Oriental Bank Mediclaim Policy

Oriental Bank Mediclaim Policy Introduction

Oriental Bank Mediclaim Policy was launched on 3^rd October 2011. Oriental Bank of Commerce signed an agreement with The Oriental Insurance Company Ltd. to sell mediclaim policies to its customers. Oriental Bank Mediclaim Policy is designed exclusively for the Account Holders of OBC (Oriental Bank of Commerce). It is available in all OBC (Oriental Bank of Commerce) Branches across the country. Oriental Bank Mediclaim Policy takes care of various medical expenses following hospitalization due to an accident/sudden illness/surgery during the policy period. Oriental insurance company reimburses the medical expenses incurred for the treatment taken by the policyholder. This Oriental Bank Mediclaim Policy is a health plan with Family Floater Option.

Oriental Bank Mediclaim Policy Eligibility Conditions

Entry Age:	Minimum: 3 months Maximum: 79 years
Policy Term:	1 Year
Sum Insured:	Minimum: 1 lakh Maximum: 5 lakhs
Oriental Bank Mediclaim Renewal:	Company shall not be responsible for non‐renewal of policy after the due date of the proposal form. You can renew your policy through online  by just entering your previous policy number, Insured Code and Policy expiry date.
Pre-medical check up:	Not required

Oriental Bank Mediclaim Policy Key Features

• A family floater scheme covers 4 family members namely, Proposer, Spouse and 2 dependent Children aged 3 months to 26 years.
• Pre – medical examination is not required, only declaration.
• Cash less facility available at Oriental Bank Mediclaim Policy network hospitals.
• Pre – Existing diseases are covered after 3 complete policy years without break.
• Tax Benefit: Income Tax benefit is available under 80D of the Income Tax act. For more information regarding Income Tax Benefits, visit www.taxqueries.in.
• Portability: If you are insured under any other health insurance policy of Non life insurer you can transfer to Oriental Bank Mediclaim policy with all your accrued benefits after due allowances for waiting periods. Request for portability has to be made at least 45 days prior to renewal date.
• Pre hospitalization expenses for 30 days before the Insured Person was Hospitalised.
• Post hospitalization expenses for 60 days after the Insured Person was discharged.

Oriental Bank Mediclaim Policy Inclusions

Inclusions under Oriental Bank Mediclaim Policy are given in below table,

HOSPITALIZATION BENEFITS
BENEFIT	Liability under the policy
Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing Home	Not exceeding 1 % of the Sum Insured per day
Intensive Care(IC) Unit Expenses as provided by the Hospital /Nursing Home.	Not exceeding 2% of the Sum Insured per day.
Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees	As per the limits of the sum insured.
Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Diagnostic Material and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs & and similar expenses.	As per the limits of the sum insured.
Ambulance services charges	For the entire policy period Actual or 1% of the sum insured or Rs.1000/- whichever less
Hospital Cash	Reimbursement of incidental expenses during the period of hospitalization of the proposer i.e. the OBC Account Holder only – actual subject to a maximum of Rs.1000 during the entire policy period.
Reimbursement of Funeral Expenses	In the event of death of the insured person due to an insured peril covered under the scope of the policy, the company shall reimburse actual funeral expenses subject to maximum of Rs. 1000 during the policy period.
DOMICILIARY HOSPITALIZATION
Surgeon, Medical Practitioner, Consultants, Specialists Fees, Blood, Oxygen, Surgical Appliances, Medicines & Drugs, Diagnostic Material and Dialysis, Chemotherapy, Nursing expenses.	10% of Sum Insured, Maximum Rs.25000/- during policy period.

Oriental Bank Mediclaim Policy Exclusions

Exclusions under Oriental Bank Mediclaim Policy are,

• Pre-existing diseases will be covered after waiting period of 4 years of continuous renewal of the policy.
• Injuries caused by War, civil war, revolution, invasion, act of foreign enemies, Nuclear energy, radiation, etc.
• Surgery for correction of eye sight, contact lenses, cost of spectacles, hearing aids etc.
• Any dental treatment which is corrective, cosmetic, filling of cavity, root canal including wear and tear etc.
• HIV or any related illness including AIDS and/or mutant derivatives or variations there of however caused.
• Massages, Steam bathing, Shirodhara and similar treatments under Ayurvedic treatment.
• Any treatment received in convalescent(recovering) hospital, convalescent home, health hydro, nature care clinic or similar establishments.
• Treatment arising from pregnancy, miscarriage, childbirth, caesarean section, abortion or complications of any of these are excluded.
• Abuse of intoxicant substance like drugs and alcohol is excluded.
• Expenses incurred in treatment of obesity and any other weight control programme, services or supplies etc.

For complete information about Exclusions please refer Oriental Bank Mediclaim prospectus and Oriental Bank Mediclaim Brochure attached below.

Oriental Bank Mediclaim Policy Customer Care

Assistance: 

For any grievance or complaint,
please write to – Mr. Masood Wahab,
Chief Manager,
Customer Service Department, Oriental House, A-25/27,
Asaf Ali Road, New Delhi-110002.
Contact details :
For all query, guidance use Toll free number: 1800 11 8485 Or 011- 33208485 (Normal Charges Apply )
Email:
For complaints/grievance related to insurance policy or claims: csd@orientalinsurance.co.in
For complaints/grievance related to online insurance policy: portal.support@orientalinsurance.co.in

Oriental Bank Mediclaim Policy Buying Procedure

Documents and conditions required to buy Oriental Bank Mediclaim Policy are,

1. Proposal form to be filled in block letters.
2. Submit two stamp size photographs of each insured person along with two copies of proposal form.
3. Name and age of the insured must be written on the back of the photo.
4. Family to include the proposer i.e., account holder/employee of the Oriental Bank of Commerce (OBC). His/Her spouse and two dependent children aged 3 completed months onwards up to 79 years as under:
   • Female child until she is married. Immediately consequent upon her marriage she shall be ceased to be covered under the policy and no claim shall be admissible.
   • Male child up to the age of 26 years if he is abonafide regular student and fully dependent on proposer i.e., the OBC account holder.

Oriental Bank Mediclaim Premium Payment:

• Premium payable under this policy shall be paid in advance.
• No receipt for premium shall be valid except on the official form of the Company signed by a duly authorized official of the company.

Oriental Bank Mediclaim Policy Claim Procedure

Intimation:

• Notice of claim should be given to the Company / TPA by Fax, Email with particulars relating to Policy Number, ID Card No., Name, Nature of disease etc.
• Notice should be given to the company within 48 hours of admission or before discharge from Hospital unless waived in writing.

Claim Procedure to avail Cashless service:

1. Claim in respect of Cashless Access Services will be through the TPA provided admission is in a listed networked hospital and is subject to pre admission authorization.
2. Upon getting the related medical details / relevant information from the insured person / Oriental Bank Mediclaim network Hospital, TPA shall verify that the person is eligible to claim under the Oriental Bank Mediclaim policy.
3. After satisfying itself will issue a pre‐authorisation letter to the Hospital mentioning the sum guaranteed as payable, also the ailment for which the person is seeking to be admitted as in‐patient.
4. The TPA may deny pre‐authorisation in case the hospital / insured person is unable to provide the relevant information or medical details as required by the TPA.
5. In such circumstances the insured person may obtain the treatment and later on submit the full claim papers to the TPA for reimbursement within 7 days of the discharge from Hospital.
6. Should any information be available to the TPA which makes the claim doubtful requiring investigations, the authorisation of cashless facility may be withdrawn.

Documents to be submitted during claim:

List of documents as listed below should be submitted to the Company / TPA within 7 days of discharge from the Hospital / Nursing Home.

• Original bills, receipts and discharge certificate / card from the hospital.
• Medical history of the patient recorded by the Hospital.
• Original Cash-memo from the hospital (s) / chemist (s) supported by proper prescription.
• Original receipt, pathological and other test reports from a pathologist / radiologist including film etc supported by the note from attending medical practitioner / surgeon demanding such tests.
• Attending Consultants / Anaesthetists / Specialist certificates regarding diagnosis and bill / receipts etc.
• Surgeon’s original certificate stating diagnosis and nature of operation performed along with bills / receipts etc.
• Any other information required by TPA / Insurance Company.
• All documents must be duly attested by the insured person.

Oriental Bank Mediclaim Premium Calculator

You can calculate the premium using Oriental Bank Mediclaim premium calculator. Personal details, Policy period, Number of members, Age and Sum assured and other details are required to calculate the premium.

Oriental Bank Mediclaim Premium Rates

Oriental Bank Mediclaim Premium Table Inclusive of service tax is as under,

Sum Insured	Premium(Including S. Tax)
Rs. 1 Lakh	Rs. 1749
Rs. 2 Lakhs	Rs. 3320
Rs. 3 Lakhs	Rs. 4620
Rs. 4 Lakhs	Rs. 5780
Rs. 5 Lakhs	Rs. 6830

Oriental Bank Mediclaim Policy FAQ’s

Give me information about cancellation of the policy?

• Company may cancel the policy at any time, by sending the Insured 30 days notice by registered letter at the Insured’s last known address and in such an event the Company shall refund to the Insured a pro‐rata premium for un‐expired Period of Insurance.
• Insured may cancel this policy at any time and in such event the Company shall allow refund of premium at Company’s short period rate only (table given here below ) provided no claim has occurred during the policy period up to date of cancellation.

Period on Risk	Rate of premium to be charged
Upto 1 Month	1/4th of the annual rate
Upto 3 Months	1/2 of the annual rate
Upto 6 Months	3/4th of the annual rate
Exceeding 6 months	Full annual rate

Can I get Ambulance Services?

The ambulance service charges are payable only if the hospitalization expenses are admissible. Further the ambulance service charges are admissible only if such expenses are paid to registered ambulance services providers.

What is meant by Domiciliary Hospitalization benefit?

“Domiciliary hospitalisation” means medical treatment for an illness/ disease which in the normal course would require treatment at a hospital but is actually taken while confined at home under any of the following situations:

• The condition o f the patient is such that he/she is not in a condition to be removed to a hospital, or
• The patient takes treatment at home on account of non availability of room in a hospital.

What is meant by TPA (Third Party Administrator)?

TPA means any Company who has obtained licence from IRDA to practice as a third-party administrator and is appointed by the Company.

Oriental Bank Mediclaim Forms and Documents

Oriental Bank Mediclaim Policy Guidelines

Oriental Bank Mediclaim Proposal Form

Oriental Bank Mediclaim Prospectus

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About Oriental Nagrik Suraksha Policy

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About Oriental Individual Mediclaim Policy

About Happy family floater policy