Oriental Insurance Individual Mediclaim Policy Introduction
Oriental Insurance Individual Mediclaim Policy is a Health Insurance policy which takes care of medical expenses following Hospitalization/Domiciliary Hospitalization of the Insured in case of a sudden illness / an accident / any surgery and requires sudden or planned hospitalization for treatment or surgery during the policy period. Oriental Insurance Individual Mediclaim Policy is only available for Individual between the age of 18 to 80 years. You can renew your Oriental Insurance Individual Mediclaim Policy online. A proposer can take the Oriental Insurance Individual Mediclaim policy for himself/herself and or for his/her family members.
Oriental Insurance Individual Mediclaim Policy Terms and Eligibility Conditions
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Oriental Insurance Individual Mediclaim Policy Key Features
- In Oriental Insurance Individual Mediclaim Policy, you can avail Income Tax benefit under Section 80D of the Income Tax Act. For more information regarding Tax Benefits, visit www.taxqueries.in.
- Wherever family members are covered, a discount of 10% in premium is available.
- A proposer can take Oriental Insurance Individual Mediclaim Policy for himself and or for his family members.
- Cashless facility for claim settlement available in network hospitals if the services of TPA (Third Party Administrators) are availed.
- Inpatient hospitalization expenses in India due to illness / disease / accident.
Oriental Insurance Individual Mediclaim Policy Inclusions
Inclusions under Oriental Insurance Individual Mediclaim Policy are,
- Company will reimburse the medical expenses incurred while the insured was admitted in the hospital as an in patient.
- Covers Room, Boarding and Nursing Expenses as provided by the Hospital or Nursing Home not exceeding 1 % of the Sum Insured or Rs. 5000 /- per day whichever is less.
- Covers I.C.U expenses not exceeding 2% of the Sum Insured or Rs. 10,000 /- per day whichever is less.
- 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 Insurance Individual Mediclaim Policy also covers Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees.
- Anaesthesia, Oxygen, Blood, Operation Theatre Charges, Medicines & Drugs, Surgical Appliances, Dialysis, Radiotherapy, Chemotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during surgical procedure like Relevant Laboratory / Diagnostic test, pacemaker, X-Ray etc.
- Ambulance services: Company will reimburse 1% of the sum insured or Rs 2000/- whichever is less.
- Covers Hospitalization expenses incurred for donating an organ by the donor to the insured person during the course of organ transplant.
For complete information about inclusions please refer Oriental Insurance Individual Mediclaim policy guidelines and Oriental Insurance Individual Mediclaim Brochure attached below.
Oriental Insurance Individual Mediclaim Policy Exclusions
Exclusions under Oriental Insurance Individual 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 Insurance Individual Mediclaim policy guidelines and Oriental Insurance Individual Mediclaim Brochure attached below.
Oriental Insurance Individual 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 Insurance Individual Mediclaim Policy Buying Procedure
Documents and conditions required to buy Oriental Insurance Individual Mediclaim Policy are,
- Proposal form and Self declaration form is to be filled in block letters and in duplicate.
- Attach two stamp size photographs of each insured person on the Enrolment form.
- The company will not be on risk until the proposal has been accepted by the company and communication of the acceptance has been given to the proposer in writing on receiving full payment of premium.
- The proposer aged above 45 years of age has to undergo pre health check up through company’s authorised diagnostic centre and cost of such expenses to be borne by him/her.
Oriental Insurance Individual 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 Insurance Individual 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:
- 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.
- Upon getting the related medical details / relevant information from the insured person / network Hospital, TPA shall verify that the person is eligible to claim under the Oriental Insurance Individual Mediclaim policy.
- 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.
- 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.
- 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.
- 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 Insurance Individual Mediclaim Premium calculator
You can calculate the premium using Oriental Insurance Individual Mediclaim premium calculator. Personal details, Policy period, Number of members, Age and Sum assured and other details are required to calculate the premium.
Oriental Insurance Individual Mediclaim 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 |
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| 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 |
Give me the list of pre-health check ups?
| Age | 45-55 | ABOVE 55 Years |
|---|---|---|
| MEDICAL TEST | PHYSICAL EXAMINATION | PHYSICAL EXAMINATION |
| URINE(MICROALBUMIN UREA) | URINE(MICROALBUMIN UREA) | |
| GLYCOCYLATED, HAEMOGLOBIN | GLYCOCYLATED, HAEMOGLOBIN | |
| ULTRASONOGRAPHY (WHOLE ABDOMEN AND PELVIS) | ULTRASONOGRAPHY (WHOLE ABDOMEN AND PELVIS) | |
| ELECTRO CARDIO GRAM | X-RAY BOTH KNEES (ANTEPOSTERIOR AND LATREL) | |
| COMPLETE EYE TEST INCLUDIND FUNDUS ETC | COMPLETE EYE TEST INCLUDING FUNDUS ETC | |
| STRESS TEST (TMT) |
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 Insurance Individual Mediclaim Forms and Documents
Oriental Insurance Individual Mediclaim claim form
Oriental Insurance Individual Mediclaim Policy Guidelines
Oriental Insurance Individual Mediclaim Proposal form