Oriental Individual Mediclaim Insurance

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Health problems are increasing and so is the medical inflation. It can be difficult to deal with financial and emotional stress at the same time. With this in place, you can enjoy your peace of mind and avail treatment in some of the best hospitals in your vicinity.

Oriental's Individual Mediclaim Policy is a basic health insurance scheme that offers coverage to individuals in case of Hospitalization or Domiciliary Hospitalization under the following circumstances -

  • In case of an emergency hospitalization
  • In case of accidental injuries
  • Hospitalization required for surgeries during the policy period

This health insurance policy can be purchased by any individual between 18 and 70 years for treatment across India. However, you can also get your family included in the same plan. Have a look at the policy benefits and limitations in detail below-

Key Features & Benefits of Oriental Individual Mediclaim Plan  

  • Up to 7 members can be insured
  • Quick claim settlement advantage
  • 10 % family discount is available
  • Entry age ranges from 18 to 65 years
  • Only Indian citizens can buy this plan
  • Policy duration is 1 year
  • Age limit is 18 to 65 years ( up to 70 years)
  • Pre-medical check-up required only after 55 years of age
  • Lifelong policy renewal option
  • Pre-medical screening not required for applicants lesser than 45 years
  • A free look period of 15 days for policy buyers
  • Pre-existing illnesses to be covered after f 4 years of the policy term
  • Voluntary co-payment between 10 and 20 percent
  • 30 days grace period for easy renewals
  • Avail discount between 10 percent and 20 percent on a minimum sum assured of Rs.2 lakhs
  • Tax saving benefit under Section 80/d

Inclusions of Oriental Individual Mediclaim Plan 

  • Hospitalization benefits like room rent, nursing charges, boarding expenses, upt0 1% of the SI per day. ICU charges up to 2% of SI per day.
  • Fees charged by the doctors, surgeons, and cost of medicines, drugs, anesthesia, operation theatre, blood, oxygen, etc.
  • Ambulance service charges up to 1% of the sum insured
  • Daily hospital cash allowance for a maximum of 6 days. Up to 0.1 % of the sum insured per day and 2 days of deductibles are also applicable
  • Pre-hospitalization expenses ( 30 days prior) and post hospitalization expenses ( post 60 days of discharge)
  • Homeopathic, Ayurvedic and Unani treatment when hospitalized in a government hospital
  • Domiciliary hospitalization subjected to policy terms and conditions
  • Treatment for animal and dog bite
  • Optional personal accident cover
  • Donor expenses conforming to the Transplantation of Human Organs Act of 1994 (amended). Please refer to policy documents for further details

Exclusions of Oriental Individual Mediclaim Plan 

Following expenses will not be covered under this plan:

  • Self-inflicted injuries and suicidal attempt
  • Any health issue arising due to involvement in military operations, air force, and naval operations
  • Any health problem resulting due to an overdose of drugs, alcohol, and other intoxications
  • Treatment for venereal diseases
  • Hospitalizations resulting due to war like conditions, rebellion, hostilities, civil war etc.
  • Any hospitalization required due to loss or damage arising due to a breach of law or conduct
  • Health ailments resulting due to nuclear radiations or from any nuclear waste
  • Pregnancy and childbirth-related complications
  • Involvement in perilous occupations and adventure sports such as deep sea diving, sky-diving, rock climbing, etc.
  • Treatment for STDs, HIV, & AIDS

Sum Assured (Rs.)

Rs 1 lakh to Rs. 10 lakhs

Waiting Period Table for Specified Diseases-

Disease/Surgery Waiting Period ( in years)
Diabetes 2
Hypertension 2
Congenital internal diseases 2
Sinus 2
Varicose Veins/Ulcers 2
Gall Bladder Surgery except for malignancy 2
Joint Replacement 4
Osteoporosis and osteoarthritis (age-related) 4
Piles/fissures 2
Cataract 2
PCOD 1
ENT treatment, tonsillectomy, mastoidectomy, etc. 1

 

You can check the oriental insurance mediclaim hospital list on their site and get the best medical treatment in India.

Reimbursement Claim Process for Oriental Individual Mediclaim

The procedure to get reimbursement for your medical expenses is as follows:

  • It is required for you to call and inform the third-party administrator within a week of hospitalization
  • You need to provide the required details like the name of the insured members, health insurance policy number, hospital details, type of injury or disease, along with the doctor’s name
  • Submit the claim documents and also the medical invoices and hospital bills within 30 days of getting discharged from the hospital
  • Submit all the documents and information as required by the TPA department or the Oriental insurance company for a smooth claim procedure
  • You can also send the documents to the registered Oriental insurance office or send them an email.

Claim Process for Cashless Treatment/Hospitalization

In the event of a planned or emergency hospitalization you need to follow the below-mentioned process is as follows:

  • For cashless treatment, you need approval of the claim form from the network hospital
  • Oriental insurance company will verify all the documents and information and determine your eligibility to get the claimed benefit
  • On completion of the process, a pre-authorization letter will be sent to the network hospital. It will mention the amount that the insurer will pay off
  • If the treatment starts before the submission of the pre-authorization letter and documents, they can contact the TPA for claim reimbursement
  • The documents must be sent to the registered office of Oriental insurance or sent over email, as suggested by the insurer.

Documents Required for Claim Settlement of Oriental Individual Mediclaim Policy-

You need to submit the medical bills, medical documents, and hospital reports as well as cash memos to the Third-Party Administrator or the insurance company within 15 days of getting discharged from the hospital. Here is the list of documents that you need to submit:

  • Original medical bills, receipts and discharge certificate
  • Insured’s medical history as per the records of the treating hospital
  • All the medical documents including the medical tests, consultation fees, and health reports
  • Cash memo from the chemists and hospital or along with medical prescriptions
  • Any other document demanded by the insurer and TPA
  • Original receipts, diagnosis report, and bills from the attending specialists, anesthetists, and consultants
  • Certificate (in original) from the surgeon confirming the diagnosis and nature of operation done.
  • Original proof of payment of pathological/ radiology tests with supporting letter from the doctor or surgeon that it is required as part of the treatment
  • Death or disability certificate ( if any)
  • Discharge summary
  • Once the documentation is complete, the TPA department will share the oriental insurance mediclaim status with you

Points to Remember when Filing a Claim for Oriental Individual Mediclaim Policy-

  • Submit all the duly attested forms and documents
  • Post-hospitalization expenses are compensated after submission of the required papers and documents to the Third-party administrator within 15 days of the treatment
  • Inform the insurance company and TPA in advance for expenses that were incurred post hospitalization on the recommendation of the concerned doctor
  • In some cases, the policyholder is given extra time for any delay of document submission. And improper submission of documents can even lead to rejection of your claim
Written By: PolicyBazaar - Updated: 09 April 2019