In this age, having a health insurance policy has become very important and one such policy is Mediclaim coverage from Oriental health Insurance. It is a comprehensive health policy to save the policyholder from the financial trauma at the time of medical emergency. Not only Oriental Health Insurance Individual Mediclaim Policy reimburses hospitalization expenses but also take care of pre and post medical expenses as well.
What is Oriental Health Insurance Individual Mediclaim Policy?
Oriental Health Individual Insurance Mediclaim Policy provides health coverage which takes care of the Hospitalization expenses in case the insured is admitted in the hospital under the following circumstances:
- In case of the sudden illness
- Due to the accident
- In case the insured needs surgery for the disease which have arisen during the policy term
Eligibility Criteria
This health cover is for one year and available for anyone between the age of 18 to 65 years. The applicant can also get his family covered.
Features Of Oriental Health Insurance Individual Mediclaim Policy
- The minimum sum insured available in this policy is Rs 1 lakh which can go up to Rs 10 lac
- The insured is provided with 15 days to review the policy document from the issued date under the Free look period
- The insured will get 5.5% discount in premium if TPA services are not opted for
- If the Sum insured is between Rs 2 Lakh to Rs 10 Lakh, the insured can avail personal accident coverage
What This Individual Mediclaim policy includes?
It is a hospitalization cover and following medical expenses will be reimbursed if the insured is in hospital as an inpatient:
- Donor expenses
- Ambulance charges
- Room, boarding and nursing expenses
- ICU expenses
- Ambulance service charges
- Daily hospital cash allowance
- Dental treatment if it becomes necessary during treatment
- Ayurvedic, unani and homeopathic treatment
- Treatment for dog bite (rabid animal bite) up to Rs 5000
Documents required for claim process
Following are the documents which are necessary to submit to the insurance provider or TPA to process claim:
- Copy of claim intimation form along with the policy and premium receipt
- Duly filed claim form
- Hospital discharge report
- Medical treatment and recovery report
- Original test reports, bills, cash memos of medical expenses
- Leave certificate from employer
As soon as the insured is admitted in the hospital, details like Policy Number, ID Card No., Name of insured person in respect of whom claim is made, Nature of disease / injury, name of the hospital, etc. should be given to the insurance company /TPA within 48 hours of admission but before discharge unless waived in writing.
Cases where you can’t claim this plan
The insurance company is not liable to pay for disablement or death of the insured under the following conditions:
- If the insured tried to attempt suicide
- Hospitalized due to the influence of liquor and drugs
- If the insured is hospitalized directly or indirectly because of radiations contaminated by nuclear fuel, nuclear weapon material
How long does it take to pay out a claim?
The final claim along with the necessary documents stated in the policy should be submitted to the company/TPA within 15 days of discharge from the hospital.
If the insured wants to opt for the cashless access service, S/he needs to take a pre admission authorization either from the insurance company or from the TPA. Upon getting the required documents, medical details from the insured and network hospital, it will issue a pre-authorization letter / guarantee of payment letter to the Hospital mentioning the sum guaranteed as payable.
If in case, the insurance company deny the claim, the insured may gets the treatment as per the doctor’s advice and later on submit the claim papers to the company for reimbursement within 7 days from the discharge.
Renewal Process Of Oriental Health Insurance Individual Mediclaim Policy
Lifelong renewals are allowed under this policy. At the time of renewing this policy, the insured can increase the sum assured amount. The maximum sum insured allowed for the policyholder who is up to the age of 45 is Rs 2 lakh and beyond 45 years, the maximum amount is Rs 1 lakh. The grace period of 30 days is allowed to make the premium payment in case; the insured missed the due date of payment.
Advantages of buying Oriental Health Insurance Individual Mediclaim Policy
- Applicant can port her/his existing mediclaim policy into this policy
- There is an additional discount of 10% provided to the insured family if any of the family members is covered under the policy
- Daily hospital allowance is provided if the insured is hospitalized for more than two days in continuance
- Cashless access service is provided if the treatment is taken in the network hospitals
- If the insured doesn’t claim for three years, S/he will be entitled to get health check-up benefit subject to maximum of Rs 3000 per insured
- If the insured opts for the co-payment of 10% or 20%, he will be eligible for the premium discount of 10%-20%
Important Aspects (Critical things you shouldn’t ignore)
- The maximum entry age can be extended up to 70 years if the applicant is willing to pay 10% additional premium on all future renewals
- Pre-existing diseases are covered after four consecutive renewals
| Features | |
| Claim Type (In-House or TPA) | Both |
| Pre-Hospitalization | 30 days prior to hospitalization |
| Network Hospital Count | 1800+ |
| Post-Hospitalization | 60 days after discharge |
| Room Eligibility | Not exceeding 1 % of the sum assured per day |
| Share Claim Payments | 10% or 20% if selected sum insured is above Rs 2 Lakh |
| Restoration of Cover | NA |
| No Claim Bonus | Covered after 3 years |
| Ambulance Charges | 1% of the sum assured or Rs 2000 whichever is less
|
| Worldwide Coverage | |
| Maternity Cover | NO |
| Hospitalization at Home | Covered |
| Day Care Treatment | Covered |
| Non-Allopathic Treatment Coverage | Covered |
| Emergency Ambulance | NA |
| Health Check-up
|
Covered after three no-claim free years |
FAQ’s
Q1. Is it necessary to go for the medical examination before getting this Mediclaim policy?
If the person is up to the age of 55 years then there is no need of going for medical examination. However for fresh covers, the applicant needs to undergo certain medical tests; 50% of the pre-insurance check-up cost will be reimbursable subject to acceptance of the proposal by the insurance company.
Q2. Is there any renewal benefit available with this policy?
Yes, if the insured doesn’t make any claim for three consecutive years, S/he will be entitled for reimbursement of cost of Health check-up. The total cost shall not exceed Rs 3000 per insured person.
Q3. What is the process of cancellation of this policy?
The insured may at any time cancel this policy by giving 30 days’ notice period to the insurance company. In such event, the company will process refund of premium at short period only provided no claim has occurred during the policy period.