Oriental Insurance Individual Mediclaim Health Insurance
Objective
A basic health insurance policy that aims to cover medical expenses, incurred as an inpatient due to illness or accident. Individuals upto 45 years of age can buy this policy online through company's website.
Our View
While buying a health insurance policy, it is necessary to look at exclusions and waiting periods. Certain diseases or illnesses mentioned in the policy document will be covered after stated waiting periods. Sub-limits imposed on certain expenses is another drawback. Though the policy features good coverage, you must look out for other plans which do not carry any sub-limits and offer lifelong renewal as well.
Suited for
It is suitable for anyone looking for a basic medical cover.
What does it do?
The policy pays a benefit in case the insured person gets hospitalised. It also covers domiciliary treatment availed at home on advice of medical practitioner, organ donor's hospitalisation expenses and day care procedures which can be treated without hospitalisation. The policy will provide for a health check-up after four continuous claim-free years.
Pros
This policy can be bought online from company's website.
Premium paid towards this policy is eligible for Income Tax benefit under Section 80D.
Cons
This policy does not offer lifelong renewal.
There are sub-limits on room rent, boarding and ICU charges.
Eligibility
Entry Age (years)
Minimum
18
Maximum Policy Renewal Age (years)
80
Coverage Type
Individual
Sum Insured (Rs)
Maximum
500000
Minimum
50000
Policy Term (years)
1
Discount
5% on premium if Third Party Administrator (TPA) services are not availed
Pre Policy Medical Check Up
Not required for persons below 45 years of age
Policy Termination
Insurance company may cancel the policy by giving a 30 days notice period. Insurance company in such a case will repay the pro-rata premium to the insurer if claim has not been made. Insurer may also cancel the policy at any time.
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)
Additions to the Plan
| Scope of Cover | |
| Cashless facility | available if treatment availed in a network hospital |
| Reimbursement facility | available if treatment availed in a non-network hospital |
| Pre and post hospitalisation | covers expenses incurred during 30 days prior to hospitalisation and 60 days after discharge from hospital |
| Inpatient hospitalisation | covered |
| Room, boarding and nursing expenses | covered upto lower of 1% of sum insured or Rs 5000 per day |
| I.C.U charges | covered upto lower of 2% of sum insured or Rs 10000 per day |
| Surgeon, anaesthetist, medical practitioner, consultants, specialist fees, blood, oxygen, chemotherapy, Radiotherapy, Artificial limbs, Cost of prosthetic devices implanted during surgical procedure like pacemaker etc., X-Ray | covered |
| Other benefits | |
| Domiciliary treatment | covered |
| Ambulance services | reimburses upto 1% of sum insured or Rs 2000 whichever is less |
| organ donor's hospitalisation expenses | medical expenses for treatment of organ donor in case of major organ transplant is covered |
| Day care procedures | covers those treatments which do not require an overnight stay in the hospital due to technological advancement |
| Cost of health check-up | reimburses an amount upto maximum of 1% of average basic sum insured once after every 4 claim free years |
| Exclusions and Waiting Period | |
| Pre-existing illnesses | will be covered after 4 years of continuous renewal with the company |
| No claim period | initial 30 days from inception of the policy |
| Waiting period | certain illnesses such as Hernia, Piles, Cataract, Hypertension, Diabetes etc, will be covered after a waiting period of 2 years.Joint Replacement due to degenerative condition and Age related osteoarthritis, and Osteoporosis will be covered after a period of 4 years. |
| General Exclusions | AIDS or related diseasesMental or related illnessesCosmetic or beauty treatment |
Cost Details
Cost Details not available on the company's website. |
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