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Individual Health Insurance Plans
Oriental Health Insurance
Formed in 1947, Oriental Insurance Company is an Indian public sector general insurance company and a subsidiary of Oriental Government Security Life Assurance Company Ltd. Health, personal accident, motor, shopkeeper, traders, and industrial, are just some of the insurance solutions provided by the company to meet the demands of various sections of society.
Individuals and families benefit from Oriental Health Insurance plans because they provide a much-needed financial buffer in the event of a medical emergency. The plans provide comprehensive coverage and protect the insured from a variety of medical costs incurred as a result of illness, sickness, disease, or injury.
Key Highlight of Oriental Health Insurance
| Incurred Claim Ratio | 102.34% |
| Share Of Members In Indian Market Terrorism Risk Insurance Pool | 11.92% |
| Network Hospitals | 4300+ |
| Premium Underwritten | 13,672.65 (2019-20) |
| Equity Share Capital | 250 (As Of March 31, 2020) |
| Solvency Ratio | 1.54 (December 2019) |
| Registered Office | Oriental House, A-25/27, Asaf Ali Road, New Delhi – 110002 |
| Types Of Plans |
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Oriental Health Insurance Plans
1. Oriental Happy Family Floater Policy
The Happy Family Floater Policy is for everyone who wants to protect their families against future medical expenses incurred as a result of unavoidable hospitalization or medical conditions. The plan comes in three variants: Silver, Gold, and Diamond.
Key Features
- Pre- & Post-Hospitalization Expenses: The policy provides coverage to the pre- and post-hospitalization expenses.
- Domiciliary Hospitalization: The plan also provides coverage to domiciliary hospitalization.
- Intensive Care Unit Expenses: The plan provides coverage to Intensive Care Unit Expenses as offered by the nursing home or hospital.
| Eligibility | Silver | Gold | Diamond |
| Entry Age | 18 To 65 Years | ||
| Sum Insured | Rs. 1,2,3,4, & 5 Lakhs | Rs. 6,7,8,9, & 10 Lakhs | Rs. 12,15,18, & 20 Lakhs |
| ICU Expenses | 2% Of Sum Insured | 2% Of Sum Insured | Rs.20,000 + 1% Of Sum Insured |
| Ambulance Expenses | Up To Rs. 1,000 Per Illness | Up To Rs. 2,000 Per Illness | Up To Rs. 3,000 Per Illness |
| Daily Hospital Cash | NA | 0.1% Of Sum Insured | 0.1% Of Sum Insured |
| Medical Second Opinion On Specified Major Illnesses | Up To Rs. 5,000 | Up To Rs. 10,000 | Up To Rs. 15,000 |
2. Oriental Individual Mediclaim Insurance Policy
Individual Mediclaim Insurance Policy is designed for individuals and their families who want to be covered in the event of an unexpected hospitalization or medical emergency.
Key Features:
- Pre- & Post-Hospitalization Expenses: Individual Mediclaim Insurance Policy provides coverage to pre-hospitalization and post-hospitalization expenses.
- Room, Boarding & Nursing Expenses: The plan provides coverage to room, boarding, and nursing expenses as offered by the nursing home or hospital.
- Donor Expenses: In-patient hospitalization medical expenses for organ donors are covered under the policy if the donation is made in accordance with the Transplantation of Human Organs Act 1994 (as modified) and other applicable laws and norms.
Eligibility:
| Entry Age | 18 To 65 Years |
| Sum Insured | Rs. 1 Lakh To Rs. 10 Lakhs |
| Family Discount | 10% |
| Room, Boarding, & Nursing Expenses | Not More Than 1% Of Sum Insured Per Day |
| ICU Expenses | Not More Than 2% Of Sum Insured Per Day |
| Ambulance Charges | Rs. 2,000 OR 1% Of Sum Insured Per Hospitalization |
| Dog Bite Treatment | Up To Rs. 5,000 Per Incident |
3. Oriental Group Mediclaim Insurance Policy
Oriental Group Mediclaim Insurance is a type of policy that can be purchased by anyone who wants to cover a target group, institution, association, or business batch.
Key Features:
- Mental Illness Cover: The policy indemnifies the insured person or the policyholder only under certain illnesses defined under mental illness.
- Maternity Coverage: The plan provides maternity as well as newborn baby coverage to the policyholder.
- Ambulance Expenses: The plan also provides coverage to ambulance expenses.
Eligibility:
| Room, Boarding, & Nursing Expenses | Not More Than 1% Of Sum Insured |
| ICU Expenses | Not More Than 2% Of Sum Insured |
| Ambulance Charges | 1% Of Sum Insured |
| Maternity Expenses & Newborn Child Cover Benefit Extension | Maximum Benefit Up To Rs. 50,000 |
4. PNB-Oriental Royal Mediclaim
The PNB Oriental Royal Mediclaim Insurance Policy is designed to protect the health of Punjab National Bank (PNB) account holders and their families at a budget-friendly cost.
Key Features:
- Organ Donor Expenses: The plan provides coverage for organ donor expenses.
- Pre- & Post-Hospitalization Expenses: The plan covers medical costs incurred 30 days before hospitalization and up to 60 days after discharge.
- Domiciliary Hospitalization Expenses: Surgeon, Medical Practitioner, Specialist Fees, Consultants, Oxygen, Medicines & Drugs, Surgical Appliances, Diagnostic Material, Chemotherapy, Dialysis, and Nursing expenses are covered under the policy.
Eligibility:
| Sum Insured | Rs. 1 Lakh To Rs. 10 Lakhs |
| Entry Age | Minimum Age: 91 Days To 18 Years Maximum Age: 79 Years |
| Ambulance Charges | Up To Rs. 1,000 During Policy Period |
| Room, Boarding & Nursing Expenses | 1% Of Sum Insured Per Day |
| ICU Expenses | 2% Of Sum Insured Per Day |
| Daily Hospital Cash | Rs. 200 Per Day Of Hospitalization |
5. OBC-Oriental Mediclaim Policy
The OBC Oriental Mediclaim Insurance Policy is designed to protect the health of Oriental Bank of Commerce (OBC) account holders and their families at a budget-friendly cost.
Key Features:
- In-Patient Treatment: The plan covers in-patient treatment by providing coverage for ICU expenses, medical expenses, equipment expenses, and others.
- Pre- & Post-Hospitalization Expenses: The policy covers medical expenses occurring before and after hospitalization of the insured person.
- Organ Donor Expenses: If the insured person is the recipient or donor, the plan covers the organ donor expenses.
Eligibility:
| Entry Age | Maximum: 79 Years Minimum: 91 Days To 18 Years |
| Sum Insured | Rs. 1 Lakh To Rs. 10 Lakhs |
| Room, Boarding, & Nursing Expenses | 1% Of Sum Insured Per Day |
| ICU Expenses | 2% Of Sum Insured Per Day |
| Ambulance Charges | Up To Rs. 1,000 |
6. Oriental Happy Cash – Nishchit Rahein!
The Oriental Happy Cash Policy provides a steady supply of cash while you’re in the hospital. In such a manner, the policy won’t deplete your funds and will keep your worries at bay.
Key Features:
- Hospitalization Expenses: Any hospitalization costs will be covered up to the daily cash limit.
- Convalescence Benefit: In case the hospitalization period exceeds 30 or 60 days, convalescence benefit is offered per policy period.
- AYUSH Treatment: Medical expenses occurring under Ayurveda, Yoga, Unani, Siddha, and Homeopathy systems of treatment will be covered under the policy.
Eligibility:
| Family Discount | For 2 Members: 5% On Premium For More Than 2 Members: 7.5% On Premium |
| Loyalty Discount | 10% On Premium |
| Initial Waiting Period | 30 Days |
| Renewability | Lifelong |
Oriental Super Health Top-Up is a high-deductible health insurance plan that pays for all-important medical expenses incurred during the required treatment if the hospitalization costs exceed the sum insured under the base policy.
Key Features:
- Pre & Post-Hospitalization Expenses: The plan covers both pre-hospitalization and post-hospitalization expenses.
- AYUSH Treatment: The plan covers the treatment under Ayurveda, Yoga, Unani, Siddha, and Homeopathy system.
- Organ Donor Expenses: The policy covers in-patient hospitalization expenses for the person donating the organ to the insured person when the insured person is the recipient.
Eligibility:
| Room, Boarding, & Nursing Expenses | 1% Of The Deductible Amount Per Day |
| ICU Expenses | 2% Of The Deductible Amount Per Day |
| Organ Donor Benefit | 10% Of Sum Insured |
| Entry Age | 18 To 65 Years |
8. Oriental Pravasi Bhartiya Bima Yojana
The Pravasi Bhartiya Bima Yojana is specifically designed to help those who migrate to foreign nations for work and have acquired emigration clearance.
Key Features:
- Hospitalization Cover: The plan provides hospitalization cover on a floater basis in the event of personal accident death or permanent disability.
- Maternity Coverage: The plan provides maternity coverage to the insured woman emigrant.
- Personal Accident Death: The policy also provides coverage for personal accident death.
Eligibility:
| Personal Accident Death | Up To Rs. 10,00,000 Of Coverage |
| Permanent Disability | Up To Rs. 10,00,000 Of Coverage |
| Hospitalization Cover | Rs. 50,000 Per Annum |
| Maternity Benefit | Normal Delivery: Rs. 35,000 Caesarean Operation: Rs. 50,000 |
9. Health Of Privileged Elders (HOPE)
The Health Of Privileged Elders policy is primarily aimed to provide valuable health insurance coverage to seniors aged 60 and above.
Key Features:
- Telemedicine Expenses: Expenses incurred by the insured for telemedicine/teleconsultation with a licensed medical practitioner for the diagnosis and treatment of a disease/illness covered by the policy.
- Hospitalization Costs: The plan provides coverage for hospitalization expenses.
- Domiciliary Hospitalization Expenses: The plan also provides coverage for domiciliary hospitalization expenses.
Eligibility:
| Room, Boarding, & Nursing Expenses | Not More Than 1% Of Sum Insured Per Day |
| ICU Expenses | Not More Than 2% Of Sum Insured Per Day |
| Ambulance Charges | Up To Rs.1,000 |
| Compulsory Co-Payment | 20% |
| Waiting Period | 30 Days |
10. Oriental Arogya Sanjeevani Policy
Oriental’s Arogya Sanjeevani Policy is a standard health insurance plan that includes a wide range of essential benefits and covers hospitalization bills.
Key Features:
- In-Patient Care OR Daycare Treatment: Expenses for in-patient care or daycare treatment incurred for the treatment of an illness contracted or an injury suffered during the policy period are covered by the policy.
- Pre-Existing Disease Cover: After 48 months of continuous coverage, all pre-existing diseases are covered, provided they are stated at the time of application and accepted by the insurer.
- No Medical Examination Up To Age 55: Under the Oriental’s Arogya Sanjeevani Policy, the policyholder needs not to undergo any medical examination up to age 55.
Eligibility:
| Sum Insured | Rs. 6,8,10,15, & 20 Lakhs |
| Entry Age | 18 To 65 Years |
| Ambulance Coverage | Up To Rs. 2,000 Per Hospitalization |
| Cumulative Bonus | 5% Of Sum Insured |
| Renewability | Lifelong |
Overseas Mediclaim Policy is a hybrid of travel and health insurance that includes health benefits as well as loss coverage while traveling abroad.
Key Features:
- Multiple Trip Facility: The option of a multiple trip facility is available under the plan.
- Comprehensive Plan: The plan provides comprehensive coverage by covering the entire family members under a single policy.
- Free Look Facility: The policy also provides the option of a free look facility to the policyholder.
Eligibility:
| Maximum Entry Age | 60 Years |
| Portal Discount | 5% |
| Staff Discount | 33% |
12. Overseas Mediclaim Policy – E & S (Employment & Study)
Overseas Mediclaim Policy – E & S is specifically designed for the students and employed persons who travel abroad. The plan covers medical expenses occurring due to illnesses, contagious diseases, and physical injuries.
Key Features:
- Outpatient Treatment: The policy covers the treatment in case of emergency outpatient expenses.
- Emergency Medical Treatment: The policy provides coverage in case of any sudden hospitalization or illness.
- Repatriation & Alternative Expenses: In the event of the death of an insured person, the company will cover the costs of preparation and transportation of the insured person’s remains.
Eligibility:
| Entry Age | 6 Months To 70 Years |
| Types Of Plan | Individual & Family |
13. Jan Arogya Bima Policy
The Jan Arogya Bima Policy from Oriental is a comprehensive health insurance policy that covers the policyholder for emergency hospitalization costs.
Key Features
- In-Patient Hospitalization Expenses: The plan provides coverage for nursing expenses, boarding room expenses, and various other costs.
- Pre-Hospitalization Expenses: Pre-hospitalization expenses occurring up to 30 days are covered under the plan.
- Post-Hospitalization Expenses: Post-hospitalization for a maximum of 60 days is covered under the policy.
Eligibility:
| Entry Age | 5 To 70 Years |
| Free Look Period | 15 Days |
14. Oriental Dengue Kavach policy
The Oriental Dengue Kavach Policy is specifically designed for providing adequate protection to the insured against dengue illness.
Key Features:
- No Medical Check-Up: Under the plan, there is no need to undergo any kind of medical check-up irrespective of age.
- Specialized Disease Benefit: On detection of Dengue Fever, the plan provides specific benefits without any co-payment or sub-limit.
- One Premium: Irrespective of the age of the policyholder, there is only one premium for all the insured.
Eligibility:
| Sum Insured | Rs. 10,000 & Rs. 20,000 |
| Entry age | 18 To 70 Years |
| Waiting Period | 30 Days |
| Family Discount | For 2 Members: 2.5% For More Than 2 Members: 5% |
The Oriental Critical Illness Plan is intended exclusively for people who have been diagnosed with critical illnesses like cancer or tumors. The policy has two variants: Plan A (covers 11 critical illnesses) and Plan B (covers 22 critical illnesses).
Key Features:
- Portability Option: Oriental Critical Illness Policy comes with a portability option, which means that you can migrate to another plan.
- Medical Second Opinion: The insurance covers medical expert fees up to 1% of the total insured in a policy period if the insured person is diagnosed with any of the mentioned critical illnesses and seeks a second opinion, whether before starting a treatment or during treatment.
- Cashless Treatment: Under this plan, you can get the cashless facility and you need not pay anything at the time of emergency.
Eligibility:
| Entry Age | 18 To 65 Years |
| Medical Second Opinion Benefit | 1% Of Sum Insured |
| Sum Insured | Rs. 2/4/6/8/10/12/14/16/18/20/25/30/35/40/45/50 Lakhs |
| Policy Period | 1/3 Years |
16. Oriental Corona Kavach (Individual & Group)
Corona Kavach Policy is a policy that protects the policyholder from the costs of COVID-19 treatment. It is available for both individuals and families.
Key Features:
- AYUSH Treatment: The plan provides coverage to the treatment done under Ayurveda, Yoga, Unani, Siddha, and Homeopathy systems.
- Pre- & Post-Hospitalization Expenses: The plan provides coverage to both pre and post-hospitalization expenses due to COVID-19 treatment.
- Hospitalization Expenses: During the policy period, the plan covers hospitalization expenses for in-patient care or home care treatment spent for the treatment of Covid-19.
Eligibility:
| Sum Insured | Rs. 50,000 To Rs. 5 Lakhs |
| Waiting Period | 15 Days |
| Hospital Daily Cash | 0.5% Of Sum Insured Per Day |
| Policy Term | 3.5 Months, 6.5 Months, & 9.5 Months |
| Maximum Entry Age | 65 Years |
17. Oriental Insurance Bank Saathi Policy
Oriental Insurance Bank Saathi Policy is a policy that provides indemnity to the proposer and their covered family members in the policy schedule for medical expenses reasonably incurred on account of the treatment of a covered disease, illness, or bodily injury caused by an accident contracted during the policy’s currency. The plan comes in two variants: Plan A and Plan B.
Key Features:
- Road Ambulance Cover: The plan provides coverage to roan ambulance charges.
- Organ Donor Expenses: The plan provides coverage for organ donor expenses in case the insured person is a recipient.
- Pre- & Post-Hospitalization Expenses: The plan also provides coverage for both pre and post-hospitalization expenses.
Eligibility:
| Maximum Entry Age | 70 Years |
| Minimum Entry Age | 91 Days To 18 Years |
| Sum Insured | Plan A: Rs. 2, 3, 4, & 5 Lakhs Plan B: Rs. 6, 8, 10, 15, 20, & 25 Lakhs |
| AYUSH Coverage | 25% Of Sum Insured |
Room, Boarding, & Nursing Expenses | 1% Of Sum Insured |
| ICU Expenses | 2% Of Sum Insured |
Oriental Cancer Protect is a policy that provides indemnity for insured expenses incurred as a result of inpatient, outpatient, or daycare treatment for cancer of a certain severity.
Key Features:
- Conventional & Advanced Methods: The policy covers all conventional and advanced treatments of cancer.
- No Pre-Medical Check-Up: Under this policy, no pre-medical check-up is required.
- Pre- & Post-Hospitalization Expenses: The policy also covers both pre and post-hospitalization expenses.
Eligibility:
| Entry Age | 18 To 65 Years |
| Sum Insured | Rs. 5, 10, 15, 20, 25, & 50 Lakhs |
| Waiting Period | 75 Days |
| Pre-Hospitalization Expenses | Up To 45 Days |
| Post-Hospitalization Expenses | Up To 90 Days |
19. Oriental Corona Rakshak Policy
On a positive COVID-19 diagnostic, the Corona Rakshak policy pays a lump sum payment if the insured is hospitalized for at least 72 hours.
Key Features:
- Lumpsum Benefit: On a positive COVID diagnosis, the policy pays a lump sum payment equivalent to 100% of the Sum Insured.
- Waiting Period: The policy provides 15 days waiting period from the first date of the policy’s commencement.
- Individual Basis: The policy is offered on Individual Basis only.
Eligibility:
| Sum Insured | Rs. 50,000 To Rs. 2.5 Lakhs |
| Policy Term | 3.5/6.5/9.5 Months |
| Entry Age | 18 To 65 Years |
| Digital Discount | 5% |
Why Health Insurance Plans From Oriental Deserve Your Attention?
- Ideal Incurred Claim Ratio
The ICR or Incurred Claim Ratio is the ratio of an insurer’s total value of claims resolved to the total value of premiums collected in a particular period. Any policyholder who has an incurred claims ratio of less than 50% is losing money. The incurred claims ratio should be between 75 and 90 percent.
When we talk about Oriental General Insurance, the company has an excellent Incurred Claim Ratio of 102.34, which itself indicates the profit of the company.
- Want Comprehensive Coverage? – Choose Oriental!
Health plans from Oriental Insurance are created by taking into account the insurance demands of a variety of people. A comprehensive health insurance cover is available to meet your insurance expectations as well as all of your medical needs.
- Healthy Solvency Ratio
It’s also important to think about the solvency ratio when choosing an insurance company. A solvency ratio is an important indicator that prospective business lenders use to evaluate an organization’s ability to meet long-term debt obligations. A solvency ratio is a financial health indicator that looks at whether a company’s cash flow is enough to cover its long-term obligations.
All insurers must currently maintain a healthy solvency ratio of 1.50, according to IRDAI. Oriental General Insurance company succeeds in maintaining a healthy solvency ratio of 1.54, as of December 2019.
- Wish To Port Your Plan? – You Can Do It With Oriental!
There may exist a time when you do not feel satisfied or happy with the Oriental services. In such a case, the Oriental Insurance company provides a portability option to the policyholder, in which he/she can port his/her plan to another insurer.
- Good Network Of Hospitals
Oriental General Insurance Company has partnered with over 4300 hospitals to offer a cashless service that includes free health screenings, pre and post-hospitalization expenses, and pre-existing illness coverage.
- Do You Wish To Have Attractive Discounts On Premium?
When we talk about Oriental health insurance plans, they are loaded with various discounts, which make them a worth buy for the policyholders. From family discounts and online discounts to cumulative bonuses, Oriental’s health insurance plans make investing worth every dime.
- Lifelong Renewability
Oriental Health Insurance plans can be renewed for a lifetime, that too, without any age restrictions.
- Quick & Easy Claim Settlement Process
This is one of the biggest reasons why you should go for health insurance plans from Oriental. The company provides a smooth and hassle-free claim experience that the insurance buyers can count on.
- Daily Cash Allowance
Under Oriental’s health insurance plans, you get daily cash according to your sum insured, in case you are hospitalized.
How To Calculate Premium For Oriental Health Insurance Plans?
- Visit the official website of Oriental General Insurance company.
- Click on the “Health” tab, select the type of health insurance under the “Go” tab, and then click on “Go”.
- Enter all the details, and then click on “Calculate Premium”.
| Age | Premium |
| 28 | Rs. 3604 |
| 40 | Rs. 4601 |
| 50 | Rs. 6206 |
| 60 | Rs. 10497 |
Buying Process Of Oriental Health Insurance Plans
- Visit the official website of Oriental General Insurance company.
- Click on the “Health” tab.
- Select the type of health insurance under the “Go” tab.
- Then, click on “Go”.
- Enter all the essential details, and click on “Calculate Premium”.
- The premium amount will be displayed to you. Click on “Agree” and then press on “Continue”.
- Enter your personal details and make the premium payment.
- Your policy document will be sent to your registered mail address.
What’s the Claim Process Of Oriental Health Insurance Plans?
CASHLESS CLAIM
- Authorization By Network Hospital: The Oriental Health Insurance claim form will be authorized by the network hospital.
- Analysis: The insurance company will then analyze the details and then decide whether the claim is eligible or not.
- Settling The Claim: Once the insurance company is satisfied with the information, it settles the claim directly with the hospital.
REIMBURSEMENT CLAIM
- Filling The Form: Firstly, the policyholder needs to fill the claim application form.
- Sending Documents: Send all the medical documents along with other documents to the insurance company within 15 days of discharge from the hospital.
- Settling The Claim: Once the claim request is approved by the company, the company reimburses the amount to the registered bank account of the policyholder.
- Visit the official website of the company and click on the “Renew Online” option.
- Enter your policy number, and then click on the “Renew Now” button.
- Make specifications about your policy details.
- Now, pay the premium amount. The policy renewal notification as well as the details will be shared with you.
Other Plans: Oriental Saksham Swasthya Insurance Policy, Oriental Youth Eco Care Policy
Frequently Asked Questions
You can contact the company through the following ways:
- Visiting The Office: Customer Service Department, 4th Floor, Aggarwal House, Asaf Ali Road, New Delhi-110002.
- Email: jdas.gupta@orientalinsurance .co.in OR csd@orientalinsurance.co.in
- Phone No: 011-43659595
As already stated, the Oriental Critical Illness policy comes in two variants: Plan A and Plan B.
The following 11 critical illnesses are covered under Plan A:
- Cancer of specified severity
- Myocardial infarction ( first heart attack)
- Open chest CABG
- Open heart replacement or repair of heart valves
- Coma of specified severity
- Kidney failure requiring regular dialysis
- Stroke resulting in permanent symptoms
- Major organs/ bone marrow transplant
- Permanent paralysis of limbs
- Motor neuron disease with permanent symptoms
- Multiple sclerosis with persisting symptoms.
The following 22 critical illnesses are covered under Plan B:
- Cancer of specified severity
- Myocardial infarction ( first heart attack)
- Open chest CABG
- Open heart replacement or repair of heart valves
- Coma of specified severity
- Kidney failure requiring regular dialysis
- Stroke resulting in permanent symptoms
- Major organs/ bone marrow transplant
- Permanent paralysis of limbs
- Motor neuron disease with permanent symptoms
- Multiple sclerosis with persisting symptoms.
- Angioplasty
- Benign brain tumor
- Blindness
- Deafness
- End-stage liver failure
- End-stage lung failure
- Loss of speech
- Loss of limbs
- Major head trauma
- Primary pulmonary hypertension
- Third-degree burns
If the claimed amount is equal to or greater than Rs. 1,00,000, a KYC document is required.
The following are the documentation you must present to the insurer for claim settlement:
- Duly filled claim form
- Medical recovery report
- Pharmacy bills with the prescription
- Nature of operation performed
- Diagnosis and test reports
- Doctor’s reports and consultation notes
- Surgeon’s bills and receipts
- Final hospital discharge summary
- A valid photo ID proof
The policies under Max Bupa are available for 1 to 2 years. The plans need to be renewed on annual basis.
No, you can only apply for portability when you renew your license, not at any other time.
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