Oriental Insurance Jan Arogya Bima Policy : Coverage, Claim & Renewal

Updated: 07-02-2019 07:50:58 AM

Every section of the society should have health insurance policy to make sure hospitalization expenses are covered in case of any mis happening and of course, for peace of mind. However, certain section in our society couldn’t afford such policies due to the higher premium they come with. In order to reach the access of insurance benefits to, Oriental insurance have Oriental Insurance Jan Arogya Bima Policy that provides medical insurance to economically backward sections of society at a very low premium.

What is Oriental Insurance Jan Arogya Bima Policy? 

Oriental Insurance Jan Arogya Bima Policy provides medical coverage to the insured in case he is admitted in the hospital due to any disease, illness, or bodily injury. This policy reimburses hospitalization and domiciliary expenses for a premium as low as Rs 70/- for an adult male or female and Rs 50/- for each dependent son or daughter. The cover also extends to pre and post hospitalization for period of 30 and 60 days respectively.

Eligibility criteria

This policy is for individuals and family with low income group

Particulars	Details
Entry Age	Adult –  5-70 yrs Child – 3 months-5 yrs provided one or both parents are covered concurrently
Sum Insured/ Sum Assured	Rs 5,000
Minimum Premium	Rs 70 (Adult male or female) Rs 50 (dependent son or daughter)

Features of Oriental Insurance Jan Arogya Bima Policy

• This policy have a free look period where the insured is allowed a period of 15 days to review the terms and conditions and return the same if not acceptable
• Oriental Insurance Jan Arogya Bima Policy provides medical coverage at a nominal premium
• Covers pre and post hospitalization
• It is offered for a period of one year

What this policy includes?

Following expenses will be reimbursable by the insurance company:

• Room, nursing, boarding expenses
• Surgeon, consultants, specialist’s fees
• Pre and post hospitalization
• Anaesthesia, surgical appliances, cost of organs and similar expenses

Documents required to claim process

The insured needs to provide preliminary notice of claim to the insurance company within 7 days from the date of hospitalization by submitting 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. S/he also needs to ensure that they file the final claim within 30 days from the date of discharge by submitting the following details:

• Hospital bills, cash memos
• Hospital discharge report
• Duly filed claim form
• Original test reports pertaining to the illness
• Medical history of the patient

Cases where you can’t claim Oriental Insurance Jan Arogya Bima Policy

The company is not liable to make any payment in respect of the following expenses:

•  Pre-existing disease
• Hospitalization expenses incurred during the first 30 days from the inception of the policy
• Dental treatment or treatment unless requiring hospitalization
• Naturopathy treatment
• Injury or disease directly or indirectly caused by weapons or nuclear materials

How long does it take to pay out a claim?

It is the duty of the insured to intimate the insurance company timely about any event which requires hospitalization. After getting the required documents from the insured or claimant, the insurance company will take 30 days to settle claims and within 7 days of acceptance of claim will transfer the funds.

Renewal Process of Jan Arogya Bima Policy 

The policyholder needs to pay the required premium to the insurance company before the due date if the insured wants to continue with the Oriental Insurance Jan Arogya Bima Policy .

Important Aspects (Critical things you shouldn’t ignore)

• Company’s liability in respect of all claims during the period shall not exceed the sum Insured of Rs 5,000 per person
•  Waiting period of one year for some diseases
• All medical treatment should be taken in India for the purpose of this Insurance

 

Features
Claim Type (In-House or TPA)	In-House
Pre-Hospitalization	30 days prior to hospitalization
Network Hospital Count	1800+
Post-Hospitalization	Expenses covered within 60 days from the date of discharge
Room Eligibility	Covered
Share Claim Payments	NO
Restoration of Cover	NO
No Claim Bonus	No
Ambulance Charges	No
Worldwide Coverage	No
Maternity Cover	NO
Hospitalization at Home	Covered
Day Care Treatment	Specified procedures are covered requiring less 24 hrs of hospitalization
Non-Allopathic Treatment Coverage	No
Emergency Ambulance	No
Health Check-up	No

 FAQ’s

Q1- What is the process of cancellation of this policy?

The insured may at any time cancel Oriental Insurance Jan Arogya Bima Policy and in such event, the company will process refund of premium at short period rate only provided no claim has occurred during the policy period.

 

Period on Risk	Rate of premium to be charged
Upto 1 month	¼ of the annual rate
Upto 3 months	½ of the annual rate
Upto 6 months	¾  of the annual rate
Exceeding 6 months	Full annual rate

 

Q2-Are pre-existing conditions covered under this plan?

No, any condition, ailment or injury which the policyholder had signs or symptoms within 48 months prior the inception of the policy. Although after a period of 1 year, specific disease can be covered under Oriental Insurance Jan Arogya Bima Policy.