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Oriental Insurance Happy Family Floater Policy

Objective

This is an online policy that can cover entire family for the sum required by policyholder.

Our View

The sub-limits on the policy benefits, co-payment under Silver plan, narrow coverage under life hardship survival benefit and an incomplete personal accident cover are a few drawbacks that make this policy less preferable over its peers in the market. Life hardship survival benefit covers lesser number of critical illnesses which may not serve the real purpose of such a benefit. Always prefer a health insurance policy that offers lifelong renewals, no sub-limits and least number of exclusions.

Suited for

This is a family floater policy that can cover self, spouse, children, parents and parents in laws under a single policy.

What does it do?

It is a floater policy where sum insured can be utilized by any member of the insured family, for illnesses or conditions covered under the policy. This policy becomes active when a member uses medical services. It is available in two variants- silver plan and gold plan. Both plans cover hospitalisation benefit and domiciliary treatment costs. Additionally, gold plan offers personal accident cover and life hardship survival benefit. Personal accident benefit covers accidental death and permanent total disability. Life hardship survival benefit covers three fatal diseases and pays a pre-specified sum insured if any insured member contracts a listed illness. Daily cash allowance and attendant’s fees is useful and can be used to cover other subsidiary expenses.

Pros

This policy can be bought online from company's website.

It offers a wide range of sum insured to choose from.

Premium paid towards this policy will be exempt from tax under Section 80D of Income Tax Act.

Cons

Biggest disadvantage is that this policy can be renewed only upto 65 years of age.

There are sub-limits on the policy benefits.

Co-payment clause under silver plan is another limitation.

Eligibility

Entry Age (years)

Minimum
18
Maximum
55
Maximum Policy Renewal Age (years)
65
Coverage Type
Family floater

Sum Insured (Rs)

Maximum
10 lakh
Minimum
1 lakh
Policy Term (years)
1
Discount
5% on premium if insurer opts out of Third Party Administrator services
No Claim Bonus
Discount of 5% on premium for each claim fre year subject to maximum of 20%
Pre Policy Medical Check Up
Not required for persons upto 60 years of age
Co Payment Clause
10% of admissible claim under Silver plan

Customer Service

Address
Oriental House,
A-25/27, Asaf Ali Road,
New Delhi - 110002
Mail to
[email protected]
Call to
1800 11 8485 (toll free), 011-33208485(non toll free)
Network Hospitals
List is available on company's website under Customer Services head.

Additions to the Plan

Scope Of Cover
Silver PlanGold Plan
Cashless facilityavailable if treatment availed in a network hospital
Reimbursement facilityavailable if treatment availed in a non-network hospital
Section A
Hospitalisation expenses
Room, Boarding expenses as provided by the Hospital/Nursing Homecovered upto 1% of Sum Insured per day
ICU expensescovered upto 2% of Sum Insured per day
Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expensescovered as per the limits stated in the policy document
Anesthesia, Blood, Oxygen, OT charges, Surgical appliances (any disposable surgical consumables subject to upper limit of 7% of Sum Insured), Medicines, drugs, Diagnostic material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbs, Cost of stent & implants
Daily Hospital Cash Allowancenot allowed0.1% of sum insured per day per illness subject to a maximum of 10 days upto maximum of 1.5% of the sum insured during a policy period
Attendant Allowance (if a child below 10 years of age is admitted)not allowedRs.500 per day of hospitalisation per illness for a maximum of 10 days per illness upto maximum of 15 days during the policy period.
Ambulance chargesRs.1000/- per illness and limited to maximum 1% of the sum insured or Rs.3000/-whichever is less, for the entire policy period.Rs.2000/- per illness and limited to maximum 1% of the sum insured or Rs.6000/-whichever is less, for the entire policy period.
Section B
Domiciliary Hospitalisation
Surgeon, Medical Practitioner, Consultants, Specialists Fees, Blood, Oxygen, Surgical Appliances, Medicines & Drugs, Diagnostic Material and Dialysis, Chemotherapy, Nursing expenses.covered upto 10% of sum insured ; maximum Rs 25000 during the policy periodcovered upto Rs 50000 during the policy period
Treatment for Dog bite (or bite of any other rapid animal like monkey, cat etc.)pays upto Rs 5000 for immunization injections in any one policypays upto Rs 5000 for immunization injections in any one policy
Other benefit(s)
Organ donor's hospitalisation expensescovered
Add On Covers (require extra premium)
Personal Accident for self and dependentsSum insured upto Rs.500,000 per person aged 18 years and above. 50% of this limit for persons less than 18 yearsSum insured upto Rs.10,00,000 per person aged 18 years and above. 50% of this limit for persons less than 18 years
Accidental deathpays 100% of sum insured
Loss of Two entire Limbs, or sight of two eyes or one entire limb and sight of one eye
Loss of one entire Limb or sight of one eyepays 50% of sum insured
Permanent Total Disablement resulting in the insured becoming in engaging in any Employment or occupation whatsoeverpays 100% of sum insured
Life Hardship Survival Benefitnot allowedcovers Cancer-metastasis (Stage-IV), End stage Renal disease (ESRD), Stroke leading to paralysis or paraplegia
Plan A15% of Sum Insured
Plan B25% of Sum Insured
Exclusions and Waiting Period
Pre-existing illnesseswill be covered after 4 consecutive renewals with the company
Survival period in case of Life Hardship Benefit180 days or 270 days after discharge for Life Hardship Benefit available only with Gold Plan.
General exclusionsAIDS or related ailmentsTreatment of any mental or related diseaseBeauty and cosmetic treatments

Cost Details

Cost Details not available on the company's website.