Organization : Oriental Insurance Company Ltd
Facility : Individual Mediclaim Policy
Individual Mediclaim Policy :
https://orientalinsurance.org.in/web/guest/individual-mediclaim-policy?isSelected=onlineProducts
Home Page : https://orientalinsurance.org.in/web/guest/home?isSelected=home
Individual Mediclaim Policy :
Mediclaim Insurance is a Health cover which takes care of medical expenses following Hospitalisation/Domiciliary Hospitalisation of the Insured in respect of the following situations
Related : Oriental Insurance Personal Accident Policy : www.statusin.in/20072.html
(A) In case of a sudden illness
(B) In case of an accident
(C) In case of any surgery which is required in respect of any disease which has arisen during the policy period.
** Individual Mediclaim policy will be available to any individual between the age of 18 to 65 years (Extended to 70 years) for treatment in India.
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The salient features of the policy are:
(i) The Policy term is one year and is available to any proposer between the age of 18 to 65 years for treatment taken in India. The proposer can also get his family covered (as defined under 2.1).
(ii) Maximum Entry age for any member, is 65years however, this can be extended upto 70 years. In such case, an additional premium of 10% (including on all future renewals) will be charged on applicable rates, including on Optional PA cover.
(iii) Sum Insured (SI) available from Rs.1lac to Rs.10lacs.
(iv) Pre-existing diseases covered after four consecutive renewals.
(v) Life long renewals allowed.
(vi) Family discount of 10% (including on PA cover) if more than one person is covered under the policy.
(vii) Option of voluntary co-payment of 10% and 20% with corresponding premium discount of 10% and 20% respectively on SI of Rs.2lacs and above. Voluntary co-payment does not apply on PA section.
(viii) No medical examination for persons upto the age of 55 years.
(ix) In case of fresh covers, 50% of the Pre-insurance medical check-up cost reimbursable, subject to acceptance of the Proposal.
(x) Daily Hospital Cash allowance in case of more than 2 days of continuous hospitalisation.
(xi) Hospitalisation expenses incurred for donating an organ by the donor (excluding cost of organ) to the insured person, is covered
(xii) Ambulance charges covered
(xiii) Personal Accident available on optional basis for SI from Rs.2lacs to Rs.10lacs.
(xiv) Free Look Period- A period of 15 days from the date of receipt of the policy to review the terms and conditions of the policy and return the same, if not acceptable.
(xv) Grace period of 30 days is allowed for payment of renewal premium.
(xvi) Premium adjustment at renewal, for the duration of OMP cover taken from Oriental.
(xvii) Discount of 5.5% in premium if TPA services not opted for.
Covered Risks:
This Health cover is a hospitalisation cover and reimburse the medical expenses incurred in respect of covered disease /surgery while the insured was admitted in the hospital as an in patient. The cover also extends to pre- hospitalsation and post- hospitalisation for periods of 30 days and 60 days respectively
SUM INSURED :
i. Minimum sum insured is Rs 1,00,000 and in multiples of Rs 50,000 thereafter, up to Rs 5,00,000.
Beyond the Sum Insured of Rs. 5,00,000 in multiples of Rs. 1,00,000 up to Rs 10,00,000.
The sum insured of each of the insured person in a policy may vary.
ii. Maximum entry age (65years) under the policy can be extended upto 70 years.
In all such cases, a 10% loading will be charged on the premium applicable to the age of the insured.
This 10% loading will also apply on each subsequent renewal thereof.
Illustration :
Age in completed years at the time of taking the policy for the first time on 01.04.2015 – 70 years.
SI chosen – Rs.4lacs
Premium as per the Rate chart – Rs.21663
Premium to be charged at inception – Rs. 21663+10% of 21663 = Rs.23829+S.Tax
Renewal date-01.04.2016
Age on renewal – 71 years
Premium as per rate chart for age 71 years – Rs.30011
Renewal premium to be charged – Rs.30011+10% of Rs.30011 = Rs.33012+S.Tax
iii. Maximum sum insured that can be opted by a person joining after the age of 65 years is Rs.5 lacs. Any increase in sum insured will be allowed as per ‘iv’ & ‘v’ below.
iv. Sum insured under the policy can be increased only at the time of renewal and at the discretion of the Company. The maximum increase allowed at each renewal is Rs. 2 lacs per insured person upto the age of 45years. Beyond 45 years, maximum increase allowed is Rs.1lac per insured person. For increased sum insured, pre-existing disease and waiting period clauses 4.1,4.2 and 4.3 of the policy, shall apply afresh.
v. No increase in sum insured is allowed for insured persons above 70 years of age.
Special Mention:
A one time discount of 25% on renewal premium will be allowed for persons presently insured for a Sum Insured of less than Rs.1lac under Oriental’s Mediclaim Insurance Policy (Individual). However, this discount is available only for insured persons opting a Sum Insured of Rs.1lac on renewal and no discount shall be allowed if the insured person opts for any higher Sum Insured.