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Oriental Saksham Swasthya Insurance Policy

The Oriental Saksham Swasthya Insurance plan is a dedicated insurance plan that offers financial assistance against medical emergencies, including hospitalization costs, health checkups, critical illness, etc. The major highlight of the plan is that it offers coverage to people of up to 65 years of age and a sum insured of up to 5 lakhs.

With the Oriental Saksham Swasthya Insurance plan, you can get extensive coverage against the expenses incurred due to medical emergencies. It covers the costs of hospitalization, in-patient/outpatient treatment, ambulance charges, etc.

Read on to know more about the Oriental Saksham Swasthya Insurance plan in detail!

Eligibility Criteria

Here are the eligibility criteria for Oriental Saksham Swasthya Insurance plan.

ParametersDetails
Age

Age eligibility for adults: 18 years to 65 years

Age eligibility for Children: Newborn to 17 years

Sum insured available (in INR)4 lakhs and 5 lakhs
Policy Period1 Year
Coverage BasisIndividual basis only

Coverage Details

Here are the coverage details for your Saksham Swasthya Insurance plan from Oriental Insurance.

ParametersDetails
Grace PeriodA fixed period of 30 days is to be allowed as Grace.
Hospitalisation ExpensesExpenses of Hospitalization for a minimum period of 24 consecutive hours only shall be admissible.
Pre-hospitalizationFor 30 days before the date of hospitalization
Post-HospitalisationFor 60 days from the date of discharge from the hospital
Sub-limit for Room/ Medical Practitioner`s fee

Room Rent, Boarding, and Nursing Expenses are all-inclusive as provided by the Hospital/Nursing Home up to a maximum of 1% of the sum per day.

Intensive Care Unit (ICU) charges all-inclusive as provided by the Hospital / Nursing Home up to a maximum of 2% of the sum insured per day

Cataract TreatmentUp to Rs.40,000/- (including IOL), per each eye in one policy year.
Modern TreatmentCovered for listed procedures up to 50% of the sum insured available for Inpatient Hospitalisation Care
Ambulance service chargesExpenses covered up to Rs. 2000 per hospitalisation
Co-pay

20% on all claims made under the policy unless a waiver for Co-pay has opted

and premium is paid for the same

Key Features of Oriental Saksham Swasthya Insurance Plan

The following are the key features and benefits of choosing the Oriental Saksham Swasthya Insurance Plan.

Inpatient Care:

The major benefit of choosing the policy is that it will pay up to the Sum Insured as stated in the Policy Schedule for medical expenses incurred for the Insured Person’s hospitalisation during the Policy Year, up to the maximum of 1% of the Sum Insured per day for room and board, board, and nursing costs provided by the hospital or nursing home.

AYUSH Treatment:

During each Policy Year, the Company will cover medical costs for inpatient care under the Ayurvedic, Yoga and Naturopathic, Unani, Siddha, and Homoeopathic systems of medicine, up to 50% of the total insured as stated in the policy, at any AYUSH Hospital.

Pre-Hospitalization Medical Expenses:

For a defined period of 30 days before the date of the admissible hospitalisation covered by the policy during the policy period, the Company shall indemnify Pre-Hospitalization Medical Expenses incurred, connected to an admissible hospitalisation requiring inpatient treatment.

Post-Hospitalization Medical Expenses:

Following an admissible hospitalisation covered under the Policy during the policy period, the Company shall indemnify Post-Hospitalization Medical Expenses incurred, related to an admissible Hospitalisation requiring Inpatient Care, for a fixed period of 60 days from the date of discharge from the Hospital.

Ambulance Service Charges:

Up to a maximum of Rs. 2000 per hospitalisation, the Company would pay Charges for expenses spent towards ambulance charges for transportation of an insured individual.

Cataract Treatment:

The major benefit of choosing the plan is that the policyholder can get up to a maximum of Rs. 40,00,000 per eye (including IOL) during the policy year, the firm would cover medical costs incurred for treating cataracts.

Modern Treatment:

When medically necessary, the following operations will be covered (either as an inpatient or as part of daycare treatment) in a hospital up to 50% of the sum insured, as stipulated in the policy, during the policy period.

  • Uterine Artery Embolization and HIFU (High intensity-focused ultrasound)
  • Balloon Sinuplasty
  • Deep Brain stimulation
  • Oral chemotherapy
  • Immunotherapy- Monoclonal Antibody to be given as an injection.
  • Intra Vitreal injections
  • Robotic surgeries
  • Stereotactic radio Surgeries
  • Bronchial Thermoplasty
  • The vaporisation of the prostate (Green laser treatment or Holmium laser treatment)
  • IONM- (Intra Operative Neuro Monitoring)
  • Stem cell therapy

Exclusions Under the Oriental Saksham Swasthya Insurance Plan

Unless expressly stated otherwise in this policy, the company is not obligated to make any payments under the Policy in connection with or in respect of the following costs or claims until the waiting period has passed. This also applies to claims regarding any insured person who is directly or indirectly responsible for, caused by, arising from, or otherwise related to any of the following.

Pre-Existing Diseases:

  • Before the expiration of 24 months for pre-existing disability and 48 months for all pre-existing conditions other than HIV/AIDS and Disability (as mentioned in the policy) of continuous coverage following the date of inception of the first policy with the insurer, expenses related to the treatment of a Pre-Existing Disease (PED) and its direct complications shall be excluded.
  • If the amount insured is increased, the exclusion will once again apply to the new amount insured.
  • The waiting period for the same would be shortened to the extent of prior coverage if the insured person maintains continuous coverage, as defined by the portability criteria of the current IRDAI (Health Insurance) Regulations, without a pause.
  • Pre-existing conditions must be disclosed at the time of application and acknowledged by the company for any pre-existing conditions to be covered under the policy once the number of months (as specified in the policy) have passed.

First 30 Days Waiting Period:

  • Except for claims stemming from an accident, which are covered, medical expenses connected to treating any sickness within 30 days of the first policy’s commencement date are excluded.
  • If the insured person has continuous coverage for more than a year, this exclusion will not be applicable.
  • If a larger sum insured is subsequently granted, the herein-referenced waiting period is rendered relevant to the enlarged sum insured.

Specified Disease/Procedure Waiting Period:

  • Until the end of a certain waiting time of continuous coverage from the date of the start of the first policy with the company, costs associated with the treatment of the mentioned conditions; surgeries/treatments shall be excluded. Claims resulting from accidents are not subject to this restriction.
  • If the amount insured is increased, the exclusion will once again apply to the new amount insured.
  • The longer of the two waiting periods will be used if any of the mentioned diseases or procedures fall under the pre-Existing disease waiting period.
  • Even if negotiated after the policy’s effective date or proclaimed and accepted without an explicit exclusion, the waiting time for the conditions listed shall apply.
  • The waiting period for the same would be shortened to the extent of prior coverage if the insured person maintains continuous coverage without a gap as specified by the applicable portability rules set forth by IRDAI.

How To Get Oriental Saksham Swasthya Insurance Plan?

Although purchasing the Oriental Saksham Swasthya Insurance Policy can provide individuals between the ages of 18 and 65 with a variety of health advantages, sadly, it is not accessible through the Oriental Insurance official website. There is no need to worry, though. Probus Insurance is still where you may make your purchase.

Probus Insurance Broker Private Limited, a specialised insurance broker, operates all over India and offers a variety of insurance plans (including life and non-life) to meet the rising demands of the populace.

Let’s discuss the steps to buy Oriental Saksham Swasthya Insurance Policy.

  • The “Product” section can be found at the top of the main page. The phrase “Health Insurance” will appear when you hover over it. Just click it.
  • The next step is to choose your gender and input your “pin code” in the section on the right-hand side of the page. Select “Continue” from the menu.
  • Choose the individual you wish to insure next. You must then choose your “deductible amount” and enter your age before continuing. (Select whether you have experienced ailments by selecting yes or no). Click “Get Plan” after that.
  • You will see a list of plans and the required premium amount as soon as you click on it. Find your “Oriental Saksham Swasthya Insurance Policy” after that, and buy it by paying the premium.

Do you still have issues purchasing the insurance? Not to worry if so! Simply contact a customer service representative to obtain the Oriental Saksham Swasthya Insurance Policy at Probus Insurance right away. The contact information is provided below.

ParametersDetails
Call+91 7304332968
WhatsAppSay “Hi” to 7304332968
Mailcare@probusinsurance.com

How to File a Claim for the Oriental Saksham Swasthya Insurance Plan?

Cashless Claim Process:

The following is the step-by-step process for submitting a cashless claim under the Oriental Saksham Swasthya Insurance policy:

  • Obtain admission to a hospital affiliated with your insurance provider, then get in touch with the facility’s insurance support desk.
  • Present your insurance company’s, i.e. Oriental Insurance health card as proof of identity.
  • You will receive a pre-authorization document from the hospital and have your identity confirmed by the facility.
  • Complete and turn in the pre-authorization paperwork at the insurance desk.
  • Your Oriental Insurance company will get the pre-authorization document from the network hospital.
  • According to the terms and circumstances of your health insurance policy, the insurance company will examine your pre-authorization request along with the submitted papers and approve your cashless claim. A field doctor may also be appointed by some insurers to facilitate the cashless claim authorization procedure.
  • Pay for any medical costs that are not covered by your health insurance at the time of discharge.
  • By the terms and conditions of your policy, your insurance provider will pay the claim amount immediately to the hospital.

Reimbursement Claim Settlement Process:

Follow the steps given below to raise a reimbursement claim under a health insurance policy:

  • Inform your Oriental Insurance company about your hospitalization at the earliest
  • Obtain treatment at the hospital
  • During discharge, pay the entire hospital bills and collect all the documents
  • Submit all the required documents to your Oriental Insurance company.
  • The Oriental Insurance company will review all the submitted documents and process the claim according to the terms and conditions of your health policy.
  • Once your claim has been approved, the claim amount will be paid to you.

Documents Required to File Claim:

The following documents should be submitted to file an Oriental Saksham Swasthya Insurance claim:

  • Health Card (Health Insurance ID Card)
  • All the consultation papers provided by the doctor
  • Completely filled-in claim form
  • All the investigation and diagnosis reports, such as CT scans, X-rays, blood reports, etc.
  • Hospital bills with payment receipts
  • Medico-Legal Certificate (MLC) or/and FIR (in case of accidents)
  • Invoices of the pharmacy with respective prescriptions and payment receipts
  • Discharge summary
  • Any other relevant documents requested by the insurer.

Frequently Asked Questions

Yes, you can claim your health insurance under the OPD and domiciliary hospitalization coverage without being admitted to the hospital.

You have an unlimited number of claims under your health insurance coverage until the policy year’s total insured is reached.

Yes. Every year, you can submit a claim for your health insurance. It will, however, have a detrimental effect on your overall bonus.

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