Oriental Insurance Individual Mediclaim Health Insurance

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Oriental Insurance Individual Mediclaim Health Insurance

	Objective			A basic health insurance policy that aims to cover medical expenses, incurred as an inpatient due to illness or accident. Individuals upto 45 years of age can buy this policy online through company's website.
Suited for			It is suitable for anyone looking for a basic medical cover.
What does it do?			The policy pays a benefit in case the insured person gets hospitalised. It also covers domiciliary treatment availed at home on advice of medical practitioner, organ donor's hospitalisation expenses and day care procedures which can be treated without hospitalisation. The policy will provide for a health check-up after four continuous claim-free years.
Pros			This policy can be bought online from company's website. Premium paid towards this policy is eligible for Income Tax benefit under Section 80D.
Cons			This policy does not offer lifelong renewal. There are sub-limits on room rent, boarding and ICU charges.
Our View			While buying a health insurance policy, it is necessary to look at exclusions and waiting periods. Certain diseases or illnesses mentioned in the policy document will be covered after stated waiting periods. Sub-limits imposed on certain expenses is another drawback. Though the policy features good coverage, you must look out for other plans which do not carry any sub-limits and offer lifelong renewal as well.
Eligibility
Entry Age (years)
Minimum		18
Maximum Policy Renewal Age (years)		80
Coverage Type		Individual
Policy Term (years)		1
Sum Insured (Rs)
Maximum		500000
Minimum		50000
Discount		5% on premium if Third Party Administrator (TPA) services are not availed
Pre Policy Medical Check Up		Not required for persons below 45 years of age
Policy Termination		Insurance company may cancel the policy by giving a 30 days notice period. Insurance company in such a case will repay the pro-rata premium to the insurer if claim has not been made. Insurer may also cancel the policy at any time.
Customer Service
Address		Oriental House, A-25/27, Asaf Ali Road, New Delhi - 110002
Mail to		csd@orientalinsurance.co.in
Call to		1800 11 8485 (toll free), 011-33208485(non toll free)

 

	Scope of Cover
Cashless facility		available if treatment availed in a network hospital
Reimbursement facility		available if treatment availed in a non-network hospital
Pre and post hospitalisation		covers expenses incurred during 30 days prior to hospitalisation and 60 days after discharge from hospital
Inpatient hospitalisation		covered
Room, boarding and nursing expenses		covered upto lower of 1% of sum insured or Rs 5000 per day
I.C.U charges		covered upto lower of 2% of sum insured or Rs 10000 per day
Surgeon, anaesthetist, medical practitioner, consultants, specialist fees, blood, oxygen, chemotherapy, Radiotherapy, Artificial limbs, Cost of prosthetic devices implanted during surgical procedure like pacemaker etc., X-Ray		covered
Other benefits
Domiciliary treatment		covered
Ambulance services		reimburses upto 1% of sum insured or Rs 2000 whichever is less
organ donor's hospitalisation expenses		medical expenses for treatment of organ donor in case of major organ transplant is covered
Day care procedures		covers those treatments which do not require an overnight stay in the hospital due to technological advancement
Cost of health check-up		reimburses an amount upto maximum of 1% of average basic sum insured once after every 4 claim free years

 

	Exclusions and Waiting Period
Pre-existing illnesses		will be covered after 4 years of continuous renewal with the company
No claim period		initial 30 days from inception of the policy
Waiting period		certain illnesses such as Hernia, Piles, Cataract, Hypertension, Diabetes etc, will be covered after a waiting period of 2 years.Joint Replacement due to degenerative condition and Age related osteoarthritis, and Osteoporosis will be covered after a period of 4 years.
General Exclusions		AIDS or related diseasesMental or related illnessesCosmetic or beauty treatment

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