How to File Insurance Claims Using Oriental Insurance Claim Form

Updated: 01-10-2019 12:36:42 PM

The Oriental Insurance Company Limited was found in 1947 and from 2003, it is governed by the central government. The company has various policies for general insurance. In general insurance, the major products sold by the company are the health insurance products. The list of health insurance plans by the company are:

• Oriental Individual Health Insurance Plan
• Oriental Happy Family Floater Plan
• Oriental Overseas Mediclaim
• Oriental Group Mediclaim Plan
• Jan Arogya Plan
• Health of Privileged Elder
• Pravasi Bhartiya Bima Yojna

Claim Processes Using Oriental Insurance Claim Form

The claim process for all the above-mentioned policies is the same, but the documentation varies in the policies. The claim process is generic and can be applied to all the policies, but the documentation varies as per the situation of the claim. Two health insurance policies can have the same documentation required for the claims if the situation is the same. For instance, Mediclaim for hospitalization. But the same policy can have a difference in documentation requirement if the claim is being made for two different situations.

Claim Process for Emergency Hospitalization

In case of emergency hospitalization, there is a process to be followed by family/friends of the insured to claim the insurance. The third-party administration is to be informed within a time period of 24 hours for making a health insurance claim. The insured has to fill the claim form provided by the company in 15 days of getting discharged from the hospital. The claim settlement will be carried out as per the terms and conditions involved in the health insurance plan purchased by the insured.

Claim Process for Planned Hospitalization

The insured can avail a cashless treatment at a network hospital if the hospitalization is planned. The network hospital has to authorize the claim form before hospitalization. After that Oriental medical insurance claim experts will evaluate the claim form and decide if the insured is eligible for the claim or not. If the claim gets approved the insured can ensure a cashless treatment at one of the network hospitals, the insurance provider will thereafter settle the payment with the hospital directly.

Documentation Involved in Oriental Health Insurance Claim

As suggested above, the documentation of a claim varies with the situation – the type of ailment for which the insured needs the coverage. The documentation required for one type of situation is the same disregard of the chosen policy. The claim settlement, however, will depend on the terms and conditions of the policy. The documentation required in various situations are:

Hospitalization Medical Claim

To make a claim in case of hospitalization, similar documents will be needed for both illness and accident. The documents needed in this situation are:

• Premium receipts
• Xerox copy of the policy
• Copy of claim intimation
• Medical Reports
• Filled claim intimidation form
• Hospital discharge documents
• Medical Recovery Report
• All diagnostic reports (Blood Tests, ECG, X-Ray, etc.)
• Employer leave certificate
• The copies of bills and payment receipts associated with the claim
• Details related to hospitalization like Hospital Registration Number
• If the hospital is not registered the details like, number of doctors and nursing staffs, number of beds and operation theatre details (how well equipped) are to be submitted
• FIR copy in case of accidental hospitalization

Accidental Injury or Permanent Disability Claim

In case the insured gets injured or suffers from a permanent disability in an accident the following documents are to be submitted for filing the claim:

• The premium receipts
• Xerox copy of the policy
• Copy of claim intimation
• Medical Reports
• Filled claim intimidation form
• Hospital discharge documents
• All hospitalization details like expenses
• Disability Certificate
• Employer leave certificate
• Employer Wage Certificate

Accidental Death Claim

In case of an accidental death, the following documents need to be submitted for filing a claim:

• Premium receipts
• Xerox copy of the policy
• Copy of claim intimation
• Filled claim intimidation form
• Post Mortem Report
• Death Certificate
• FIR Report Copy
• Medical expense related documents
• Medical reports
• Age proof
• Employer Wage Certificate

Temporary Total Disability due to Accident (Weekly Cash Claim)

In case the insured suffers from a temporary total disability he or she is entitled to weekly cash benefits for a specified time period. In order to claim these benefits the following documents are to be submitted by the insured and beneficiaries:

• Premium receipts
• Xerox copy of the policy
• Copy of claim intimation
• Filled claim intimidation form
• Medical expense related documents
• Medical reports
• FIR Report Copy
• Employer leave certificate

Exclusions in Oriental Health Insurance Claims

The terms and conditions of your policies can help you in understanding the exact inclusions and benefits in your plan. But, there are certain situations that are excluded from all the health insurance policies, and they are:

• Any health issues that arise due to psychometric or psychiatric disorders are excluded
• Pre-existing diseases are excluded for the first three years of policy
• Any claim made due to injury or disease occurred during a sports/adventurous activity is excluded
• All kinds of cosmetic surgeries, obesity treatment, hormonal replacement, sex transition and stem cell implantation are excluded from the plans
• Treatment cost incurred for the convenience and comfort of the insured are not considered necessary and are hence, excluded from the claim
• Expenses incurred on experimental treatments and alternative medicines like acupuncture etc. are excluded
• Expenses incurred on injuries occurred due to war or warlike activities are excluded
• Dental treatments related to cosmetic or corrective reasons are excluded from the plan. These treatments include root canal due to wear and tear, filling of tooth cavity, and aesthetic procedures. The dental treatment coverage is only provided if the reason behind it is accidental damage or disease that requires hospitalization.
• Treatments relating to diseases like Bronchitis, Asthma, Sinusitis, Piles, Fitual of Anus, Hernia, Fibromyoma or Menorrhagia, Hysterectomy, Benign Prostatic Hypertrophy and cataract

Many people do not opt for insurance policies due to the long and complicated claim procedures along with exhaustive documentation process. After such long procedures also, there are chances that your insurance provider will reject your claim, but this is not the case with Oriental Insurance Company Limited. The claim procedure of Oriental Medical Insurance is very simple to provide you are well aware of inclusions and exclusions along with the required documentation. The Oriental insurance claim form makes it very simple for the insured and the beneficiaries to provide details of the claim and simplify the claim process as a whole.

FAQs

Q1. How can the payment of premiums be made?

The premium can be paid both online and offline. For the offline payment, the insured has to make a cash payment at the branch office. For online payment the following options are available:

• Net Banking
• Debit Card
• Credit Card

Q2. What is the process to check the status of policy with Oriental Health Insurance?

The policy status can be checked on the website of Oriental Insurance Company Limited by simply logging in the portal.

Q3. What is the renewal process for the policy?

For renewal of the policy, the insured has to log in to the official website and make the payment.