Oriental Health Insurance

Oriental Insurance Company, a subsidiary of Oriental Government Security Life Assurance Company Ltd, laid its foundation on September 12, 1947. 

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Oriental Health Insurance

All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply
*Tax benefit is subject to changes in tax laws. Standard T&C Apply

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    Oriental Health Insurance Overview

    Oriental Insurance provides insurance coverage to a mega range of projects including power plants, chemicals, steel, and petrochemical plants. Oriental Health Insurance provides different insurance options to the rural and urban population of the country. Oriental Insurance (OI) has registered its wide presence across India. It has 31 regional offices and 1800 plus operating offices. Oriental Insurance Company's Claim Settlement Ratio (CSR) for the financial year 2015-16 was 83.71 percent. Oriental Insurance Mediclaim plans are much-liked by its insurance buyers.

    Oriental Health Insurance at a Glance:

    Key Features

    Highlights

    Network Hospitals

    4300+

    Incurred Claim Ratio

    113.86

    Renewability

    Lifelong

    Waiting Period

    4 years


    Salient Features of Oriental Health Insurance

    Oriental Health Insurance plans provide the much-needed financial cushion in case of a sudden or a planned hospitalization. Oriental Insurance offers various health plans so that you can pick a plan that fulfills your insurance expectations.

    Here are the key features of Oriental health plans

    • Avail Cashless Treatment in the Network-Listed Hospitals- When you get hospitalized at a network-listed hospital, you get to enjoy a cashless treatment.
    • No Initial Screening up to 55 Years old Individuals- This is one of the reasons why Oriental insurance mediclaim plans are a big hit. If pre-existing illnesses don't let you enjoy a compressive insurance coverage, check out the insurance plans offered by Oriental health
    • Comprehensive Health Coverage- Oriental health plans are formulated after considering the insurance needs of various individuals. To fulfill your insurance expectations, a comprehensive health insurance cover is offered.
    • Daily Cash Allowance- When you are hospitalized, you get daily cash according to your sum insured.
    • Highest Available Amount Insured- Oriental health has formulated plans that offer maximum sum insured to its insurance buyers.
    • Enjoy Attractive Discounts on Premium- Who doesn't like discounts? Oriental health plans are loaded with attractive discounts that make investing in health insurance worth every dime.
    • Avail Quick Claim Settlement- An insurance company's reputation is driven by its claim settlement process. Oriental health offers a smooth, easy and hassle-free claim experience to its insurance buyers.
    • Lifelong renewability is offered- No matter how old you are, if you are covered by an Oriental health plan, you can enjoy its insurance benefits lifelong.
    • Portability Option is Available- If you have an unpleasant experience with Oriental Insurance then you can easily switch to another insurance provider of your choice.

    On the other hand, if you are fed up with your current insurance provider or policy, you can switch to Oriental health and avail better insurance benefits.


    *All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.

    Advantages of Buying Oriental Health Insurance

    Here are the advantages of buying Oriental health insurance policies.

    • In-patient hospitalization Costs- Expenses like boarding expenses, room rent, nursing charges, ICU charges, OT charges, medical professional's fee, medicine bills, etc. are covered.
    • Pre-hospitalization Costs- Pre-hospitalization costs incurred before hospitalization are covered for a time period of 30 days.
    • Post-hospitalization Costs- Post-hospitalization incurred after the hospitalization are covered for a time period of 60 days.
    • Hospital Cash- Daily cash benefit is provided to meet the non-medical costs.
    • Domiciliary Treatment Costs- Up to a specific time period, domiciliary treatment costs are covered.
    • Day Care Procedures or Treatment- As per your plan, day care procedures/treatment are covered.
    • Organ Donor Charges- For organ donation, donor charges are covered according to the selected plan.
    • Maternity Cover- Maternity coverage for infant and mother is available.
    • Convalescence Benefit- Convalescence coverage is offered as mentioned in the chosen policy.
    • Tax Benefits-Tax deductions are offered for the payment of insurance premiums, as per section 80D of the IT Act, 1961.

    The Various Plans Offered by Oriental Health Insurance are as:

    • Oriental Individual Mediclaim Plan
    • Oriental Happy Family Floater Plan
    • Oriental Overseas Mediclaim Plan
    • Oriental Group Mediclaim Plan
    • Jan Arogya Plan
    • Group Mediclaim Plans for Bank account Holder/Employee
      • Oriental Bank Mediclaim Plan
      • PNB Oriental Royal Mediclaim Plan
      • Thana Janta Sahakari Bank Mediplus Plan
    • Health of Privileged Elders (HOPE) Plan
    • Pravasi Bharatiya Bima Yojana(PBBY) Plan

    Oriental Health Insurance Plans, Features & Coverage

    Oriental Health Insurance Plan Sum Assured  Pre-existing Disease Cover  Eligibility Age  Pre And Post- Hospitalization Cost 
    Oriental Individual Health Insurance Plan Rs.50,000 to 5 lakh After waiting period of 4 years Medical tests are mandatory for persons over 45 years Covers 30 days for pre hospitalization and 60 days for post-hospitalization
    Oriental Happy Family Floater Plan 1.5 lakh to 10 lakh After waiting period of 4 years Medical tests are mandatory for persons above 60 years NA
    Oriental Overseas Mediclaim Plan Rs.50,000 to 5 lakh After waiting period of 4 years No medical Test are required Na
    Oriental Group Mediclaim Plan NA After waiting period of 3 years Entry age is between 3 months to 75 years Covers 30 days for pre hospitalization and 60 days for post-hospitalization
    Jan Arogya Plan Rs 5000 p.a NA Entry Age between 5 to 70 years Covers 30 days for pre hospitalization and 60 days for post-hospitalization
    Health of Privileged Elder Rs. 1 lakh to 5 lakh The plan only covers critical diseases Entry age is 60 years and above NA
    Pravasi Bharatiya Bima Yojna Up to Rs. 10 lakh It covers spouse and 2 children Children are covered up to 21 years of age Na
    • Oriental Individual Mediclaim Plan

      A comprehensive Oriental health Insurance plan designed to cater the financial needs of an individual in times of medical emergency .

      The key features of Oriental Individual Mediclaim Insurance Plan are

      • Cover for hospitalization cost incurred in India due to any sudden illness, disease, or accident .
      • Applicable for individuals till the age of 80 years.
      • Higher range of sum insured of Rs 50,000/- till 50 lakhs.
      • Coverage for pre existing disease from 5th years onwards subject to continuity of plan without any break.
      • Cashless facility for ailment in network hospitals through dedicated Third Party Administrators desk.
      • Available for individuals and family under  by way of family package cover.
      • Discount on oriental health insurance premium available for family package cover. 
      • Cover available for pre- hospitalisation expenses of 30 days  and post- hospitalisation expenses  for periods of 60 days.

      Eligible Expenses

      • Room, Boarding and Nursing Expenses to the quantum of  1 % of the Sum Insured or Rs. 5000 /- per day whichever is less.
      • Intensive care unit expenses up to 2 % of the sum insured Rs. 10,000 /- per day whichever is less.
      • Any other expenses related to Surgeon, Anesthetist, Medical Practitioner, Consultants, and Specialists Fees.
      • Cost incurred towards the purchase of Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs,
      • Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during
      • Surgical procedure like pacemaker, Relevant Laboratory / Diagnostic test, X-Ray etc.
      • 1% of the sum insured or Rs 2000/- whichever is less towards Ambulance services.
      • Expense incurred for the hospitalisation of the donor as per the limit of Sum Insured of the Insured Person.
      • Expenses towards any day care treatment availed wherein the patient hadn’t be admitted for a period of more than 24 hours in the hospital.
      • For any treatment done as home instead of Hospitalisation with apt reasons, the expenses shall be reimbursed for 3 days subject to maximum limit of 20% of basic sum insured.

      EXCLUSIONS

      • Any pre existing disease till 4 years post commencement of the policy shall not be covered under the plan.
      • Any expense towards newly incepted disease within 30 days waiting period post commencement of plan.
      • Claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports/activities.
      • Medical expenses incurred in the treatment of obesity, hormone replacement therapy, sex change , Genetic disorders, stem cell implantation and surgery.
      • Any expense towards the personal comfort and convenience item services shall be refereed as non medical expense and hence not covered under the plan.
      • Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies.
      • Any expenses towards the injury caused in events of nuclear accident, war or any other event as a consequence to War, Invasion,
      • Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc unless arising from disease or injury and which requires hospitalisation for treatment.
      • Treatment for Cataracts, Benign prostatic hypertrophy, Hysterectomy, Menorrhagia or Fibromyoma, Hernia, Fitula of anus,Piles, Sinusitis, Asthma, Bronchitis,
      • Ailments for all Psychiatric or Psychosomatic disorders are excluded under this plan
    • Happy Family Floater Plan Oriental Health Insurance

      The Key features of this Oriental Health Insurance plan are

      • An inclusive health care protection floater plan for the entire family .
      • Single Sum Insured for entire family residing in India.
      • No medical checkup required for persons up to 60 years.
      • Coverage for pre existing disease starts post 4 years of commencement of incessant  policy renewal.
      • Flexibility to choose TPA or Non TPA services.
      • Discounts on premium if NON TPA services are availed.
      • Discount in OMP premium
      • Available under two variants (a) Gold Plan (b) Silver Plan.

      (a) Gold Plan

      • The sum assured is between 6 lakhs to 10 lakhs on floater basis.
      • Integrated daily cash allowance and attendant allowance cover as per the sum insured limits.
      • Life hardship survival benefit and Personal Accident cover available under this plan.

      (b) Silver Plan 

      • The sum assured is between 1  lakh to 5 lakhs on floater basis.
      • 10% Mandatory co-pay attached with this plan.
      • Integrated daily cash allowance and attendant allowance cover as per the sum insured limits.
      • Personal Accident cover available under this plan.

      The Benefits Under Oriental Happy Family Floater Plans are

      Gold Plan

      • The expenses towards Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing Home. Are covered up to 1 % of the Sum Insured per day.
      • Intensive Care (IC) Unit Expenses as provided by the Hospital /Nursing Home. Are covered up to 2% of the Sum Insured per day.
      • Expenses incurred towards Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees as against the limit of sum insured.
      • Cost towards the purchase of Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Diagnostic Material and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs & and similar expenses.
      • Expenses towards the Ambulance services is assigned to Rs.2,000/- per illness or up to  maximum 1% of the sum insured or Rs. 6,000/- whichever is less,
      • Daily Hospital cash allowance available @ 0.1% of sum insured per day per illness for a maximum tenure of 10 days in hospital.
      • The net liability for cash hospital allowance under this plan for complete policy tenure is 1.5% of the sum insured.
      • Rs.500/- per day of hospitalisation per illness allowed as Attendant allowance.
      • For Domiciliary Treatments , a cover to quantum of Rs.50000/ is allowed as Surgeon, Medical Practitioner, Consultants, Specialists Fees, Blood, Oxygen, Surgical Appliances, Medicines & Drugs, Diagnostic Material and Dialysis, Chemotherapy, Nursing expenses.
      • Reasonable expenses towards treatment such as Treatment for animal bite (Dog or any other rabid animal)  are reimbursable up to Rs.5,000/- towards  immunization injections in any one policy period.

      Silver Plan

      • The expenses towards Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing Home. Are covered up to 1 % of the Sum Insured per day.
      • Intensive Care (IC) Unit Expenses as provided by the Hospital /Nursing Home. Are covered up to 2% of the Sum Insured per day.
      • Expenses incurred towards Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees as against the limit of sum insured.
      • Cost towards the purchase of Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Diagnostic Material and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs & and similar expenses.
      • Expenses towards the Ambulance services is assigned to Rs.1,000/- per illness or up to  maximum 1% of the sum insured or Rs. 3,000/- whichever is less,
      • For Domiciliary Treatments , 10% of Sum Insured to a Maximum quantum of Rs.25000/ is allowed as Surgeon, Medical Practitioner, Consultants, Specialists Fees, Blood, Oxygen, Surgical Appliances, Medicines & Drugs, Diagnostic Material and Dialysis, Chemotherapy, Nursing expenses.
      • Reasonable expenses towards treatment such as Treatment for animal bite (Dog or any other rabid animal) are reimbursable up to Rs.5, 000/- towards immunization injections in any one policy period.

      Exclusions

      • Any pre existing disease till 4 years post commencement of the policy shall not be covered under the plan.
      • Any expense towards newly incepted disease within 30 days waiting period post commencement of plan.
      • Claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports/activities.
      • Medical expenses incurred in the treatment of obesity, hormone replacement therapy, sex change , Genetic disorders, stem cell implantation and surgery.
      • Any expense towards the personal comfort and convenience item services shall be refereed as non medical expense and hence not covered under the plan.
      • Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies.
      • Any expenses towards the injury caused in events of nuclear accident, war or any other event as a consequence to War, Invasion,
      • Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc unless arising from disease or injury and which requires hospitalisation for treatment.
      • Treatment for Cataracts, Benign prostatic hypertrophy, Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma, Bronchitis,
      • Ailments for all Psychiatric or Psychosomatic disorders are excluded under this plan
    • Overseas Mediclaim Plan by Oriental Health Insurance

      An all-inclusive protection plan for those who are planning any trip overseas . 

      The Key Features are

      • Complete protection cover for medical expenses on the trip outside India.
      • Medical expenses covering both inpatient and Outpatient expenses.
      • Sum insured between Rs.50000/- to Rs.500000/-
      • Cashless services available overseas in partnership with M/s Coris International.
      • Different category of plan available as per requirement of the traveler.
        • Business and Holiday Travel cover for individuals
        • Policy for students undertaking studies abroad
        • Corporate Frequent Policy for corporate companies sending their executives abroad. 
    • Business and Holiday Travel Cover Plan for Individuals by Oriental Health Insurance

      The scope of coverage under this Oriental Health Insurance plan are

      • Expenses for physician services, hospital and medical services and local emergency
      • medical transportation in partnership with APRIL USA INC.
      • For cases of dental pain expenses Up to US $ 225 per occurrence for the immediate relief
      • For cases where patient is critically ill, Expenses for emergency medical evacuation, including medically appropriate transportation and necessary medical care en route, to the nearest suitable hospital as per the recommendation of physician
      • Expenses for medical evacuation, including transportation and medical care en route to a hospital in the Republic of India or the Insured Person’s normal place of residence in the Republic of India when deemed medically advisable by the Medical Advisors and the attending physician.
      • If the Insured Person dies outside the Republic of India, the expenses for preparing the air transportation of the remains for repatriation to the Republic of India or up to an equivalent amount for a local burial or cremation in the country where the death occurred. All expenses must be approved by APRIL USA before the remains are prepared for transportation to the Republic of India or for local burial or cremation.
      • For Foreign Expats working in India can avail this policy from the day of arrival in India expires on the last day of the number of days specified in the policy, or on return to India, whichever is earlier. In case of a frequent traveler abroad, there is a special policy which covers all the trips undertaken during the period of 12 months.

      Exclusions

      • For any claim prior to commencement of oriental health insurance plan cover or due any consequential event in past prior to the commencement of plan.
      • For any health claim which has occurred due to denunciation of physician advice.
      • For cases wherein the customer is already under treatment to a physician at the time of plan issuance.
      • Cases where insured has received a terminal prognosis for a medical condition.
      • Cases where the insured is taking part in any kind of Naval, Military or Air Force operation.
      • For any claim arising out of illnesses or accidents that the Insured Person has caused intentionally or by committing a crime or as a result of drunkenness or addiction (drugs, alcohols).
      • For any claims arising out of mental disorder, anxiety, stress of depression, venereal disease or any loss arising directly or indirectly from any injury, illness, death, loss or expense or any other liability
      • Any medical expense towards the attributable to HIV (Human Imnuno Deficiency Virus) and/ or any HIV related illness including AIDS (Acquired Imuno Deficiency Syndrome) and/ or any mutant derivative or variations thereof howsoever caused.
      • For illness and accidents that are results of wars and warlike occurrences or invasions, acts of foreign enemies, hostilities, active participation in riots, civil war, rebellion, insurrection, military or usurped power or confiscation or nationalization or requisition of or destruction of or damage to the property by or under the order of any government or local authority.
      • For any claim arising from damage to any property whatsoever or any loss or expenses whatsoever resulting or arising from or any consequential loss directly or indirectly caused by or contributed to by or arising from Ionising radiation or contamination by radioactivity from any nuclear waste from the combustion fuel or the radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof.
      • For any claim arising out of sporting risk in so far as they involve the training or participation in competitions of professional or semi professional sportsmen or women
    • Oriental Health Insurance Plan For Students Undertaking Studies Abroad

      The Key features of this oriental health insurance plan are

      • The minimum period of cover is 2 months, and maximum is 12 months.
      • The sum insured is US$ 75,000
      • The premium has to be paid in US dollars, irrespective of the country of visit.
      • Exclusion under the plan
      • Any claims for dental treatment except as a result of injury.
      • Pregnancy including miscarriage and child birth.
    • Oriental Group Mediclaim Plan

      A protection plan by oriental health insurance intended to provide complete coverage a group of family member or corporate employees.

      The key benefits are

      • Cost incurred towards Room charges, Boarding and Nursing Expenses to the quantum of  1 % of the Sum Insured or Rs. 5000 /- per day whichever is less.
      • Intensive care unit expenses up to 2 % of the sum insured Rs. 10,000 /- per day whichever is less.
      • Any other expenses related to Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees.
      • Cost incurred towards the purchase of Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs,
      • Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during
      • Surgical procedure like pacemaker, Relevant Laboratory / Diagnostic test, X-Ray etc.
      • 1% of the sum insured or Rs 2000/- whichever is less towards Ambulance services.
      • Expense incurred for the hospitalisation of the donor as per the limit of Sum Insured of the Insured Person.
      • Expenses towards any day care treatment availed wherein the patient hadn’t be admitted for a period of more than 24 hours in the hospital.
      • For any treatment done as home instead of Hospitalisation with apt reasons, the expenses shall be reimbursed for 3 days subject to maximum limit of 20% of basic sum insured.
      • Optional cover of maternity and new born child  can be obtained on payment of 10% of the total basic premium for all the insured persons under the policy.

      Exclusions

      • Any pre existing disease till 4 years post commencement of the policy shall not be covered under the plan.
      • Any expense towards newly incepted disease within 30 days waiting period post commencement of plan.
      • Claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports/activities.
      • Medical expenses incurred in the treatment of obesity, hormone replacement therapy, sex change , Genetic disorders, stem cell implantation and surgery.
      • Any expense towards the personal comfort and convenience item services shall be refereed as non medical expense and hence not covered under the plan.
      • Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies.
      • Any expenses towards the injury caused in events of nuclear accident, war or any other event as a consequence to War, Invasion,
      • Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc unless arising from disease or injury and which requires hospitalisation for treatment.
      • Treatment for Cataracts, Benign prostatic hypertrophy, Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma, Bronchitis,
      • Ailments for all Psychiatric or Psychosomatic disorders are excluded under this plan
      • Ailments which are generally covered in outpatient department are not covered under this policy, even though covered as day care surgery or as in patient admitted in hospital for more than 24 hours.
    • Oriental Jan Arogya Plan

      A bespoke  protection plan for the lower and middle income families in india which is not only available at a affordable premium but also cast the importance of medical cover for each and every one in the society.

      The salient features of this plan are

      • The policy covers reimbursement of Hospitalisation / Domiciliary Hospitalisation expenses for illness / diseases or injury sustained.
      • Affordable premium
      • Valid on yearly basis and can be renewed periodically.
      • Free look period for 15 days allowed to review the terms and conditions of the policy and return the same, if not acceptable.

      Scope of benefit under the plan

      • The cost as mentioned below shall be considered for the reimbursement of the claim under this plan Room, Boarding Expenses as provided by the hospital/nursing home Nursing Expenses.
      •  Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees.
      • Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs & Cost of Organs and similar expenses
      • Medical Expenses incurred in the period up to 30 days prior to the date of admission shall be considered under the purview of this plan .
      • Expenses incurred up to 60 days post the date of discharge from hospital , shall also be considered under the scope of benefit under this plan .
      • The maximum Liability for all consolidated claims could be of Rs. 5,000/- per person.

      Exclusions from the plan

      • Any pre existing disease till 4 years post commencement of the policy shall not be covered under the plan.
      • Any expense towards newly incepted disease within 30 days waiting period post commencement of plan.
      • Claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports/activities.
      • Medical expenses incurred in the treatment of obesity, hormone replacement therapy, sex change , Genetic disorders, stem cell implantation and surgery.
      • Any expense towards the personal comfort and convenience item services shall be refereed as non medical expense and hence not covered under the plan.
      • Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies.
      • Any expenses towards the injury caused in events of nuclear accident, war or any other event as a consequence to War, Invasion,
      • Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc unless arising from disease or injury and which requires hospitalisation for treatment.
      • Treatment for Cataracts, Benign prostatic hypertrophy, Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma, Bronchitis,
      • Ailments for all Psychiatric or Psychosomatic disorders are excluded under this plans
      • Ailments which are generally covered in outpatient department are not covered under this policy, even though covered as day care surgery or as in patient admitted in hospital for more than 24 hours.
    • Oriental Group Mediclaim Plans

      Oriental Insurance offers its Group Mediclaim Plans in partnership with two of the most reputed government banks offering financial needs to a large section of society.

      • Oriental Bank Mediclaim Plan - An exclusive group protection plan to the account holders of Oriental Bank of commerce account holders.
      • PNB Oriental Royal Mediclaim Plan - This Mediclaim Policy will be available to any Account Holders / Employees of PUNJAB NATIONAL BANK - (PNB)
      • Thana Janta Sahakari Bank Mediplus Plan - This Mediclaim Policy will be available to any Account Holders / Employees of Thana Janta Sahakari Bank – a cooperative society bank registered under the cooperative act of Maharashtra.

      Salient Features of the plans are

      • This Oriental health insurance plan is available for any account holders or Employees of the bank for whom the policy has been assigned as
      • Available as Individual cover or family cover .
      • Family shall include account holder /employee along with his/her spouse and two children aged between 3 months and 79 years.

       Scope of Benefits

      • 1% of sum insured of Rs. 5000/- per day whichever is less as Room, Boarding and Nursing Expenses.
      • I.C. Unit expenses @ 2% of the Sum Insured or Rs. 10,000 /- per day whichever is less.
      • Charges for Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists.
      • Expenses incurred towards the purchase of Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances,
      • Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of
      • Prosthetic devices implanted during surgical procedure like pacemaker, Relevant
      • Laboratory / Diagnostic test, X-Ray etc
      • Expense for emergency Ambulance services @ 1% of the sum insured or Rs 1000/- whichever is less
      • Cash allowance of maximum Rs. 1000/- during the entire policy period towards  incidental expenses during the period of hospitalisation of the Proposer
      • Funeral Expenses @ Rs.1,000 during the policy period in the event of death of the Policyholder .
      • Domiciliary Hospitalisation expenses @ 10% of Sum Insured, Maximum Rs.25000/- during oriental health insurance policy period towards Surgeon, Medical Practitioner, Consultants, Specialists Fees, Blood, Oxygen, Surgical Appliances, Medicines & Drugs, Diagnostic Material and Dialysis, Chemotherapy, Nursing expenses.

      Exclusions in all the Oriental Health Insurance plans

      • Any pre existing disease till 3 years post commencement of the policy shall not be covered under any of the plans.
      • However many a disease and ailments are excluded on different periodicity and the comprehensive list if available with policy handbook and website.         
      • Claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports/activities shall not be considered for claims in any of the above plans.
      • Medical expenses incurred in the treatment of obesity, hormone replacement therapy, sex change , Genetic disorders, stem cell implantation and surgery are excluded in the plans benefits.
      • Any expense towards the personal comfort and convenience item services shall be refereed as non medical expense and hence not covered under the plans.
      • None of the above oriental health insurance plans cover expenses on naturopathy, experimental or alternative medicine, acupressure, and acupuncture, magnetic and similar therapies.
      • Any expenses towards the injury caused in events of nuclear accident, war or any other event as a consequence to War, Invasion,
      • Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc unless arising from disease or injury and which requires hospitalisation for treatment under the above mentioned group plans .
      • Treatment for Cataracts, Benign prostatic hypertrophy, Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma, Bronchitis,
      • Ailments for all Psychiatric or Psychosomatic disorders are excluded under the plans
    • Health of Privileged Elders (HOPE) Plan by Oriental Health Insurance

      A specialized protection plan for the privileged elder to cover particularly old age disease. Salient features of this plan are

      • Exclusively designed for Citizens aged 60 years and above for hospitalisation in India only.
      • Policy is available for Sum of 1 lac, 2 lac, 3 lac, 4 lac and 5 lacs.
      • This Oriental Health Insurance plan covers specified diseases only.
      • Compulsory co-payment of 20% on admissible claim amount.
      • Discount in premium for opting Voluntary Co-payment.
      • No claim discount in premium.
      • Loading for new entrants.
      • Benefit of continuity extended if already insured with any Mediclaim policy of the Company.
      • TPA service available.
      • Cashless Service through TPA only and limited to Rs. 1 lakh.

      Scope of Cover

      Oriental Insurance Cover is provided as per the nature of ailment and disease. The disease which are covered under this Oriental health Insurance Plan are

      Sl no.

      Name of Disease

      Max Limit

      1

      Accidental Injury

      100% of Sum Insured

      2

      Knee Replacement

      70% of Sum Insured

      3

      Cardio Vascular Diseases

       50% of Sum Insured

      4

      Chronic Renal Failure

      50% of Sum Insured

      5

      Cancer 50% of Sum Insured

      50% of Sum Insured

      6

      Hepato-BilliaryDisorders

      50% of Sum Insured

      7

      Chronic Obstructive Lung Diseases

      20% of Sum Insured

      8

      Stroke

      20% of Sum Insured

      9

      Benign Prostrate

      15% of Sum Insured

      10

      Orthopaedic Diseases

       15% of Sum Insured

      11

      Ophthalmic Diseases

      10% of Sum Insured

       

      • Apart from the above mentioned nature of expenses, other treatments’ are also included in the scope of benefits, however up t o the limit of the sum insured.
      • 1% of sum insured of Rs. 5000/- per day whichever is less as Room, Boarding and Nursing Expenses.
      • I.C. Unit expenses @ 2% of the Sum Insured per day.
      • Charges for Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists.
      • Expenses incurred towards the purchase of Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during surgical procedure like pacemaker, Relevant Laboratory / Diagnostic test, X-Ray etc
      • Rs 1000/- as expense for emergency Ambulance services

      Exclusions under Oriental Health of Privileged Elder Plan(HOPE)

      • Any pre existing disease till 2 years post commencement of the policy shall not be covered under the plan.
      • Under this Oriental Health Insurance Plan, expenses on treatment of following ailments / diseases / surgeries for first two policy years are not payable.
        • Non infective Arthritis.
        • Cataract.
        • Surgery of benign prostatic hypertrophy.
        • Surgery of gallbladder and bile duct excluding malignancy.
        • Surgery of genito urinary system excluding malignancy.
        • Gout and Rheumatism.
        • Calculus diseases.
        • Joint Replacement due to Degenerative condition.
        • Age related osteoarthritis and Osteoporosis.
      • Circumcision (unless necessary for treatment of a disease included hereunder or as may be necessitated due to any accident), vaccination, inoculation or change of life or cosmetic or of aesthetic treatment of any description, hair transplant, plastic surgery other than as may be necessitated due to an accident or as a part of any illness / disease.
      • Claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports/activities.
      • Medical expenses incurred in the treatment of obesity, hormone replacement therapy, sex change , Genetic disorders, stem cell implantation and surgery.
      • Any expense towards the personal comfort and convenience item services shall be refereed as non medical expense and hence not covered under the plan.
      • Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies.
      • Any expenses towards the injury caused in events of nuclear accident, war or any other event as a consequence to War, Invasion,
      • Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc unless arising from disease or injury and which requires hospitalisation for treatment.
      • Treatment for Cataracts, Benign prostatic hypertrophy, Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma, Bronchitis,
      • Ailments for all Psychiatric or Psychosomatic disorders are excluded under this plan
    • Oriental Pravasi Bharatiya Bima Yojana(PBBY)

      This plan is based on the directives issued by Ministry of External Affairs, Government of India wherein all the Indian emigrants going abroad for employment purposes with ECR (Emigration Check Required) endorsement on their passport have  to compulsorily enroll for this  insurance plan . It offers special fortification to such Nonresident Indian who are residing abroad for employment purpose. Being away from home country and working in different geographic conditions, make them prone to various kinds of risks and health hazard.

      The key features of Oriental Pravasi Bharti Bima Yojana Plan are

      • Capital Sum of Rs. 10.00 lacs in the episode of accidental death or permanent disablement or loss of employment abroad due to injury or temporary or permanent disablement.
      • Add on benefit of medical family floater plan of Rs. 50,000/- for the family of the policyholder residing in India consisting of spouse and two dependent children up to 21 years of age.
      • One way Economy Class airfare for sudden job loss where the policyholder falls sick or is declared medically unfit to commence or continue or resume working and the service contract is terminated by the foreign employer within the fist twelve months of taking the insurance cover.
      • In case of death , besides the cost of transporting the dead body , the cost incurred in economy class return air fare for the attendant will be reimbursed.
      • Reimbursement of repatriation  or other transport expenses if he /she is not received by the employer or if there is any substantive change in the job /Employment Contract /agreement, to the disadvantage of the policyholder , or if the employment is prematurely terminated within the period of employment from such arrival, for no fault of the policyholder.
      • Rs 30, 000 / - as legal expenses reimbursement which the policyholder has incurred towards filing any legal suit in the country of employment provided the necessity of filing such case is certified by the appropriate ministry of that country against the foreign employer.
      • Under this oriental health insurance plan, medical cover for amount up to Rs. 75,000/- as hospitalisation cover in case the insured while his stay in foreign country during the term, of employment has contract any disease or suffer from any illness or sustain any bodily injury through accident.
      • Maternity benefit expenses to the policyholder Women Emigrant for an amount  up to a maximum limit of Rs. 25,000/ - .

      Exclusions under Oriental Pravasi Bharti Bima Yojana

      • Any pre existing disease till 2 years post commencement of the policy shall not be covered under the plan.
      • Circumcision (unless necessary for treatment of a disease included hereunder or as may be necessitated due to any accident), vaccination, inoculation or change of life or cosmetic or of aesthetic treatment of any description, hair transplant, plastic surgery other than as may be necessitated due to an accident or as a part of any illness / disease.
      • Oriental Health Insurance claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports/activities.
      • Medical expenses incurred in the treatment of obesity, hormone replacement therapy, sex change , Genetic disorders, stem cell implantation and surgery.
      • Any expense towards the personal comfort and convenience item services shall be refereed as non medical expense and hence not covered under the plan.
      • Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies.
      • Any expenses towards the injury caused in events of nuclear accident, war or any other event as a consequence to War, Invasion,
      • Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc unless arising from disease or injury and which requires hospitalisation for treatment.
      • Treatment for Cataracts, Benign prostatic hypertrophy, Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma, Bronchitis,

      Ailments for all Psychiatric or Psychosomatic disorders are excluded under this plan


    *All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.

    How to Register a Claim with Oriental Health Insurance?

    In case you wish to avail cashless treatment, here is the process you need to follow.

    Procedure to File a Planned or Emergency Hospitalization Cashless Claim

    In case, a cashless treatment is availed, the claim form must be authorized by the network hospital. The insurance provider will assess the medical information and analyze if the claim is eligible or not.

    The insurance company will take a look at the medical information and determine whether that particular individual is eligible for the claim.

    If the insurance company is satisfied by the information, the insured person can avail cashless treatment and the insurance company will settle the medical expenses directly with the hospital.

    Procedure to File an Emergency Hospitalization Reimbursement Claim

    If there is an emergency hospitalization, the insurance provider or the Third-Party Administrator must be intimated within 24 hours of admission. The insured person must fill out a claim form, attach original medical documents, and submit them to the insurance provider within 15 days of discharge. According to the terms and conditions of the plan, the insurance provider will approve or disapprove the reimbursement claim.

    The Documents Required to File a Claim

    The insured person must submit specific documents for initiating the claim process.

    Here is the list of the required documents.

    • A duly filled claim form along with a photocopy of policy and premium receipt
    • Hospital discharge report
    • Employer's leave certificate
    • Medical treatment report
    • Original test reports such as Sonography, X-Rays, EGG etc.
    • Medical recovery report
    • Medical expenses information like cash memos, prescriptions, original bills etc.
    • Registration number of the hospital/ nursing home. If hospital or nursing home isn't registered, a certificate issued by the doctor-in-charge will have to be provided. This certificate should contain information regarding the number of beds, availability of qualified staff around the clock, the number of doctors and nurses, and the number of fully equipped operation theatres
    • In case of an accident, First Information Report containing the accident's details

    Oriental Health Insurance- FAQs

    Oriental Health Insurance - Latest News

    • Oriental Health Insurance with 3 General Insurance companies have major share in a health insurance market in last fiscal Year

      The health insurance market section has seen a steady growth on the back of increasing health care cost. The health insurance market has maintained a growth of double digit. The Oriental Group of insurance with three major played in insurance market accounted for 64% of health premiums. During 2014-15 Rs 20,096 is collected as health insurance premium with a record increase of RS 17,495 Crore. The health insurance sector has seen growth of 14.87 percent, according to the latest annual report of insurance regulatory & development authority of India. According to the report, stand alone health insurance constitutes 14 percent. There is a marginal increase in share of stand lone and public sector health insurance, while private non life insurers show a drop of 22 percent from 26 percent in year 2013-14.
    Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.
    Average Rating
    (Based on 21 Reviews)

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    Oriental Health Insurance Reviews & Ratings

    4.5 / 5 (Based on 21 Reviews)
    (Showing Newest 9 reviews)
    Banjeet
    Baarod, March 09, 2021
    Fast Claim Approval
    I have covered my parents under the Oriental Health of Privileged Elders (HOPE) plan and I must say that their claim approval process is very fast. My father was admitted to the hospital due to some health issues and for cashless claim settlement, I contacted them through policybazaar.com (as I purchased this plan through policybazaar.com only) and they responded instantly and approved my claim beforehand.
    Haresh
    Laharpur, March 04, 2021
    Cashless Hospitalization
    I have the Royal Mediclaim policy from Oriental Insurance, which I had purchased from Policybazaar. A few days back, I had met with an accident and I had to be admitted to a hospital. I found out about the cashless hospitalization facility available under my insurance policy. I stayed in the hospital for 3 days and paid nothing as the treatment was cashless. Really impressed!
    Ashish
    Maanikpur, March 04, 2021
    Best Family Plan
    I came to Policybazaar to buy a health insurance policy for myself and my family. On entering a few details, I could see family health plans from different insurance companies. I compared the plans and selected the Happy Family Floater policy from Oriental Insurance. I paid the premium and got the policy on the same day. Great website.
    Hardeep
    Laharpur, February 25, 2021
    Nice features
    I purchased Oriental Group Mediclaim plan for the employees of my organization. It has very nice features and provides an option to customize. Thanks, policybazaar for showing me this option. It is a nice plan.
    Pintu
    Habra, February 25, 2021
    Impressed with their service
    Right from a perfect and suitable policy search to purchasing a health insurance plan everything is impressive with policybazaar.com. I ended up purchasing a health insurance plan from Oriental Health Insurance company and happy.
    Sanjeev
    Odagoan, February 25, 2021
    The app is a little sluggish
    I wanted to renew my Happy Family Floater plan through the policybazaar app and let me tell you that their app is nice. It is very easy to understand and I liked its look and feel. However, the renewal process took some time due to the sluggish response of this app.
    Ranbir
    J.n.prasad, February 23, 2021
    Discounts are good
    The Oriental Mediclaim Insurance policy is one of the best policies for individuals. This is because it offers many discounts like loyalty benefits.
    Saksham
    Udagamandalam, February 23, 2021
    Satisfactory Reimbursement
    I got the reimbursement of my wife's delivery through the Oriental Individual Mediclaim plan with the help of policybazaar.com. They helped me throughout the reimbursement process and I am very satisfied with the reimbursement amount.
    Nitya
    Ichoda, February 22, 2021
    Happy with the service of policybazaar.com
    Policybazaar.com has offered me one of the best services while I was searching for a health insurance plan. They not only suggested me the Jan Arogya Plan but also helped me to buy this policy online. This is because I was not very confident while purchasing a policy online. It was really helpful.
     
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