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The Oriental Insurance Company Ltd

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Family Floater Policy

Oriental health insurance family floater policy is issued for a period of one year and it offers two plans:-

Silver plan Sum insured in multiples of Rs.1,00,000/- and up to Rs.5,00,000/- per person aged 18 years and above . 50% of this limit for persons less than 18 years.

Gold plan Sum Insured in multiples of Rs. 2,00,000/-, and up to Rs.10,00,000/- per person aged 18 years and above. 50% of this limit for persons less than 18 years.

Oriental Health Insurance - Eligibility

The Entry age limit of the proposer is maximum 55years

Continuous renewals will be accepted till the proposer is 65years old.

Oriental Health Insurance - Coverage Benefits

The following reasonable and necessary expenses (subject to limits) are payable under the policy for various benefits:
BenefitSilver Plan
(Limit of Reimbursement)
Gold Plan
(Limit of Reimbursement)
Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing HomeNot exceeding 1 % of the Sum Insured per dayNot exceeding 1 % of the Sum      Insured per day
Intensive Care (IC) Unit Expenses as provided by the Hospital/Nursing HomeNot exceeding 2% of the Sum Insured per day.Not exceeding 2% of the Sum      Insured per day.
Surgeon, Anaesthetist, Medical      Practitioner, Consultants, Specialists FeesAs per the limits of the sum insuredAs 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 expensesAs per the limits of the sum insuredAs per the limits of the sum insured
Ambulance services chargesRs.1,000/- per illness and      limited to maximum 1% of the sum insured or Rs.3,000/- whichever is less, for the entire policy periodRs.2,000/- per illness and limited to maximum 1% of the sum insured or Rs.6,000/- whichever is less, for the entire policy period
DAILY HOSPITAL CASH ALLOWANCENIL0.1% of sum insured per day per      illness subject to a maximum compensation for 10 days per illness. The overall liability of the Company during the policy period will be limited to 1.5% of the sum insured
Attendant allowanceNILRs.500/- per day of hospitalization per illness and up to 10 days per illness. The overall liability of the Company during the policy period will be limited to compensation for 15 days of hospitalization
DOMICILIARY HOSPITALIZATION
Surgeon, Medical Practitioner,      Consultants, Specialists Fees, Blood, Oxygen, Surgical Appliances,      Medicines & Drugs, Diagnostic Material and Dialysis, Chemotherapy,      Nursing expenses10% of Sum Insured, Maximum      Rs.25000/- during policy periodRs.50000/-,during policy period
Treatment for Dog bite (or bite      of any other rabid animal like monkey, cat etc.)Reasonable expenses limited up      to Rs.5,000/- actually incurred for immunization injections in any one      policyReasonable expenses limited up      to Rs.5,000/- actually incurred for immunization injections in any one      policy
ADD ON Covers (OPTIONAL, SUBJECT TO EXTRA PREMIUM)
BenefitsSilver PlanGold Plan
Personal AccidentSum insured in multiples of Rs.1,00,000/- and up to Rs.5,00,000/- per person aged 18 years and above. 50% of this limit for persons less than 18 yearsSum Insured in multiples of Rs.2,00,000/- and up to Rs.10,00,000/- per person aged 18 years and above. 50% of this limit for persons less than 18 years
Life Hardship SurvivalNILPlans of benefit AS DEFINED HEREINAFTER
Oriental Mediclaim Insurance - Pre-existing Exclusions

Pre-existing health condition or disease or ailment / injuries

Any ailment / disease / injuries / health condition which are pre-existing (treated / untreated, declared / not declared in the proposal form), in case of any of the insured person of the family, when the cover incepts for the first time, are excluded for such insured person up to 4 years of this policy being in force continuously.

For the purpose of applying this condition, the date of inception of the policy taken from the Company, for each insured person of the family, shall be considered, provided the renewals have been continuous and without any break in period.

This exclusion will also apply to any complications arising from pre existing ailments / diseases / injuries. Such complications shall be considered as a part of the pre existing health condition or disease. To illustrate if a person is suffering from hypertension or diabetes or both hypertension and diabetes at the time of taking the policy, then policy shall be subject to following exclusions.
DiabetesHypertensionDiabetes & Hypertension
Diabetic RetinopathyCerebro Vascular accidentDiabetic Retinopathy
Diabetic NephropathyHypertensive NephropathyDiabetic Nephropathy
Diabetic Foot /woundInternal Bleed/ HaemorrhagesDiabetic Foot
Diabetic AngiopathyCoronary Artery DiseaseDiabetic Angiopathy
Diabetic Neuropathy Diabetic Neuropathy
Hyper / Hypoglycaemic shocks Hyper / Hypoglycaemic shocks
  Coronary Artery Disease
  Cerebro Vascular accident
  Hypertension Nephropathy
  Internal Bleeds/ Haemorrhages
Expenses incurred on any disease, except as specified under the following table, contracted by the Insured person during the first 30 days from the commencement date of the policy except treatment for accidental external injuries.

The expenses on treatment of following ailment / diseases / surgeries for the specified periods are not payable if contracted and / or manifested during the currency of the policy.

If these diseases are pre-existing at the time of proposal the exclusion for pre-existing condition shall be applicable in such cases.
Ailment / Diseases / SurgeriesSpecified Period
Benign ENT disorders and surgeries i.e. Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty etc.1 Year
Polycystic ovarian diseases1 Year
Surgery of hernia2 Year
Surgery of hydrocele2 Year
Non infective Arthritis2 Year
Undescended Testes2 Year
Cataract2 Year
Surgery of benign prostatic hypertrophy2 Year
Hysterectomy for menorrhagia or fibromyoma or myomectomy or prolapse of uterus2 Year
Fissure / Fistula in anus2 Year
Piles2 Year
Sinusitis and related disorders2 Year
Surgery of gallbladder and bile duct excluding malignancy2 Year
Surgery of genito- urinary system excluding malignancy2 Year
Pilonidal Sinus2 Year
Gout and Rheumatism2 Year
Hypertension2 Year
Diabetes2 Year
Calculus diseases2 Year
Surgery for prolapsed inter vertebral disk unless arising from accident2 Year
Surgery of varicose veins and varicose ulcers2 Year
Joint Replacement due to Degenerative condition4 Year
Age related osteoarthritis and Osteoporosis4 Year

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Guys, Please stay away from Oriental insurance..!!! I am having its policy, It is not at all satisfactory, for my case. My claim has been approved for payment around one and a half month back, but still I am unable to receive the said amount [They reduced around 30% of claimed amount, this is bit high too]. You wont get any reply if you try contacting customer care service. In short you will not have any idea about your claim!!. Better to go for LIC. I am using it without much issues. Oriental is from my company side, thus I made this mistake. Think and act wisely. Cheers.
Unais Thursday, September 11, 2014
If i change my mediclaim insurance from National insurance to you, the pre- existing diseases clause will start afresh from you for 4 years or the period which was under national, without any claim would be honored by you ? Is there any age restriction in case of a govt. certified handicapped dependent to be included with parents? P.K.Agrawal
pkagrawal Wednesday, September 10, 2014
I want group mediclaim policy with accidentally covee
Ashok28 Friday, August 22, 2014
I want to take a oriental Insurance health/medicalim poliy. Pl. guide me where and to whom I should contact.

Lal Singh
IIT Delhi

lala523 Monday, June 09, 2014
I want to take insurance.
Guest Sunday, June 15, 2014
YOU CAN CONTACT ME AT 9910041099.
Guest Saturday, August 09, 2014
Hello ! I am 39 yrs age and want a good insurance scheme for my wife , 2 child of 10 yrs and 4 years and for parents.
digantarumi Tuesday, May 13, 2014
I am retired person from Punjab National Bank and have taken Medi-claim family floater policy of rupees five lakh. I also want to take another Medi-claim policy for the family of my elder son his wife and daughter if 1.9 yr. I want ti know the list of diseases which are not covered up to three years so that proper information be conveyed to my son and his wife.
rajesh21_pd Monday, March 03, 2014
it cover risk of pregnancy and abortion also if yes than how much
rachana1234 Thursday, January 09, 2014
Sir i want medical insuranc policy . so plz send detail yearly premiam and detail. thank you .
dashrathkumar Friday, October 25, 2013
I want mediclaim policy for me, my hubby and a child.
who is the contact person in Coimbatore city. I would like to join in the mediclaim policy.

sreejamurali Thursday, October 17, 2013
i wish to medical insurance for me and for my mother...

Regards
Koushik S

Koushik80 Tuesday, September 03, 2013
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