Plan Overview

Oriental Individual Mediclaim Health Plan is a standard health insurance plan designed especially for individuals having different Sum Assured ranges, benefits and discounts which makes the plan quite flexible.

Benefits included

Hospitalization means any impatient treatment (min. 24 hrs stay) as well as the named 30 day care procedures.

  • Accident related hospitalisation are covered from day 1.
  • Other hospitalisations are covered after 30 days. Cover starts after 30 days, except accidents which are covered from day 1
  • Exceptions : Any pre-existing diseases (PED) which are covered after 4 years and some specified diseases which are covered after 1 years from the policy start date.

Other additional benefits :

  • Cover restoration
  • No claim bonus
  • Free Health Check-up
  • Ambulance charges
  • Daily cash allowance
  • 30 days pre-hospitalisation
  • 60 days post hospitalisation
  • Organ donor expenses
  • Maternity
  • New-born treatment
  • Home treatment
  • Outpatient
  • Ayush treatments
  • Recovery allowance

Out of pocket expenses

  • You will bear all the expenses not covered by the policy. Refer to the list of such expenses in the Policy Exclusions section below
  • Additionally, you will pay 10% copay for each admissible claim.
  • Besides, you will have to pay more if you stay in a room category above 5000

Policy Exculsion

  • Cosmetic surgery
  • Birth defects
  • Medical expenses due to drugs/alcohol abuse
  • Self-inflicted injury
  • Hazardous sports or war related injuries
  • HIV or AIDS
  • Sexually Transmitted Disease(STDs)
  • Consumables
  • Mental illness
  • Genetic disorders
  • Dental treatment / Surgery
  • Eye disorders & lasik laser treatment
  • Hospitalization for only diagnostic purpose
  • Diagnostic Charges
  • Hospital registration or admission fees
  • Administrative Charges
  • Non medical expenses

Claims settlement

  • If you go to a non-network hospital, you will have to get the claim settled on reimbursement basis by providing the original bills and documents to the insurer.
  • If you get admitted to a network hospital, you can get a cashless authorization from the insurer and then the insurer will settle the expenses directly with the hospital. See the list of the network hospitals near you below

Oriental Health Insurance