PNB Oriental Royal Mediclaim 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

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,

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 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:

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 / PNB Oriental Royal Mediclaim network Hospital, TPA shall verify that the person is eligible to claim under the PNB Oriental Royal 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.

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,

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.

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

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