The Oriental Insurance Company Ltd
Family Floater Policy
• 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:
(Limit of Reimbursement)
(Limit of Reimbursement)
|Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing Home||Not exceeding 1 % of the Sum Insured per day||Not exceeding 1 % of the Sum Insured per day|
|Intensive Care (IC) Unit Expenses as provided by the Hospital/Nursing Home||Not exceeding 2% of the Sum Insured per day.||Not exceeding 2% of the Sum Insured per day.|
|Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees||As per the limits of the sum insured||As 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 expenses||As per the limits of the sum insured||As per the limits of the sum insured|
|Ambulance services charges||Rs.1,000/- per illness and limited to maximum 1% of the sum insured or Rs.3,000/- whichever is less, for the entire policy period||Rs.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 ALLOWANCE||NIL||0.1% 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 allowance||NIL||Rs.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|
|Surgeon, Medical Practitioner, Consultants, Specialists Fees, Blood, Oxygen, Surgical Appliances, Medicines & Drugs, Diagnostic Material and Dialysis, Chemotherapy, Nursing expenses||10% of Sum Insured, Maximum Rs.25000/- during policy period||Rs.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 policy||Reasonable expenses limited up to Rs.5,000/- actually incurred for immunization injections in any one policy|
|Benefits||Silver Plan||Gold Plan|
|Personal Accident||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||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|
|Life Hardship Survival||NIL||Plans of benefit AS DEFINED HEREINAFTER|
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.
|Diabetes||Hypertension||Diabetes & Hypertension|
|Diabetic Retinopathy||Cerebro Vascular accident||Diabetic Retinopathy|
|Diabetic Nephropathy||Hypertensive Nephropathy||Diabetic Nephropathy|
|Diabetic Foot /wound||Internal Bleed/ Haemorrhages||Diabetic Foot|
|Diabetic Angiopathy||Coronary Artery Disease||Diabetic Angiopathy|
|Diabetic Neuropathy||Diabetic Neuropathy|
|Hyper / Hypoglycaemic shocks||Hyper / Hypoglycaemic shocks|
|Coronary Artery Disease|
|Cerebro Vascular accident|
|Internal Bleeds/ Haemorrhages|
• 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 / Surgeries||Specified Period|
|Benign ENT disorders and surgeries i.e. Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty etc.||1 Year|
|Polycystic ovarian diseases||1 Year|
|Surgery of hernia||2 Year|
|Surgery of hydrocele||2 Year|
|Non infective Arthritis||2 Year|
|Undescended Testes||2 Year|
|Surgery of benign prostatic hypertrophy||2 Year|
|Hysterectomy for menorrhagia or fibromyoma or myomectomy or prolapse of uterus||2 Year|
|Fissure / Fistula in anus||2 Year|
|Sinusitis and related disorders||2 Year|
|Surgery of gallbladder and bile duct excluding malignancy||2 Year|
|Surgery of genito- urinary system excluding malignancy||2 Year|
|Pilonidal Sinus||2 Year|
|Gout and Rheumatism||2 Year|
|Calculus diseases||2 Year|
|Surgery for prolapsed inter vertebral disk unless arising from accident||2 Year|
|Surgery of varicose veins and varicose ulcers||2 Year|
|Joint Replacement due to Degenerative condition||4 Year|
|Age related osteoarthritis and Osteoporosis||4 Year|