured or Rs.10,000 per day, based on whichever is the lesser of the two
    Ambulance Charges 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
    Hospital Cash 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
    Domiciliary Hospitalisation 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.

    FAQs on PNB Oriental Royal Mediclaim Policy

    1. When should the premium be paid?
    2. The premium is required to be paid in advance before the purchase of the policy. The renewal premium can be paid the following year before the premium payment due date. The company generally sends the renewal notice and it will contain details of the premium amount to be paid. The company may or may not revise the premium amount to be paid by the individual. The premium payment is not automatic and should hence be paid in time to continue enjoying the benefits under the plan.

    3. How much time do I have after admission to the hospital to intimate the insurance company for a claim?
    4. The insurance company requires the policyholder to notify them about any possible claims within 48 hours of admission to the hospital or before discharge from the hospital, whichever is earlier. The intimation needs to be given in writing through fax or e-mail with the following information:

      • ID Card number
      • Policy number
      • Name of the insured person
      • Nature of the illness/injury for which admission has been made
      • Name of attending doctor
      • Name of the hospital/nursing home

    5. How do I apply for a reimbursement of the expenses incurred on the treatment?
    6. To get a reimbursement of the expenses incurred on your treatment, you can submit the following documents to the insurer/TPA:

      • Original bills and receipts
      • Discharge summary
      • Medical history of the insured person recorded by the hospital
      • Receipts and reports for any tests conducted along with the note from the attending medical practitioner
      • Original cash memo from the chemist along with the prescription
      • Original certificate by the surgeon regarding the diagnosis and operation performed, plus original receipts and bills
      • Original certificate by the attending specialist, consultant, or anaesthetist along with receipts and bills

      The documents should be duly attested by the insured person and submitted to the insurer/TPA within 7 days from the date of discharge from the hospital. In case the insurer/TPA asks for any other information, the same will need to be provided at the earliest.

    7. How do I avail cashless services from Oriental Insurance?
    8. You can avail cashless services under your Royal Mediclaim policy from any network hospital or nursing home. You will have to get a pre-authorisation letter to avail the service. Once you submit all relevant information regarding your policy and the treatment you are going to avail, the insurer/TPA will verify the details and either approve or reject the request. If the request is denied, you can always pay the hospital bill yourself and apply for a reimbursement within 7 days from the date of discharge from the hospital.

    9. Can I cancel my Royal Mediclaim insurance policy?
    10. Yes, you can cancel your policy if you need to. The company may even permit a refund of the premium paid by you, provided no claims have been made from the start of the policy up to cancellation.

    11. What are the contact numbers of Oriental Insurance?
    12. The insurance company has two contact numbers:

      • Toll-free: 1800-11-8485
      • Non-toll-free: 011-33208485

    13. Can I renew my policy online?
    14. Yes, you can visit the official website of Oriental Insurance to renew your health insurance plan.

    15. How do I know if the hospital I plan to get hospitalised in is a network hospital or not?
    16. You can find a list of network hospitals of Oriental Insurance on the official website of the company. Once you open the website, click on ‘Locator’ found in the main menu and click ‘Network Hospitals’. You can then select the state and city in which you are looking for the network hospital.

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