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


• Hospitalization expenses – Yes

• Daycare hospitalization – Yes

• Pre hospitalization expenses – 30 days

• Post hospitalization expenses - 60 days

• Cost of health check up – Yes


• Medical test - After 45 years

• Max. entry age (years)- 55 years

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


• 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.


• 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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my policy 48/2016/10202 My name is Pradipbhai Rajani - Rajkot. I was submit my discharge voucher on 28/01/2016 but till date of 06/02/2016 my claim amount is not credit in my account. I was inquiry to The oriental Insurance Co. Ltd. Rajkot. He hed reply me [now we have no fund] so please consider the matter and do the needful. My mobile no. is 91 9428251786 please give me the reply.
pradip786 Saturday, February 6, 2016
I am going to operate cataract of my eye from a nursing home which is not enlisted by TPA. So, cashless benefit will not be entitled there . Now pl tell me how I can proceed for reimbursement of the amount . I am policy holder for more than last 10 years. Sanghamitra Ghosh Policy no. 311202/48/2016/473
vipenclave Tuesday, January 5, 2016
can I get detailed information about my Mediclaim policy No. 311303/48
sankar_kabiraj Thursday, December 31, 2015
i rajessh sufering from piles @fistula intrested take a mediclam policy
nandore Monday, July 20, 2015
I am 64 yrs old and my wife is 62 yrs old I am interested in taking mediclaim policy [Cashless] please advise me for the floating policy for one year.
Ashokgkurup Tuesday, July 7, 2015
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 9, 2014
I want to take insurance.
Guest Sunday, June 15, 2014
Guest Saturday, August 9, 2014
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