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The Oriental Insurance Company Ltd

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Individual Mediclaim Policy

Brief Description:-

Mediclaim Insurance is a cover for reimbursement of medical expenses following Hospitalization/Domiciliary Hospitalization of the Insured in respect of the following situations: (A) In case of a sudden illness (B) In case of an accident (C) In case of any surgery which is required in respect of any disease which has arisen during the policy period. The major benefit for taking a Group Mediclaim policy is that the insured gets a Group discount, hence the premium per person is lower.

Covered Risks:-

It is a hospitalization cover for reimbursement of the medical expenses incurred in respect of covered disease /surgery while the insured was admitted in the hospital as an in-patient. The cover also extends to pre- hospitalization and post- hospitalization for periods of 30 days and 60 days respectively.

Salient Features

Product name - Individual Mediclaim Policy

Coverage amount - Rs. 1,00,000

Premium (cost of coverage) - Rs. 5,196/-

Policy term (years) 1 year

Cashless facility - Yes

Coverage

Hospitalization expenses Yes

Daycare hospitalization Yes

Pre hospitalization expenses 30 days

Post hospitalization expenses - 60 days

Cost of health check up Yes

Eligibility

Medical test - After 45 years

Max. entry age (years)- 55 years

Eligibility conditions - Indian National only. No coverage for treatment outside India

Benefits

Income tax benefit Yes

Sub-limits applicable- Yes

Sub-limits description - The following provisions for reasonable & customary expenses, which are reimbursable under the policy have been introduced: Room, Board and Nursing Expenses as provided by the Hospital /Nursing Home not exceeding 1 % of the Sum Insured or Rs. 5000/- per day whichever is less.

ICU expenses not exceeding 2 % of the Sum Insured or Rs. 10,000/- per day whichever is less (Room stay plus I.C.U. stay should not exceed total number of admission days). Ambulance services - 1% of the sum insured or Rs 2000/- whichever is less shall be reimbursable where the patient has to be shifted from residence to hospital in case of admission in Emergency Ward / I.C.U. or from one Hospital / Nursing home to another Hospital / Nursing Home for better medical facilities. These expenses are payable only when registered ambulance is used.

Pricing

Family discount - Yes

Cumulative bonus - Yes

No Claim bonus Yes

Other Details

Provider type - PSU Companies
List of permanent exclusions - i-Benign ENT disorders and surgeries i.e. Tonsillectomy, Adenoidectomy,  Mastoidectomy, Tympanoplasty etc. 1 year
Polycystic ovarian diseases - 1 year
Surgery of hernia- 2 years
Surgery of hydrocele- 2 years
Non infective Arthritis- 2 years
Un-descended testes-2 Years
Cataract.2 Years
Surgery of benign prostatic hypertrophy- 2 Years
Hysterectomy for menorrhagia or fibromyoma or myomectomy or prolapse of uterus -2 Years
Fissure / Fistula in anus-2 Years
Piles- 2 Years
 Sinusitis and related disorders-2 Years
Surgery of gallbladder and bile duct excluding malignancy- 2 Years
Surgery of genitor- urinary system excluding malignancy-2 Years
Pilonidal Sinus-2 Years
Gout and Rheumatism-2 Years
Hypertension - 2 Years
Diabetes-2 Years
Calculus diseases-2 Years
Surgery for prolapsed inter vertebral disk unless arising from accident-2 Years
Surgery of varicose veins and varicose ulcers - 2 Years
Congenital internal diseases -2 Years
Joint Replacement due to Degenerative condition - 4 Years
Age related osteoarthritis and Osteoporosis - 4 Years

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I had insured my son Varun Jude Cruz for Individual Mediclaim Policy Number 214500/48/2014/2427. He has to undergo surgery, his details have been forwarded on 11th October 2014 by Yashoda Hospital Hyderabad, the approval is still awaited on 19 October 2014 with another query for copies of previous policies from 2011, do you not have copies of these policies. What is the reason for this delay of more than a week over bureaucratic queries of which details are held with the Company. If it was an emergency my son would be in grievous trouble.
Brig JL Cruz.

Cruzl Sunday, October 19, 2014
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
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