The Oriental Insurance Company Limited was incorporated on 12th September 1947 as a wholly-owned subsidiary of the Oriental Government Security Life Assurance Company Limited to carry out the general insurance business. From 1956 to 1973, the Oriental Insurance Company was a subsidiary company of Life Corporation of India. Later, all the shares of the company in 2003 were transferred to the Government by the Central Insurance Corporation of India. With its head office situated in New Delhi, the company has overseas operations in Dubai, Kuwait, and Nepal. The company offers various types of insurance to cater to the needs of both rural as well as urban populations of India.
Claim settlement ratio 90.18%
NCB* 5%, up to 20%* of SI
PED Waiting 48 months
Network Hospital 4300+
Paybima's Right Advisor = Expert Solutions
| Oriental Health Insurance Plan(s) | Plan Type | Entry Age |
|---|
| Underwritten Global Premium | INR 12,747.42 crores at the end of the year 20-21 |
| Number of offices | 29 regional offices 1800 + operating officers across the country |
| Number of employees | 13500+ employees |
| Solvency margin | 1.52 as of 31st March 2021 |
The company has been awarded as the “Best General Insurance- Public” in the CNBC TV18 Best Bank and Financial Institution Awards for FY11 presented by MCX.
| Features | Meaning |
| Inpatient hospitalization | If you are hospitalized for 24 hours or more, the cost of such hospitalization is covered under the policy. You would get coverage for room rent, ICU rent, doctor’s fees, nurse’s fees, etc. |
| Pre- and post-hospitalisation | You might incur medical expenses both before and after you are hospitalized. Such expenses are covered under the policy for a specific number of days |
| Ambulance cost | The expenses incurred on hiring an ambulance for hospitalization are covered up to specified limits |
| Daycare treatments | Daycare procedures are those that do not require 24-hour hospitalization. Such procedures are covered under Oriental health insurance plans up to the sum insured |
| Organ donor treatments | If you undergo any organ transplant surgery, the cost of harvesting the organ from a live donor would be covered under the health insurance plan |
| Domiciliary hospitalisation | Domiciliary hospitalization is when you are hospitalized at your own home due to the non-availability of hospital beds or if you are not in a condition to be moved to the hospital. Such hospitalization would also be covered under the policy |
| No claim bonus | No claim bonus is a reward that is offered under Oriental health insurance plans if you do not claim your policy |
| Free health check-ups | Oriental health insurance plans allow free health check-ups after specified intervals so that you can keep a regular track of your health |
Oriental Individual Mediclaim is a unique health plan designed to suit the various insurance needs of individuals. You can also include one or more family members in the policy. Some highlights of the plan are as follows:
The plan pays for ambulance charges incurred for traveling to the hospital from the place of the incident and from one hospital to another for medical treatment. Cover of Rs 2, 000 or 1% of the sum insured, whichever is higher can be availed up to a maximum of Rs 4, 000.
The plan offers a 10% discount on premiums if more than one family member is covered in the plan.
The plan provides coverage for dog bite treatment. This plan covers expenses up to Rs 5,000 for this incident.
Domiciliary hospitalization of 20% of the sum insured up to a maximum of Rs.50,000 can be availed for domiciliary hospitalization.
| Entry age | 18 years to 65 years |
| Policy term | 1 year |
| Sum insured | Rs.1 lacs to Rs. 10 lacs |
| Discounts on premium | 10% if more than one family member is covered |
| Health Check-up | Not required up to age 55 years |
| Pre-existing waiting period | 48 months |
| Features | Silver | Gold | Diamond |
| Organ Donor benefit | Covered up to 10% of the sum insured | Covered up to 10% of the sum insured | Covered up to 10% of the sum insured |
| Hospital cash allowance | Not covered | Rs 600 to rupees 1000 or 0.1% of the sum insured per day of hospitalization, whichever is higher. Maximum compensation would be for 10 days per illness. | Rs 600 to rupees 1000 or 0.1% of the sum insured per day of hospitalization, whichever is higher. Maximum compensation would be for 10 days per illness |
| Medical Second Opinion | Covered up to a maximum of Rs 5,000 | Covered up to Rs 10,000 | Covered up to Rs 15,000 |
| Attendant allowance | Not covered | Covered up to Rs 500 per day up to a maximum of compensation for 10 days per illness | Covered up to Rs 500 per day up to a maximum of compensation for 10 days per illness |
| Maternity expenses | Not covered | Not covered | Covered up to 2.5% of the sum insured |
| Restoration benefit | Available in two options: 50% and 100% of the sum insured | Available in two options: 50% and 100% of the sum insured | Not available |
| Newborn baby cover | Not covered | Not covered | Covered up to 2.5% of the sum insured |
| Compulsory Co-payment | 10% of every claim | Not applicable | Not applicable |
| Telemedicine | Covered up to Rs 2,000 per insured individual | Covered up to Rs 2,000 per insured individual | Covered up to Rs 2,000 per insured individual |
| HIV AIDS cover | Covered | Covered | Covered |
| Entry age | 8 to 70 years | 8 to 70 years | 8 to 65 years |
| Some insured | Rs 1 lacs, Rs 2 lacs, Rs 3 lacs, Rs 4 lacs and Rs 5 lacs | Rs 6 lacs, Rs 7 lacs, Rs 8 lacs, Rs 9 lacs and Rs 10 lacs | Rs 12 lacs, Rs 15 lacs, Rs 18 lacs and 20 lacs |
| Policy term | 1 year | 1 year | 1 year |
| Free existing waiting period | 48 months | 48 months | 48 months |
Locating the nearest network hospital
Oriental Insurance offers both cashless and reimbursement claims. To avail of the cashless claim facility, you will have to get admitted to one of the networked hospitals of the company. You can easily locate the nearest networked hospital through the website of the company. Then, show your health card and identity proof for admission to the hospital.
Pre-authorization claim form
To get your cashless claim approved, you need to duly fill out and submit a pre-authorization claim form to the insurance company. Submission of pre-authorization claim form is the method of initiation of the claim. You can get the form from the hospital or you can also download the form from the website of the insurance company. Fill out the form with relevant details of the claim and then submit it at least prior 3-4 days before you are hospitalized. In the case of emergencies, however, the form can be submitted within 24 hours of hospitalization.
Cashless treatments
Based on the details filled in the pre-authorization form, the insurance company would provide you with the approval to avail of cashless claims. The company will communicate this to the networked hospital which would only after approval is received to proceed with the treatments and all the bills would be directly settled by the insurer.
Reimbursement claims
If you want to get admitted to a non-networked hospital or if your approval for the cashless claim has been rejected, your claim would be then settled on a reimbursement basis. In the reimbursement facility, you will have to clear all the bills initially which would be reimbursed by the insurance company later. You would have to intimate the claim to the insurer before your planned admission and in case of emergencies; you have an option to intimate the claim after the admission but before the discharge. After discharge from the hospital, fill up the claim form and submit all the medical bills, prescriptions, original bills, and receipts to the insurance company. The company would verify your claim and reimburse you for the expenses incurred for treatment.You can also seek help from PayBima for easy claim settlements. Just dial 1800 267 67 67 or send an email to paybima.care@mahindra.com and we will help you with your claims. For a successful claim settlement, certain documents are required to be submitted along with the claim form. These include –
* The accumulated cumulative bonus or the NCB shall not exceed 20% of the Sum Insured on the Renewed Policy as specified in the policy terms.
# Ailments diagnosed within 48 months before the policy issuance date or any medical treatment received within 48 months before the issue date of the policy
