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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:-
BENEFIT SILVER PLAN

(Limit of Reimbursement)

GOLD PLAN

(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
DOMICILIARY 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

ADD ON Covers (OPTIONAL, SUBJECT TO EXTRA PREMIUM)

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

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.

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
    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.

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
Cataract 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
Piles 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
Hypertension 2 Year
Diabetes 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

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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
premium calculation
NIM_JHAN Monday, August 12, 2013
sir, i wish to know about the Family Floator Policy of Oriental Insurance Co Ltd Also the concern person contact details of Bangalore
raviblr05 Wednesday, June 19, 2013
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