Oriental Health of Privileged Elders

Oriental Health of Privileged Elders Policy: An Overview

Extra care is required for the elders and senior citizens, who are more vulnerable to specific diseases, as they age or suffer serious injuries even due to small accidents. A health plan to cover the medical needs of senior citizens is a must to provide them with adequate health facilities when the need arises. The Oriental Health of Privileged Elders plan is one such policy that is offered by Oriental Health Insurance and is designed exclusively for the senior citizens. The health plan covers specific diseases and treatments such as knee replacement, cancer, stroke, cardiovascular diseases etc., along with related hospitalization expenses.

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Oriental Health of Privileged Elders Policy: Key Highlights 

Coverage Offered

One can buy Oriental Health of Privileged Elders plan up to the sum insured ranging from Rs 1 lakh to Rs 5 lakhs on an individual basis with an option of voluntary co-payment after the application of compulsory co-payment. 

The following basic coverage is offered under the Oriental Health of Privileged Elders insurance policy:

• In-hospitalization- Any medical treatment that requires more than 24 hours of hospitalization is covered. Expenses incurred on room rent will be covered up to 1% of the sum insured and ICU charges up to 2% of the sum insured for specified diseases.
• Pre-hospitalization- The plan provides coverage formedical expenses incurred before hospitalization of the insured, up to a maximum of 30 days.
• Post-hospitalization -The plan provides coverage for medical expenses incurred after hospital discharge of the insured, up to a maximum of 60 days
• Procedures like Haemodialysis, radiotherapy, eye surgery, accidental dental surgery, prostate surgery, coronary angioplasty, etc., which require hospitalization for less than 24 hours, will be covered for hospitalization benefits without the specified time limits.
• Diseases covered- The following specified diseases are covered under this policy, providing coverage ranging from 10% to 100% of the sum insured, as per the specified limits:
• Accidental Injury
• Knee Replacement
• Cardiovascular Diseases
• Cancer
• Hepato-Biliary Disorders
• Chronic Obstructive Lung Diseases
• Stroke
• Benign Prostate
• Orthopaedic Diseases
• Ophthalmic Diseases
• Chronic Renal Failure

Inclusions of the Plan

Apart from the basic coverage offered, the following benefits are also included in the Oriental Health of Privileged Elders health insurance plan:

• Medical Procedures & Expenses covered- The following treatments are covered, if treated as a part of in-patient care, domiciliary hospitalization or as day care treatment in the hospital: Anaesthesia, Oxygen, Blood, OT Charges, X-Ray, Surgical Appliances, Dialysis, Chemotherapy, Medicines & Drugs, Radiotherapy, Artificial Limbs, Prosthetic devices like a pacemaker, and other laboratory or diagnostic tests, etc.
• Domiciliary Hospitalization- If the patient cannot be transferred to the hospital due to a critical health condition or shortage of beds at the hospital, medical expenses incurred for domiciliary hospitalization are covered. This will not be applicable for gout, arthritis, chronic nephritis, pyrexia, etc., as per specified conditions.
• Ambulance Cover- Ambulance charges incurred for hospital transfers are covered up to Rs 1000 or actual expenses, whichever is less.

Exclusions of the Plan 

The following treatment and diseases are not covered under the Oriental Health of Privileged Elders insurance policy:

• Diseases other than specified
• Pre-existing diseases
• Hospitalization for evaluation or investigation purpose only
• Sex change, cosmetic surgeries or cosmetic dental surgeries
• Infertility treatments
• Obesity-related treatments
• Gender treatments
• Refractive error treatment
• Excluded providers
• Adventure sports
• Substance abuse or alcoholism
• Breach of law
• Health hydro or nature clinic treatment

One can find a detailed list of exclusions in the policy document.

Features and Benefits of the Oriental Health of Privileged Elders Policy 

The Oriental Health of Privileged Elders health insurance offers the following key benefits and features:

• Cashless facility covered
• Compulsory co-payment up to 20%
• Voluntary co-payment
• Renewal benefits include health check-up to a maximum of 1 % of the average sum insured after every four claim-free years
• 30 day waiting period for all illnesses except for accidents
• Pre-existing diseases are covered after a waiting period of 24 months
• AYUSH treatment is covered

Eligibility Criteria

Cancellation of the Oriental Health of Privileged Elders Policy 

Please refer to the following rules to cancel the Oriental Health of Privileged Elders insurance policy:

• One may cancel the policy within a free look period of 15 days. The premium amount will be refunded after deducting any claims incurred by the insurer and any stamp duty charges.
• If the policy is cancelled after 15 days, the premium amount refunded will be on a short-term rates basis.