Oriental Health Insurance

Features of Oriental Health Insurance

• No. of members- The plan covers maximum 7 members of your family with up to 3 children and 4 adults.
• Lifelong Renewal – The plans offered are lifelong renewable, hence it saves you from the financial burden and stress caused by a medical emergency and keeps you well prepared to handle any situation.
• Pre & Post hospitalization cover- The plan covers medical expenses for 30 days prior to hospitalization and 60 days post hospitalization only for related medical expenses.
• Health Check-ups – Offers health check-up for insured after every 4 continues claim-free year.
• Pre-existing diseases- Pre-existing diseases are covered after 4 years of waiting period
• Co-payment- The insured has to pay 10% of the claim amount as co-payment.

Benefits of Buying Health Insurance from Oriental Health Insurance

• One of the oldest health insurance companies in India, Oriental Insurance has an evolved model to cater to the newer needs and audience.
• Holds an excellent standing amongst its customers for settling claims and have a very low claim rejection record.
• Provides you deductions on your premium by offering various capping limits. Oriental health insurance fairs okay in terms of the pricing of their products.

Nagrik Suraksha Policy

This personal accident disability plan offers compensation for only two conditions, namely permanent or temporary disability.

• This is a personal accident plan, which offers coverage in case of permanent or temporary disability.

Note: For any claims under this policy the disability should be more than 40%.

Happy Family Silver Plan

This is family floater coverage

• This is a family floater plan, which offers coverage to the entire family in the range of Rs. 1 lakh to Rs. 5 lakh.
• Dependents between age 3 months and 25 years and adults above age 18 years can be covered under this plan.
• A maximum of two members can be covered under this plan.
• Basic coverage like pre and post hospitalization expense, ambulance charges, etc. are covered under this plan.

Happy Family Gold Plan

• This is a family floater plan, which offers coverage to the entire family in the range of Rs.2 lakh to Rs.10 lakh.
• Dependents between age 3 months and 25 years and adults above age 18 years can be covered under this plan.
• A maximum of two members can be covered under this plan.
• In addition to silver plan, the gold plan offers daily cash allowance, add-on coverage for personal accidents, etc. are benefits provided in this plan.

Claims Process at Oriental Health Insurance

There are two ways to make a claim under a Health Insurance Policy: on cashless basis and on reimbursement basis. In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form. In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for the claim on reimbursement are obtained after hospitalization.

Oriental Health Insurance has a well-defined claim processing system.

Cashless Service: Seeking Pre-Authorization

• Complete the pre-authorization form available at the hospital's insurance/TPA Desk.
• Send the completed form via email or fax.
• Approved letter will be sent by the claim management team. Remember that the claim management team could send an inquiry to the hospital or you before authorization.
• In case the authorization is rejected, initiate the treatment and file for reimbursement claim.

Reimbursement Claim: Claim Submission

• Complete the necessary form and submit along with required documents, as per the policy terms and conditions.
• Necessary documents include discharge summary, prescriptions, bills etc.
• Approved letter will be sent by the claim management team. Remember that you will be answerable to any queries raised by the claim management team before the letter is issued.
• In case the claim is rejected, the team will communicate the reasons.

In case of any emergencies, you need to inform Oriental Insurance within 24 hours of the admission. In case of planned emergencies, the notification has to reach the company 48 hours prior to the hospitalization. The claim intimation can be done via Oriental Insurance's toll free number 1800-118-485. The same could also be emailed to csd@orientalinsurance.co.in .