Oriental Health Insurance
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ORIENTAL HEALTH INSURANCE

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Oriental Health Insurance

Overview
The Oriental Health Insurance Co Ltd is one of the oldest non-life insurance companies in India. It is a public sector undertaking owned by the Government of India and established in the year 1947. The company has more than 30 regional offices and 1800 active branches across the country, excluding the presence in regions like Nepal, Kuwait and Dubai.

Oriental Health Insurance at a Glance
  • Cashless access to over 4300 network hospitals
  • 1429424 policies issues till date
  • Offers lifetime renewability
  • Approximately 95.07% grievances resolved.
  • The brand has an incurred claims ratio of 114.48%.
  • Claim settlement ratio of 46.7% for FY 2015-16.

Awards & Recognitions
  • Best General Insurance - Public" in the CNBC TV18 Best Bank and Financial Institution Awards presented by MCX for FY11

Documents needed to apply for Oriental Health Insurance
  • Age proof - (Any One)
    Driving License, Passport, Voter ID Card, Birth Certificate, etc
  • Identity proof – (Any One)
    Driving License, Passport, Voter ID card, PAN Card, Aadhar Card, or any document which proves citizenship
  • Income proof
  • Address proof – (Any One)
    Driving License, Passport and Utility Bill should clearly mention the permanent address
  • Income proof – (Any One)
    Salary Slip, Form 16, ITR
  • Recent passport size photograph

Why Oriental Health Insurance?
Here are some reasons why Oriental is the right insurance provider for you:

Features Description
Sum Insured Widest range of sum insured ranging from Rs. 50,000 to Rs. 50 lakh.
Cashless hospitalisation Oriental provides access to over 8200 network hospitals across India where you can avail cashless facility.
Claim process Cashless access to over 4300 hospitals. Oriental has a claim settlement ratio of 47.6%.
In-patient hospitalization/treatment Expenses incurred during hospitalisation for 24hours or more is covered by all Oriental Health Insurance plans.
Pre-hospitalization Expenses Expenses incurred during 30 days prior to hospitalisation are also covered.
Post-hospitalization Expenses Expenses incurred during 60 days post hospitalisation are covered.
Floater Basis Family is covered in all policies, where family is specified as the policy holder, spouse and dependent children (upto 25 years of age)

Types of Oriental Health Insurance Plans
Oriental offers insurance coverage in three variations: Individual Plans, Family Health Insurance Plans and Senior Citizen Health Insurance Plans.

1: Oriental Happy Family Floater Policy - This is Oriental’s most popular insurance plan. It is one of the most subscribed products for families that are growing and is popular due to its floater benefits.

2: Oriental Individual Mediclaim Policy – This policy is specifically geared towards the needs of senior citizens and provides them with all the privileges generally required for those aged 60 years and more.

3: Oriental Group Mediclaim Policy –This is Oriental’s most comprehensive plan and provides a lot of options for individual and families. This policy has automatic restoration and covers over 400 day care procedures.

4: Oriental Health of Privileged Elder (HOPE) Policy – This plan is often preferred by families as it provides health check-up benefits and bonus option.

5: Oriental Bank Mediclaim Policy - A Top Up Plan that offers higher sum insured at economic premiums. The plan has no pre-acceptance medical required and is available for individuals and families.

6: Oriental Royal Mediclaim Policy (PNB) –This policy is specially crafter for individuals looking for co-pay benefits and two-years of policy coverage.

7: Oriental Jan Arogya Bima Policy - This plan helps people who require cardiac treatments by providing coverage for cardiac related complications that require surgery or medical intervention. There are two plans available – Silver and Gold.

8: Oriental Happy Cash Policy – This is Oriental’s first ever product for cancer patients and is offered only on a limited time basis. Apart from covering cancer ailments, it also facilitates expenses for illnesses other than cancer.

Oriental Health Insurance Plans in detail
1: Oriental Happy Family Floater Policy
Three plans available – silver, gold and diamond

Features Description
Entry age 18 – 65 years for adult and 91 days for child
Type of Plan Individual / Floater
Sum Insured 2-20 lacs
Coverage for Self, spouse, dependent children (upto 25 years of age), parents/parents-in-law and financially dependent siblings.
Policy term 1-2 years

Inclusions, Benefits and Features
  • Ambulance expenses – Ambulance charges for emergency hospitalisation covered upto a specific limit. Limits range from Rs 1,000-3,000 per illness depending upon plan (silver/gold/diamond).
  • Day-Care Procedures - The medical expenses for all day-care procedures, which do not necessarily require 24 hours of admittance, will also be covered
  • Domiciliary Treatment–Treatment of illness done at home, which would normally need hospitalisation will also be covered in the policy.
  • Organ Donor–Covers treatment expenses for organ donor.
  • Daily Hospital Cash Allowance –The policy entitles the insured person to lump sum amount for choosing shared accommodation at a hospital. Range varies from Rs. 600-2000 per day depending upon plan.
  • New Born Baby cover – Cover for new born baby starts available with diamond plan upto 2.5% of sum insured.
  • Personal Accident – In case of accident resulting in temporary or permanent disability or accidental death the insured person will get upto 100% of the sum insured in a lumpsum payment.
  • Shared Accommodation–Upto certain limits
  • AYUSH treatment– Covered when treatment is taken as in-patient in Government hospital or any institute recognised and accredited by Govt. or Quality Council of India / National Accreditation Board on Health
  • Second Medical Opinion–The policy beneficiaries can get a second medical opinion. The cost for the same is limited upto Rs 5000-15000, depending upon plan type.
  • Maternity Expenses–Covered under diamond plan.
  • Restoration of Sum Insured – Available with two options – 50% or 100%.
Details Silver Gold Diamond
Basic Sum insured per insured person per policy year(Rs. in Lakhs) 1-5 lakhs 6-10 lakhs 12-20 lakhs
Inpatient treatment Covered Covered Covered
Pre-hospitalisation 30 days 30 days 30 days
Post hospitalisation 60 days 60 days 60 days
Day Care procedures Covered Covered Covered
Domiciliary treatment Covered Covered Covered
Organ donor Covered Covered Covered
Ambulance Rs. 1000 Rs. 2000 Rs. 3000
Second Opinion Rs. 5000 Rs. 10000 Rs. 15000
Daily Cash NA Rs. 600-1000 Rs. 1200-2000
Restoration of Sum Insured 50%/100% 50%/100% NA

2: Oriental Individual Mediclaim Policy
Features Description
Entry age 18 – 65 years for adult and 91 days for child
Type of Plan Individual / Floater
Sum Insured 1-10 lacs
Coverage for Self, spouse, dependent children (upto 25 years of age), parents/parents-in-law and financially dependent siblings.
Policy term 1year

Inclusions, Benefits and Features
  • Hospitalization Cover: Room, Boarding and Nursing expenses at 1% of the sum insured subject to a maximum of 1% of SI per day.
  • Daily Hospital Cash Allowance
  • Personal Accident
  • Ambulance expenses
  • Pre hospitalisation – 30 days
  • Post hospitalisation – 60 days
  • Day care procedures – Upto 25 procedures covered
  • Domiciliary treatment

3: Oriental Group Mediclaim Policy
Features Description
Type of Plan Group/50 persons or families
Coverage for Self, spouse, dependent children (upto 25 years of age), parents/parents-in-law and financially dependent siblings.
Policy term 1 year

Inclusions, Benefits and Features
  • In-patient expenses - Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing
  • Pre Hospitalization - Medical expenses upto 30 days prior to the date of admission.
  • Post Hospitalization - Medical expenses up to a period of 60 days after the discharge
  • In-patient hospitalisation expenses
  • Domiciliary treatment
  • Day care treatment – Upto 25 procedures/illnesses

4: Oriental Health of Privileged Elder (HOPE) Policy
Features Description
Entry age Any individual of the age 60 years and above
Type of Plan Individual
Sum Insured 1-5 lacs
Coverage for Individual
Policy term 1

Inclusions, Benefits and Features
  • In-patient expenses - Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing
  • Home not exceeding 1% of the Sum Insured per day
  • Pre-hospitalization medical expenses up to 30 days prior to the date of admission
  • Post-hospitalization up to 60 days from the date of discharge from the hospital
  • Critical illness – 11 critical illnesses covered
  • Day care treatment - 25 treatments covered

5: Oriental Bank Mediclaim Policy
Features Description
Entry age 18 to 65 years. Dependent child from 3 months to 25 years
Type of Plan Group with Floater for Oriental Bank employees
Coverage for Self, spouse, dependent children (upto 25 years of age), parents/parents-in-law and financially dependent siblings.
Policy term 1 year

Inclusions, Benefits and Features
  • In-patient expenses - Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing Home not exceeding 1% of the Sum Insured per day
  • Pre-hospitalization medical expenses up to 30 days prior to the date of admission
  • Post-hospitalization up to 60 days from the date of discharge from the hospital
  • Surgeon’s fees, Consultant’s fees, Anesthetist’s and Specialist’s fees
  • Domiciliary treatment
  • Hospital Cash – Reimbursement of expenses during hospitalisation capped at Rs. 1000.
  • Reimbursement of Funeral Expenses – Funeral expenses reimbursed upto Rs. 1000.
  • Day care procedures – Upto 25 procedures.

6: Oriental Royal Mediclaim Policy (PNB)
Features Description
Entry age 18 to 65 years
Type of Plan Group / Floater for PNB Employees
Coverage for Self, spouse, dependent children (upto 25 years of age), parents/parents-in-law and financially dependent siblings.
Policy term 1 years

Inclusions, Benefits and Features
  • In-patient expenses - Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing Home not exceeding 1% of the Sum Insured per day
  • Pre-hospitalization medical expenses up to 30 days prior to the date of admission
  • Post-hospitalization up to 60 days from the date of discharge from the hospital
  • Surgeon’s fees, Consultant’s fees, Anesthetist’s and Specialist’s fees
  • Domiciliary treatment
  • Day care procedures – Upto 25 procedures.

7: Oriental Jan Arogya Bima Policy
Features Description
Entry age 5 years to 70 years; Children – 3 months to 5 years; subject to at least one parent being covered under this plan.
Type of Plan Individual
Sum Insured Rs.5,000 p.a
Policy term 1year

Inclusions, Benefits and Features
  • Inpatient hospitalisation.
  • Domiciliary hospitalisation.
  • Expenses of treatment for covered events/ailments/injuries.
  • Pre-hospitalisation up to 30 days.
  • Post-hospitalisation up to 60 days.

8: Oriental Happy Cash Policy
Features Description
Entry age 18 to 65 years. Dependent child from 91st day
Type of Plan Individual
Coverage for Individuals with focus towards Women Empowerment
Policy term 1year

Inclusions, Benefits and Features
  • Hospitalisation Benefit - Daily Cash Benefit as is payable for every completed 24 hours of hospitalization, for a maximum period of 30/60 days per illness.
  • Convalescence Benefit - For a Hospitalisation beyond 30 / 60 consecutive days a fixed lumpsum amount as the Benefits chosen is payable towards convalescence, in addition to the Daily Cash Benefit.
  • Increased daily Cash Benefit for females with no additional premium

Oriental Exclusions:
  • Pre-Existing Diseases / Illness: coverage offered after 48 months
  • Pre-acceptance medical screening: Person above 50 years will need to undertake medical tests before being covered
  • Treatments for intentional self injury
  • Injury/disease directly or indirectly caused by or arising from war or warlike operations
  • Treatment arising from or traceable to pregnancy, childbirth, family planning, miscarriage, abortion and complications of any of these
  • Expenses incurred for weight control treatment
  • Medical and / or surgical treatment of Sleep apnea, treatment for genetic and endocrine disorders
  • Expenses on vitamins and tonics as part of treatment
  • Unconventional, Untested, Unproven, Experimental therapies
  • Stem cell Therapy, Chondrocyte Implantation, Procedures using Platelet Rich plasma and Intra articular injection therapy.
  • Oral Chemotherapy, Immuno therapy and Biological, except when administered as an in-patient
  • All types of Cosmetic, Aesthetic treatment of any description
  • Cost of spectacles and contact lens, hearing aids, walkers and crutches, etc
  • Hospital registration charges, admission charges, record charges, telephone charges and such other charges

Oriental Login:
  • For Individuals: Log into the Oriental Health Insurance website with your User ID and password.
  • You can generate user id and password by registering on the website with your name, phone, email, and password. You can login with your registered email ID and password.

Oriental Health Insurance Claim Settlement:
Cashless Reimbursement
Hospital will submit pre-authorization form to TPA Customer must provide the insurance company with details regarding the particulars of the policy number, the insured individual’s name in whose name the claim is going to be made, nature of injury / illness, and the name and contact details of the nursing home / hospital / medical practitioner
If the TPA finds the information satisfactory, a guarantee of payment or pre-authorisation letter will be sent to the day care centre / nursing home / hospital Original reports and bills will need to be submitted for review.
  After final scrutiny, if expenses have been verified they will be reimbursed.

Oriental Health Insurance FAQs:
1. Where can I download claims form from?
You can download claims form from this link - https://orientalinsurance.org.in/web/guest/download-claim-form?isSelected=policyDownload&isRefresh=true

2. What are the details to be provided at the time of intimation of claim?
Following are the information required at the time of intimation:
  1. Health card
  2. Duly filled claim form
  3. Doctor's consultation papers
  4. Investigation reports (e.g. X-ray, scans, blood report, etc.)
  5. Pharmacy invoices supported by respective prescriptions
  6. In cases of accidents, Medico Legal Certificate (MLC) and / or FIR
  7. Discharge summary
  8. Other relevant documents
3. Are my existing diseases covered?
Existing diseases covered after 48 months of continuous coverage with Oriental. There are exceptions in illness specific policies like policies designed for diabetic patients, cancer patients, HIV positive patients etc

4. Does health insurance cover diagnostic charges like X- ray, MRI or ultrasound?
All diagnostic charges like X- ray, MRI, blood tests etc. are covered if they are in relation to hospitalisation for at least 24 hours.

5. Is a medical check-up necessary before buying a Health policy?
Medical check-up is necessary for persons aged 60 years and above.

6. What is the maximum number of claims allowed during the year?
Unlimited number of claims is allowed during the year up to the maximum exhaustion of sum insured.

7. How to claim for pre and post hospitalization?
The claim documents for pre and post hospitalization should be submitted within a specific number of days of completion of treatment or period.

8. Does any health policy cover expenses on outpatient treatment also?
Usually policies cover only in-patient treatment but the Oriental Health Gain policy covers out-patient treatments.

9. Can foreigners avail policy or is it restricted to Indian nationals?
Foreigners living in India can avail policy but the coverage will be limited to India.

10. Does the list of hospitals remain the same?
The list of hospitals may or may not change and Oriental Health Insurance reserves the right to modify, add or restrict any network hospital for cashless services available under the policy.