Oriental Health Insurance

The Oriental Insurance Company Limited was formed in the year 1947 as a fully owned subsidiary of The Oriental Government Security Life Assurance Company Limited. Thereafter, from the year 1956 to the year 1973, the company operated as a subsidiary of the Life Insurance Corporation of India. Finally, in the year 2003, the company’s shares were transferred to the Indian Government and as of today the Government of India owns and controls the operations of Oriental Insurance.

Oriental Insurance is among one of the four public sector general insurance companies in India in the general insurance segment. The company offers general insurance policies for individuals as well as corporates. Oriental Insurance has a range of general insurance products to protect you against possible financial contingencies. Health insurance is one such product offered by the company. Let’s explore Oriental health insurance plans and check their features –

Features and benefits of Oriental health insurance policies

Health insurance policies offered by the Oriental Insurance Company are characterized by the following features and benefits –

1. The company has its presence pan India with more than 29 regional offices, 1800+ offices and a wide distribution channel with about 13,500 employee
2. The company’s gross premium at the end of the financial year 2018-19 stood at INR 13,199 crores showing the popularity of the company’s products
3. Besides selling insurance in India, Oriental Insurance also offers insurance plans in Dubai, Nepal and Kuwait making it a multinational company

Benefits of Oriental health insurance policies

Oriental Insurance Company offers a range of health insurance plans which suit the coverage requirement of every individual. Oriental medical insurance policies have the following common coverage benefits –

Other benefits of Oriental health insurance plans

Besides providing you with the above-mentioned coverage benefits, Oriental Insurance mediclaim policies also offer various value-added benefits under their plans. These benefits are as follows –

1. Health check-ups

   If you continue renewing the policy with Oriental Insurance, the company would allow you the facility of free health check-ups after a specified number of policy years. These check-ups can be availed by you as well as your family members if they are also covered under the plan.

2. Cumulative bonus

   If no claim is made in a policy year, the company rewards you with a cumulative bonus. This bonus can either increase the sum insured without affecting the premium or give you a premium discount in the renewal premium. Moreover, you can accumulate the bonus for each subsequent claim-free year.

3. Premium discounts

   Every health plan offered by Oriental Insurance also offers you attractive premium discounts. Discounts can be allowed for buying the policy online, for adding two or more family members to the coverage or for choosing a long term coverage period.

Optional riders under Oriental health insurance plans

Besides the inbuilt coverage benefits offered by Oriental health insurance policies, there are optional riders too which are available under different plans. If you want to increase the scope of coverage, you can choose one or more of the available optional riders by paying an additional premium. The available riders are as follows –

1. Personal accident cover

   This cover allows you a lump sum benefit if you face accidental death or permanent disablement due to an accident.

2. Restoration of the sum insured

   You can choose to get the sum insured restored if it is exhausted on previous claims. This restoration can be opted for up to 50% or 100% of the original sum insured.

3. Life hardship survival benefit

   Under this cover, you get coverage for critical illnesses. The plan covers 11 critical illnesses and if you suffer from any of the illness the plan pays a lump sum benefit if you survive a specified period.

3. Voluntary co-payment

   If you choose to pay a part of the claim yourself you can get a premium discount. Oriental health insurance plans allow you to choose a voluntary co-payment of 10% or 20% of the claim and you get a premium discount.

Exclusions under Oriental mediclaim insurance plans

There are some instances of claims for which you would not get coverage under Oriental health insurance plans. These are called exclusions and some of the common exclusions which you can find in all health plans of the company include the following –

1. In the case of pre-existing illnesses, coverage is allowed only after a specified waiting period. Claims for pre-existing conditions occurring during the waiting period would not be covered
2. There are some specified illnesses for which coverage is allowed after a specified waiting period
3. Dental treatments, maternity and outpatient expenses are not covered under the plan unless otherwise mentioned
4. Mental disorders and related treatments are not covered
5. War, rebellion, mutiny, nuclear risks and other related perils are not covered
6. Cosmetic treatments are not covered under health insurance plans
7. Sexually transmitted illnesses and HIV/AIDS infections are excluded from coverage
8. Self-inflicted injuries attempted suicide and deliberate injuries are not covered
9. Congenital illnesses and debilitating conditions are not covered

List of health plans offered by The Oriental Insurance Company 

Here’s a list of health insurance plan offered by Oriental along with their salient features –

1. Oriental Insurance Happy Family Floater Policy 

This is one of the most popular as well as a comprehensive health insurance plan offered by Oriental Insurance. The plan covers the entire family under a floater coverage and has the following salient features –

1. Dependent parents, as well as siblings, can be covered under the plan
2. Coverage can be extended to SAARC countries if you want without paying any additional premium
3. There are three coverage options of Silver, Gold and Diamond
4. If you are the organ donor you would get coverage for the costs incurred in harvesting the organ
5. Maternity and the newborn baby cover is allowed under the plan
6. The sum insured is restored if you exhaust it in a policy year on earlier claims
7. You can avail a free medical second opinion in case of critical illnesses
8. Personal accident cover and other optional coverage features can be taken if you like
9. Premium discounts are available for buying the policy online and for not choosing TPA services
10. A daily cash benefit is paid in case of hospitalisation

Eligibility parameters of Oriental Insurance Happy Family Floater Policy:

Entry age	Children – 3 months to 25 years Adults – 18 years to 70 years
Sum insured	INR 2 lakhs to INR 20 lakhs
Policy term	1 year

2. Oriental Super Health Top-up Plan

This is a super top-up health plan which pays the excess medical costs incurred if your base health insurance policy’s coverage is exhausted. The policy has a deductible limit. If the claim exceeds the deductible limit the policy pays the benefit. The salient features of the plan are as follows –

1. Coverage can be extended till 70 years of age if you pay 10% additional premium
2. AYUSH treatments are also covered under the plan
3. You can get coverage for organ donor expenses whether you are a recipient or a donor yourself
4. Maternity and the newborn baby cover is available under the plan
5. You can extend your coverage to avail hospitalisation in SAARC countries too without any additional premium

Eligibility parameters of Oriental Super Health Top-up Plan

Entry age	Children – 3 months to 18 years Adults – 18 years to 70 years
Sum insured	INR 3 lakhs to INR 30 lakhs
Deductible limits	INR 3 lakhs to INR 20 lakhs
Policy term	1 year

3. Oriental Insurance Pravasi Bharatiya Bima Yojana 2017

This is a health insurance plan which has been specifically designed for Indian citizens who undertake emigration clearance or who become emigrants to work abroad. The features of the plan are as follows –

1. The policy covers personal accidental injuries including death and disablements
2. The family living in India is also covered for their hospitalisation expenses on a floater basis
3. Females who are insured under the plan can also avail coverage for maternity-related costs
4. The policy covers repatriation of mortal remains as well as medical repatriation
5. Airfare costs of the insured and an attendant are covered in case of death or disability
6. In case of any litigation with which the insured is involved, coverage would be allowed for legal costs incurred 

Eligibility parameters of Oriental Insurance Pravasi Bharatiya Bima Yojana 2017

Sum insured	Depends on the coverage benefit
Policy term	2 years or 3 years

4. OBC Oriental Mediclaim Policy 2017

This is a group health insurance policy designed for the account holders of the Oriental Bank of Commerce. The features of the policy are as follows –

1. Three types of policies can be taken under the plan – One account one policy, multiple accounts one policy and one person one policy
2. No pre-policy health check-ups are required under the plan
3. Daily hospital cash benefit of INR 200/day of hospitalisation is payable under the plan
4. Funeral expenses of the insured are also covered
5. You get coverage for more than 116-day care treatments

Eligibility parameters of OBC Oriental Mediclaim Policy 2017:

Entry age	Children – 3 months to 18 years Adults – 18 years to 79 years
Sum insured	INR 1 lakh to INR 10 lakhs
Policy term	1 year

5. PNB Oriental Royal Mediclaim Policy 

This is also a group health insurance scheme for account holders of Punjab National Bank. The policy’s salient features are as follows –

1. Up to three dependent children can be covered along with the account holder
2. Organ donor expenses are covered under the plan
3. You get coverage for funeral expenses
4. A daily cash benefit is paid if you are hospitalised for 24 hours and above
5. You can avail cashless claim settlements at networked hospitals

Eligibility parameters of PNB Oriental Royal Mediclaim Policy

Entry age	Children – 3 months to 25 years Adults – 18 years to 70 years
Sum insured	INR 2 lakhs to INR 20 lakhs
Policy term	1 year

6. Oriental Insurance Group Mediclaim Policy

As the name suggests, this is a group health insurance scheme which can be availed by groups which have at least 50 members. The salient features of the plan are as follows –

1. The coverage can be taken for family members too
2. Members who can be covered include you, your spouse, dependent children, dependent parents and dependent parents-in-law
3. Cashless claim settlements are available if you seek treatments at networked hospitals
4. You can choose to enhance the coverage by opting for maternity and newborn baby cover at a 10% additional premium
5. Premium discounts are allowed if the claim experience of the group is low
6. Larger groups can also avail premium discounts for covering more members

Eligibility parameters of Oriental Insurance Group Mediclaim Policy 

Entry age	Children – 3 months to 18 years Adults – 18 years onwards
Sum insured	INR 50,000 to INR 2 lakhs
Policy term	1 year

7. Oriental Insurance Health of Privileged Elders (HOPE)

This is a senior citizen health insurance plan designed for individuals who are older. The features of the policy are as follows –

1. A premium discount is allowed if you choose voluntary co-payment
2. You can also claim a premium discount if you don’t make a claim in a policy year
3. The policy covers specific illnesses and pays a percentage of the sum insured on the covered illness
4. Hospitalisation expenses are also covered under the plan
5. There is no maximum entry age. Individuals aged 60 years and above can buy the policy

Eligibility parameters of Oriental Insurance Health of Privileged Elders (HOPE)

Entry age	60 years onwards
Sum insured	INR 1 lakh to INR 5 lakhs
Policy term	1 year

8. Oriental Insurance Overseas Mediclaim Policy (B & H)

It is an international travel-cum-health insurance plan which is available for individuals travelling abroad on business or holiday. The features of the plan are as follows –

1. Coverage is allowed for international treatments if you face any medical contingency when travelling abroad
2. Personal accident cover is inbuilt in the plan
3. You also get coverage for loss or delay of your baggage as well as the loss of passport
4. Personal liability faced in case of third party injuries or property damage is covered under the plan

9. Oriental Insurance Overseas Mediclaim Policy (E & S)

This is also an international travel and health insurance product which covers international trips taken for the purpose of employment or higher education. The features of the plan are as follows –

1. Medical treatments, evacuation and repatriation are covered under the plan
2. Sponsored students get covered for contingencies which might render them unable to study further

10. Oriental Happy Cash Policy 

This is a fixed benefit hospital cash plan which pays a lump sum daily cash benefit if you are hospitalised for a period of 24 hours or more. The salient features of the policy are as follows –

1. Females can enjoy a 25% additional cash benefit upon hospitalisation
2. The policy would pay a benefit even in case of multiple hospitalisations in the same policy period
3. No pre-entrance medical check-ups are required to buy the policy
4. A lump sum convalescence benefit is also paid if your hospitalisation period exceeds 30 or 60 days
5. You earn a premium discount if family members are also covered under the plan
6. Non-allopathic AYUSH treatments are also covered under the plan

Eligibility parameters of Oriental Happy Cash Policy

Entry age	Children – 3 months to 18 years Adults – 18 years to 60 years
Daily hospital cash benefit	INR 500 to INR 3000
Policy term	1 year

11. Oriental Jan Arogya Bima Policy

This is an affordable health insurance plan which covers all the basic medical expenses and comes at a very low premium rate. The features of the policy are as follows –

1. Inpatient hospitalisation costs are covered under the plan
2. Diagnostic tests, chemotherapy, radiotherapy, etc. are covered by the plan
3. You get coverage for domiciliary treatments too

Eligibility parameters of Oriental Jan Arogya Bima Policy 

Entry age	Children – 3 months to 5 years Others – 5 years to 70 years
Sum insured	INR 5000
Policy term	1 year

12. Arogya Sanjeevani Policy Oriental Insurance

Arogya Sanjeevani Policy Oriental Insuranceis a standard health insurance policy issued under the guidelines of IRDAI. Available on a Family Floater as well as an individual basis, the plan is available at affordable premium rates. The plan is a straightforward health insurance plan that offers you financial support in case you or a covered family member has to be hospitalised for 24 hours or more.

Its main features are as follows:

1. The plan offers coverage for the sum insured for a minimum of INR 1 lakh and a maximum of INR 25 lakhs. Up to INR 5 lakhs, the sum insured is available in multiples of INR 50,000. Above that, the sum insured amounts are: INR 6 lakhs, 8 lakhs, 10 lakhs, 15 lakhs and 20 lakhs
2. Expenses on room rent, boarding and nursing are covered up to 2% of the sum insured
3. ICU charges are covered up to 5% of the sum insured
4. The premium of the policy remain the same all over the country
5. You can cover your spouse and your dependent children who are in the age group of 3 months to 25 years
6. Parents and parents-in-law can also be covered in this plan
7. For each claim-free year, you can avail of a cumulative bonus of 5%, up to a maximum of 50%
8. There is the option of lifelong renewability with no maximum age limit
9. Per hospitalisation, an ambulance cover up to INR 2,000 is available
10. You can avail of a 5% discount when you buy the policy online
11. Expenses on dental treatment and plastic surgery are covered when necessitated after an illness or an injury
12. Specified Modern treatments are covered up to 50% of Sum Insured
13. The policy covers daycare procedures, specific modern treatments and AYUSH treatments as well
14. The claim can be availed on a cashless as well on a reimbursement basis 
15. The plan comes with a 5% mandatory co-payment 
16. No pre-policy medical tests are required till the age of 55 years
17. You have the option to increase the sum insured

Eligibility parameters ofOriental Arogya Sanjeevani Policy

Entry Age	18 years to 65 years
Sum Insured	INR 1 lakh to INR 20 lakhs
Policy Term	1 year
Waiting period on Pre-existing disease	48 months
Co-payment	Mandatory 5% on all claims
Pre-policy Medical screening	Not Required up to 55 years of age
Pre-Existing Disease Waiting period	48 months

13. Oriental Dengue Kavach

Oriental insurance Dengue Kavach is a fixed-benefit, disease-specific health insurance cover that is paid out when the insured is detected with Dengue fever. The premium of the policy remains the same across age groups. To settle the claim, you need to submit the Doctor’s prescription advising the test and the Positive Test Report. However, make sure that the Dengue fever positive test report is from a Government Approved Diagnostic/Pathological Laboratory in India.

 This plan has the following features:

• The Oriental insurance Dengue Kavach pays out the benefit in a lump sum without any cost-sharing/ sub-limits
• You can choose a sum insured out of the 2 available choices: INR 10,000 and INR 20,000 on an individual basis
• The plan is available on an individual basis, you can cover self, spouse, dependent parents/ in-law, up to 2 dependent children
• No medical check-up is required before buying the policy
• There is a waiting period of 30 days
• Family Discount of 2.5% in case 2 members are covered and 5% if more than 2 members are covered 
• Online Discount of 5% can be availed, when there is no intermediary in the process
• After a claim-free year, at the time of renewal, you can enhance the sum insured to the immediate next slab

Eligibility parameters of Oriental Dengue Kavach

Entry Age	18 years to 70 years
Sum Insured	INR 10,000 and INR 20,000
Policy Term	1 year
Waiting period	30 days
Co-payment	Not applicable
Pre-policy Medical screening	Not required
Payment Basis	Lump-sum benefit

14. Oriental Critical Illness Policy

Oriental Insurance Critical Illness Policy is a fixed benefit policy. Under this plan, when an insured person is diagnosed with any of the listed 22 critical illnesses, a lump-sum benefit is paid out. The plan comes with 2 plan variants: 

• Plan A, which covers 11 specified critical illnesses
• Plan B which covers 11 more illnesses apart from those in Plan A

Let us take a look at the salient features of theOriental Critical Illness Policy:

1. The plan is available on an individual basis, you can cover self, spouse, either dependent parents or dependent parents-in-law, dependent children, unmarried dependent siblings
2. The maximum age of a family member can be 65 years
3. The policy can be bought as an annual policy for a year or as a long-term policy for 3 years
4. Long-term renewals can be made, without an upper age limit
5. The main illnesses covered are:
1. Cancer of specified severity 
2. Major Head trauma 
3. Primary pulmonary hypertension 
4. Open heart replacement or repair of heart valves 
5. Coma of specified severity
6. Multiple sclerosis with persisting symptoms
7. Myocardial infarction
8. Open chest CABG 
9. Kidney failure that requires dialysis on a regular basis
10. Stroke causing permanent symptoms 
11. Permanent limb paralysis 
12. Motor neuron disease 
13. Blindness 
14. Benign brain tumour 
15. Major organs/ bone marrow transplant 
16. Deafness 
17. Last stage lung failure 
18. Last stage liver failure 
19. Loss of Limbs 
20. Loss of speech
21. Third-degree burns
22. Angioplasty 
6. Under both the plans all sum insured options are available 
7. Lifelong renewability available
8. There is a waiting period of 90 days
9. There is a survival period of 30 days
10. Depending on the sum insured that has opted, you would be able to avail of the Second Medical opinion benefit
11. No pre-policy medical tests required up to 45 years of age
12. At the time of renewal, you can increase the sum insured

Eligibility parameters ofOriental Critical Illness Policy

Entry Age	18 years to 65 years
Sum Insured	For Policyholders Up to 50 years of age: INR 2 lakhs to INR 50 lakhs For Policyholders over 50 years of age: INR 2 lakhs to INR 20 lakhs
Policy Term	1 year/ 3 years
Waiting Period	90 days
Survival Period	30 days
Co-payment	Not applicable
Pre-policy Medical screening	Not required up to 45 years of age
Payment Basis	Lump-sum benefit

15. Corona Kavach and Group Corona Kavach

To help deal with the financial aspect of Covid-19, the IRDA advised the health insurance companies to offer pandemic-specific health plans to the public. Corona Kavach is standard health insurance and hence, the terms and conditions and premium rates of this plan are similar among different health insurance companies. The policy covers Covid-specific treatment expenses incurred due to hospitalisation of over 24 hours. Apart from the in-patient expenses, the policy also covers doctor prescribed home care treatments for up to 14 days. Apart from COVID, no other illness or injury is covered under this plan. 

Given below are the main features of the Corona Kavach Policy:

1. The policy covers hospital expenses due to in-patient care that includes: room rent, boarding and nursing, ICU and ICCU charges, along with
1. Fee of Specialists, surgeons, medical practitioners, consultants
2. Blood, oxygen, OT charges, surgical appliances, ventilator charges, medicines
3. PPE kits and gloves, masks
4. Costs towards diagnostic investigations
5. Road ambulance expenses up to INR 2,000 of an insured for covid-related hospitalisation will be covered 
2. In-patient AYUSH treatment expenses taken in AYUSH hospitals are covered up to the sum insured, without any sub-limits
3. You can take home-care treatment which is prescribed by a medical practitioner and otherwise requires hospitalisation of more than 24 hours. This benefit can be taken for a maximum period of 14 days.
4. As an add-on cover, you can get Hospital daily cash of 0.5% of the sum insured for every 24 hours on break-free hospitalisation
5. There are no deductibles in this policy
6. No medical screening is required before buying a fresh policy
7. Pre and post-hospitalisation expenses, related to COVID-19, are covered for 15 and 30 days respectively
8. There is a waiting period of 15 days from the policy inception date
9. Claims can be made in the form of Cashless Claim or Reimbursement
10. The following discounts can be availed of:
1. 5% digital account when the policy is bought online
2. Health care workers are eligible for a 5% discount
3. If TPA services are not opted for, you can avail of a 5.5% discount on the premium

Eligibility parameters of Oriental Insurance Corona Kavach and Group Corona Kavach

Entry Age	18 years to 65 years
Sum Insured	INR 50,000 to 5 lakhs
Policy Term	3.5 months, 6.5 months, 9.5 months
Waiting Period	15 days
Sub-Limits	Nominal sub-limits
Co-payment	Not applicable
Pre-policy Medical screening	Not required
Payment Basis	Indemnity basis for the base cover Benefit basis for optional cover

How to buy Oriental health insurance plans?

Health insurance plans offered by Oriental Insurance Company can be bought either offline or online. The process is as follows –

1. Offline 

   To buy offline you can meet with an agent of the company and buy the policy from him/her. Alternatively, you can visit the company’s nearest branch and apply for a desired health insurance policy from the branch itself. You would have to fill up an application form and submit your documents to buy Oriental health insurance plans.

2. Online 

   Oriental Insurance also allows online purchase facility wherein you can buy the plans online from the company’s website. You just have to visit the website at https://orientalinsurance.org.in/web/guest/home, choose ‘products’ choose ‘Health’ and then select the desired policy. You can fill an online application form, pay online premiums and buy the policy directly from the company’s website.

   You can also choose to buy Oriental health insurance from Turtlemint. Turtlemint allows you an easy interface to buy the desired health insurance policy at the best premium rates. You can also compare the available plans and find the best health insurance plan on Turtlemint’s platform. To buy all you have to do is visit Turtlemint and take the following steps –

   1. Choose ‘Health’ to be taken to Turtlemint’s health insurance page
   2. Choose whether you want to buy a new plan, top-up an existing one or change your insurance company
   3. You would then have to enter your details on the basis of which the recommended health insurance plans and their premiums would be shown. The details include your age, gender, members to be insured, their age, pre-existing illnesses, income level, etc.
   4. After the details are given, you can also leave your name and contact information so that you can get personalised assistance in buying the best health insurance plan
   5. When you proceed, you would be able to check out the available health insurance policies, their coverage details and their premium rates
   6. You can compare the available plans to choose the best policy for your needs
   7. When you select the policy, fill up an online application form with your details and pay the premiums online
   8. As the premiums are paid, the company would verify your details and issue the policy easily

How to renew Oriental health insurance plans?

Timely renewals of Oriental health insurance policies are a must so that you can enjoy non-stop coverage lifelong. Moreover, when you renew the policy continuously, you also enjoy renewal benefits like cumulative bonus, premium discounts, coverage for existing illnesses, etc. To renew your Oriental mediclaim policy online, you can visit the company’s website and renew the plan. On the home page, there is the option of renewing online. You can choose the option, enter in your existing policy details and pay the renewal premium online. The policy would be renewed.

Even Turtlemint allows you online renewal facilities. If you are an existing customer who has bought a policy from Turtlemint, you can simply log into your online account and renew your policy instantly. You would have to choose the policy which you want to renew, check the policy details and pay the renewal premiums and the policy would be easily renewed.

Claim process of Oriental health insurance plans

Claims under your Oriental medical insurance policy can be made in two ways – cashless or reimbursement. Cashless claims are when you seek treatment at a hospital which is tied-up with the insurance company. In this case, the company pays your hospital bills directly to the hospital. Reimbursement claims are when you take treatments at a non-networked hospital. In that case, you would have to pay the medical bills yourself and then get them reimbursed from the insurance company. The claim process involves the below-mentioned steps –

1. You have to inform the TPA (Third Party Administrator) of the insurance company immediately about the claim
2. If you are undergoing a planned hospitalisation, the information should be given 3-4 days in advance. In case of emergency hospitalisation, the TPA should be informed within 24 hours of your hospitalisation
3. You would have to fill up a pre-authorisation form and submit it to the TPA. The TPA would forward this form to the insurance company based on which your claim would be approved
4. Once the claim is approved by the insurance company, you can take treatments and the insurance company would handle the medical costs
5. After you are discharged from the hospital, you should collect the discharge summary and all relevant medical bills and reports. You should, then, fill up the claim form and submit the form with all the documents so that the claim is settled.

You can also make your health insurance claim through Turtlemint. Turtlemint has an internal claims department which handles customers’ claims. You just have to inform Turtlemint by calling up its toll-free number 1800 266 0101 or send an email at claims@turtlemint.com. Once the company is involved, its claim experts would get your claims processed so that you can get an easy and a quick settlement.

Documents required for claims

Health insurance claims can be processed only when you substantiate your claim with the relevant documents. The documents required for making a valid claim in your Oriental health insurance plan are as follows –

1. Claim form
2. Discharge summary
3. Original medical bills of the hospital 
4. Medical bills of the pharmacy from where the medicines and supplies have been purchased
5. Doctor’s reports
6. Doctor’s prescriptions advising hospitalisation
7. Any other document as needed by the insurance company 

Once the documents are submitted and they are complete, you would get the settlement of your health insurance claim.