Policy Highlights
- 1 PNB Oriental Royal Mediclaim Policy Introduction
- 2 PNB Oriental Royal Mediclaim Policy Eligibility Conditions
- 3 PNB Oriental Royal Mediclaim Policy Key Features
- 4 PNB Oriental Royal Mediclaim Policy Inclusions
- 5 PNB Oriental Royal Mediclaim Policy Exclusions
- 6 PNB Oriental Royal Mediclaim Policy Customer Care
- 7 Assistance:
- 8 PNB Oriental Royal Mediclaim Policy Buying Procedure
- 9 PNB Oriental Royal Mediclaim Policy Premium Payment:
- 10 PNB Oriental Royal Mediclaim Policy Claim Procedure
- 11 Intimation:
- 12 Claim Procedure to avail Cashless service:
- 13 Documents to be submitted during claim:
- 14 PNB Oriental Royal Mediclaim Policy Premium Calculator
- 15 PNB Oriental Royal Mediclaim Policy Premium Rates
- 16 PNB Oriental Royal Mediclaim Policy FAQ’s
- 17 PNB Oriental Royal Mediclaim Policy Forms and Documents
- 18 About Oriental Gramin Personal Accident Insurance
- 19 About Oriental Group Mediclaim Policy
- 20 About Oriental Janata Personal Accident Policy
- 21 About Oriental Nagrik Suraksha Policy
- 22 About Oriental Bank Mediclaim Policy
- 23 About Oriental Individual Mediclaim Policy
- 24 About Happy family floater policy
PNB Oriental Royal Mediclaim Policy Introduction
PNB Oriental Royal Mediclaim Policy is a Customised Group Health Product launched by Punjab National Bank (PNB). Punjab National Bank (PNB) signed an agreement with The Oriental Insurance Company Ltd. to sell mediclaim policies to its customers/employees. PNB Oriental Royal Mediclaim Policy is designed exclusively for the Account Holders/Employees of Punjab National Bank (PNB). This policy will be available in all PNB Branches across the country. Entire Family i.e. Proposer, Spouse and 2 dependent children (Female dependent child until she is married and Male dependent child upto the age of 26 years, provided he is bonafide regular student) are covered under PNB Oriental Royal Mediclaim Policy.
PNB Oriental Royal Mediclaim Policy Eligibility Conditions
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PNB Oriental Royal Mediclaim Policy Renewal: |
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PNB Oriental Royal Mediclaim Policy Key Features
- All customers (depositors as well as borrowers) of the PNB shall be eligible to take PNB Oriental Royal Mediclaim cover.
- It is with a family floater Scheme, which covers the Entire Family.
- Cashless facility is available at PNB Oriental Royal Mediclaim Policy Network Hospitals. The policy will be serviced by TPA(Third Party Administrators).
- Uniform Premium for persons of all age-groups up to 80 years’ age.
- 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.
- Benefits such as Ambulance Charges, Cost of Health Check-up, Hospital Cash etc. are also available under PNB Oriental Royal Mediclaim Policy.
PNB Oriental Royal Mediclaim Policy Inclusions
Coverages under PNB Oriental Royal Mediclaim Policy are,
- 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 1000/- whichever is less.
- Hospital Cash: Reimbursement of incidental expenses subject to a maximum of Rs.1,000 during the entire policy period.
- Reimbursement of Funeral Expenses: The company shall reimburse funeral expenses subject to a maximum of Rs.1,000 during the policy period.
- Domiciliary hospitalization: Surgeon, Consultants, Medical Practitioner, Specialists Fees, Oxygen, Blood, Surgical Appliances, Diagnostic Material and Dialysis, Medicines & Drugs, Chaemotherapy, Nursing expenses – 10% of Sum Insured, Maximum Rs.25000/- during policy period.
PNB Oriental Royal Mediclaim Policy Exclusions
Exclusions under PNB Oriental Royal 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 PNB Oriental Royal Mediclaim Policy prospectus and PNB Oriental Royal Mediclaim Policy Brochure attached below.
PNB Oriental Royal 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
PNB Oriental Royal Mediclaim Policy Buying Procedure
Documents and conditions required to buy PNB Oriental Royal Mediclaim Policy are,
- Proposal form to be filled in block letters.
- Submit two stamp size photographs of each insured person along with two copies of proposal form.
- Name and age of the insured must be written on the back of the photo.
- Family to include the proposer i.e., account holder/employee of the Punjab National Bank (PNB). 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 PNB account holder.
PNB Oriental Royal Mediclaim Policy 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.
PNB Oriental Royal 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 / PNB Oriental Royal Mediclaim network Hospital, TPA shall verify that the person is eligible to claim under the PNB Oriental Royal 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.
PNB Oriental Royal Mediclaim Policy Premium Calculator
You can calculate the premium using PNB Oriental Royal Mediclaim premium calculator. Personal details, Policy period, Number of members, Age and Sum assured and other details are required to calculate the premium.
PNB Oriental Royal Mediclaim Policy Premium Rates
PNB Oriental Royal 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 |
PNB Oriental Royal 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 |
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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 |
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.
PNB Oriental Royal Mediclaim Policy Forms and Documents
PNB Oriental Royal Mediclaim Claim Form
PNB Oriental Royal Mediclaim Proposal Form
PNB Oriental Royal Mediclaim Prospectus
Do you have portability option,
never buy insurance from any private company specially from Appollo Munich claim settlement ratio is 65.59% very low), these companies always hide required information from customer, Appollo Munich have increased the premium recently upto 40% by taking permission from IRDA, and according financial planners for a sum assured of Rs 3 lakhs at age of 60yrs the premium will be as below
according to company after every 3 yrs (may be every years according to policy terms) apollo munich will increase premium to 40 % and let us make calculations for sum assured of 3 lakhs at age of 33 yrs premium is 10000/- approx, if ur aspect-ed age is 80 years
total number of yrs for premium 80-33= 47 years
total number of times premium increases 47/3= 16 times
premium increases 1st time 40%> 10000@40%= 4000/- total premium of next 3 yrs= 4000+10000=14000/-
and 2nd time increase in premium 14000*40% =5600/- total premium of next 3 yrs= 5600+14000=19600/-
and soon… upto 16 or 17 times in ur life
in addition to this regular premium increase according to age group 36 to 45=5000/-
46 to 50=7000/-
50 to 55=23000-/-
56 to 60=32000/-
61 t0 65=70000/-
Now gross premium paid by you at age of 36=4000+10000+5000=19000/-
after 3 year with 40% increase in premium to 39 5600+14000+7000=26600/-
and so on……….
at age of 60 years ur gross premium will be= 2.7 lakh for a sum assured of Rs 3lakh and at age of 75yrs premium will be 6 lakhs for sum insured of rs 3 lakhs
this is how apollo munich optima restore plan lot the Indian people by a other country company
and also optima restore option will not act effectively at that age and no other company will give u an option to by any other plan.. its premium increases exponentially after age of 45 years
sir,
i have to pay 6830 rupee for the year 13/8/15 to 13/8/16. please let me know the procedure for payment. i have by from bhopal . i live in HARDA . up till now i have paid by cheque please tell me how to pay on line . my policy no is 152104/48/2015/830
Never buy any private company policy, they are all doing fraud. Only government policy is provide the real benefit to you.
From last five years I am member of PNB -Oriental Royal Mediclaim Policy .
Do you have portability option, in star health to PNB Oriental Royal Mediclaim Policy
कम्पनी के जो ढेरो न. मुझे दिये गये है उनमे से एक ने तो यहॉ तक कह डाला की उपर वाले( नोयडा) हमारा ही फोन नही उठाते है.जब दो बाते मेने सुनाई तो कहने लगे ऐसी ही है हमारी कम्पनी
उपर एक नम्बर 01133208485 दे रखा है अभी फोन लगाया आवाज आयी…….ये नम्बर अस्थाई तौर पर बंद है………….मत खरीदो इसकी पॉलिसी
i want chick the police
When is risk covered by company? Suppose I pay for premium the will the company start to cover risk from the first day of policy?
Sir,
we are five members including me i.e. my wife three children and me.
please suggest me how to purchase PNB Oriental Medical Policy
MY OPEN FAMILY MEDICLAIM POLICY. PLEASE DETAILS SHARE THE ADVISE
PNB Oriental is joint venture for mediclam offering for PNB customers only, for ex. but if PNB holders paid premium for 10 years and after a long period, if joint venture would not continue, in that case what about the policy which customers paid for long tie credit. ???
please tell me how to premium paid on line
The premium as mentioned above is monthly or yearly???
If u have require any details for choose meduclaim policy just contact 8802709152
Regds
Amir gutta
Sjbnm
Director
Any kind of claim assistant and for best mediclain cover
Sir/Mam
we took a mediclaim ploicy in 17/4/2016(2 month later) but did not recevied a card.No one give a right feedback about cards.
your company insurer officer of branch neglect this issue.
Can a P N B bank account holder change insurance company without loosing the benefit
of previous years of mediclaim policies
Pls send the hospital penal list of pnb royal policy…
I recently purchased a mediclaim policy from PNB Royal mediclaim policy through my home branch of PNB sector 46, gurgaon,
can anyone tell me the which hospitals are listed under this policy
my sum insured is Rs 300000/-
Premium is 4730/-
sir, mera salary account punjab national bank main hai main govt. job karta hun, punjab oriyantal mediclame policy ka primiam main monthly instaalment main de sakta hun kiya plz. rply
regarding PNB Oriental health insurance it is advisable to give the customers to online payment..After remitting online the company can ask the customers for any additional details if needed. This will benefit the company and customers more convenience to renew the policy in an easy manner that we do in LIC presently paying the premium online.
How are any diseases arising due to high/low Blood Pressure covered under this PNB Royal Oriental Mediclaim policy covered. Please let me know
Pnb group health insurance
Sir insurance cover 1lac se bada kar 3 lac karna he new premium kya hoga plz advice Kare . Policy no. R. 242606/48/2016. Insured code 47134719 due date 16/01/2017
I would like join the Policy of PNB and Oriental Mediclaim .Please inform the tenure of the scheme.
If the insured have no claim since last four yrs. can he eligible for medical checkup once in four yrs? If yes what is the procedure.
Hi all never buy universal sompo health insurance policy, pure fraud company while claim settlement they deny all the documents.