Oriental Insurance Plans

Oriental Health Insurance

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Oriental Insurance offers best India health insurance to the insured with the option of availing quality treatment at more than 4300+ leading hospitals across the country. They have an incurred claims ratio of 108.00%, and also covered 303.25 lac lives during the same year 2018-19, as per the data provided by IRDAI.

Key Features of Oriental Health Insurance

  • Room Rent: Covered upto 1% of Sum Insured as a daily limit
  • Co-pay: Option of Voluntary Copay of 10% or 20% with premium reduction
  • Restoration Benefit: NIL Restoration benefit

Oriental Health Insurance Review

Oriental Health Insurance
Oriental Health Insurance sum insured
1 lac − 20 lacs options available
Incurred Claims Ratio *
108.80%
Oriental Health Insurance tenure options
1 year
Claims Settlement Ratio **
99.48%
List of network hospitals
4,300+ hospitals
Number of policies issued *
1,250,812
Maximum family floater coverage
Self, Spouse + dependent (children + parent)
Number of lives covered *
30,325,000
* As per IRDAI report for 2018-19   |   ** As per NL25 data published on the Insurance Company website

Why Should One insure themselves through Oriental Insurance Health Insurance plans?

  • Wide Range Of best India mediclaim Insurance Products from Oriental From Individual Plans to Family Floater Schemes with Sum Insured ranging from ₹1 lacs to ₹20 lacs.
  • Covers Hospitalisation Treatment including coverage for Covid 19 Expenses.
  • Tax benefit: Premium paid by any mode other than cash is eligible for tax relief as provided under Section 80-D of the Income Tax Act.
Oriental Insurance Health Insurance is today one of the leading Government Owned general insurance players in India with a lot of focus on both retail and group insurance products. Today the Oriental Insurance health insurance premium is one of the most competitive in the market across all their plans apart from being competitive in their benefit structure. They are also one of the players who have built a strong hospital network across India with a current strength of 4,300+ and growing. Most of the customer’s Oriental Insurance health insurance reviews have been positively influencing the growth of their business year on year.

Oriental Health Insurance benefits

  • Benefits
  • Claim Process
  • Exclusions

Benefits under Oriental Insurance Health Insurance plans include:

The key features under the Oriental mediclaim Insurance Plan include:
  • 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). (DO WE NEED THIS??)
  • 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.
  • Sum Insured (SI) available from Rs.1lac to Rs.10lacs
  • Pre-existing diseases covered after four consecutive renewals. Life long renewals allowed
  • Family discount of 10% (including on PA cover) if more than one person is covered under the policy.
  • 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
  • No medical examination for persons upto the age of 55 years.
  • In case of fresh covers, 50% of the Pre-insurance medical check-up cost reimbursable, subject to acceptance of the Proposal.
  • Daily Hospital Cash allowance in case of more than 2 days of continuous hospitalisation.
  • Hospitalisation expenses incurred for donating an organ by the donor (excluding cost of organ) to the insured person, is covered
  • Ambulance charges covered
  • Personal Accident available on optional basis for SI from Rs.2lacs to Rs.10lacs.
  • 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.
  • Grace period of 30 days is allowed for payment of renewal premium.
  • Premium adjustment at renewal, for the duration of OMP cover taken from Oriental.
  • Discount of 5.5% in premium if TPA services not opted for.

Oriental health insurance - Claim Process

Assistance Contact Numbers:
Call at: Toll Free 1800 118 485
Call at: 011-33208485
Cashless Claims Process (Planned Admission)
Step 1 Get admitted to any one of Oriental Insurance network hospitals, currently they have 6500+ hospitals across India…hospital list at Oriental Health Insurance
Call at : Toll Free 1800 118 485
The insured should approach the hospital 48 hours in advance and provide his / her policy details / e-cards along with govt. issued photo ID card like Driver’s License / Aadhaar to TPA / Insurance desk.
Step 2 The hospital validates the claim and sends the pre-authorization request to Oriental Insurance. Oriental Insurance shall review, confirm and approve the claim as per policy terms and conditions.
Step 3 The hospital and the insured will be intimated in case of any additional information that is required.
Step 4 Settlement of the claim shall be done by Oriental Insurance to the hospital.

Cashless Claims Process (Emergency Hospitalisation / Admission)
Step 1 Get admitted to any one of Oriental Insurance network hospitals, currently they have 6500+ hospitals across India…hospital list at Oriental Health Insurance
Call at : Toll Free 1800 118 485
In case of emergency hospitalization, contact any of our Network Hospitals within 48 hours of hospitalization along with his/her policy details/e-cards along with govt. Issued photo ID card like Driver’s License/Aadhaar.
Step 2 The hospital validates the claim and sends the pre-authorization request to Oriental Insurance. Oriental Insurance shall review, confirm and approve the claim as per policy terms and conditions.
Step 3 The hospital and the insured will be intimated in case of any additional information that is required.
Step 4 Settlement of the claim shall be done by Oriental Insurance to the hospital.

Reimbursement Claims Process
Step 1 In case of hospitalization, notify us within 48 hours of admission at our Network or non-Network Hospital.
Step 2 Pay directly at the hospital after getting admitted.
Step 3 Oriental Insurance shall review, confirm and approve the claim as per policy terms and conditions.
Step 4 Settlement of the claim shall be done by Oriental Insurance to the hospital.Settlement of claim : Upon approval of claim by us, payment of the reimbursement claim will be made to the policy holder either through EFT or through cheque/DD.

The indicative list of documents required is mentioned below:
  • Oriental Insurance Claim Form properly filled in and signed by the claimant along with Medical Certificate Form filled, signed and stamped by the treating doctor.
  • Copy of Claim intimation given to Company together with xerox of policy & premium receipt.
  • Hospital Discharge Report/Medical Treatment Report.
  • Medical recovery report.
  • Original Test Reports(X-Rays/Sonography/ECG etc.).
  • Details of medical expenses original bills/cash memos receipts alongwith prescriptions.
  • Leave certificate from employer (if required).
  • Hospital / Nursing Home Registration No. if not registered then treating doctor's certificate about no of beds, availability of qualified doctors, qualified nurses/staff round the clock and fully equiped operation theater in the hospital / Nursing home.
  • Police Panchnama / first information report about accident.
The list given is indicative in nature. Further additional documents may be called for depending on the nature of the claim.

Oriental mediclaim insurance -Exclusions Under the Policy

Some of the general exclusions under this policy where Oriental Insurance Company shall not be liable to make any payment in respect of any expense whatsoever incurred by any Insured Person are:
  • All Pre-existing Disease (whether treated / untreated, declared or not declared in the proposal form), which are excluded upto 48 months of the policy being in force. Pre-existing diseases shall be covered only after the policy has been continuously in force for 48 months.
  • Illnesses Contracted by the Insured person during the first 30 days from the inception date of fresh policy. This shall, however, not apply in case the insured person is hospitalised for injuries suffered in an accident, which occurred after inception of the policy.
  • The expenses on treatment of following ailments / diseases / surgeries, if contracted and / or manifested after inception of first policy ( subject to continuity being maintained), are not payable during the respective waiting periods – kindly refer detailed policy wordings /terms and conditions.
  • Circumcision (unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to any accident), vaccination, inoculation or change of life or cosmetic or of aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness.
  • Surgery for correction of eye sight, cost of spectacles, contact lenses, hearing aids etc.
  • Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, crowns, root canal treatment including treatment for wear and tear etc unless arising from disease or injury and which requires hospitalisation for treatment.
  • Convalescence, general debility, “run down” condition or rest cure, congenital external diseases or defects or anomalies, sterility, any fertility, sub-fertility or assisted conception procedure, venereal diseases, intentional self-injury/suicide, all psychiatric and psychosomatic disorders and diseases / accident due to and or use, misuse or abuse of drugs / alcohol or use of intoxicating substances or such abuse or addiction etc.
  • All expenses arising out of any condition directly or indirectly caused by, or associated with Human T-cell Lymphotropic Virus Type III (HTLD - III) or Lymphadenopathy Associated Virus (LAV) or the Mutants Derivative or Variations Deficiency Syndrome or any Syndrome or condition of similar kind commonly referred to as AIDS, HIV and its complications including sexually transmitted diseases.
  • Expenses incurred at Hospital or Nursing Home primarily for evaluation / diagnostic purposes which is not followed by active treatment for the ailment during the hospitalised period.
  • Any treatment arising from or traceable to pregnancy, childbirth, miscarriage, caesarean section, abortion or complications of any of these including changes in chronic condition as a result of pregnancy except in the case of abdominal operation for extra uterine pregnancy (ectopic pregnancy) which is proved by diagnostic means and certified to be life threatening by the attending Medical Practitioner, if left untreated.
  • Naturopathy treatment, unproven procedure or treatment, experimental or alternative medicine (other than Ayurveda, Unani & Homeopathy as expressed in clause 2.4 A) and related treatment including acupressure, acupuncture, magnetic and such other therapies.
  • Genetic disorders and stem cell implantation / surgery.
  • Cost of external and or durable Medical / Non medical equipment of any kind used for diagnosis and or treatment including CPAP, CAPD, Infusion pump etc., Ambulatory devices i.e. walker , Crutches, Belts ,Collars ,Caps , splints, slings, braces ,Stockings etc of any kind, Diabetic foot wear, Glucometer / Thermometer, Blood Pressure monitoring machine and similar related items and also any medical equipment which is subsequently used at home. Exhaustive list available on our website (www. orientalinsurance.org.in).
  • Treatment of obesity or condition arising therefrom (including morbid obesity) and any other weight control programme, and similar services or supplies.
  • Out patient Diagnostic, Medical or Surgical procedures or treatments, non-prescribed drugs and medical supplies, Hormone replacement therapy, Sex change or treatment which results from or is in any way related to sex change.

Oriental Insurance Health Insurance FAQ’s

Oriental Insurance has an extensive network of 4,300+ network hospitals across India. One must get admitted to a network hospital in order to avail cashless treatment for their illness. One can get the Oriental health Insurance top network hospital list which is available on the website

There is no upper limit on the number of claims during the policy period. However, the total cumulative claim amount cannot exceed the Policy Sum Insured, unless the chosen plan has a Sum Insured Refill benefit, which provides additional coverage even after filing a claim.

Till the age of 55 years, Medical checkup is not required for buying Individual Health Insurance. Above 55 years a medical checkup is required at the time of first purchase of the policy. Medical checkups are usually not needed for renewal of policies.

When you get a new Oriental Health Insurance Policy, there will be a 30 day waiting period starting from the policy start date, during which period any hospitalization charges will not be payable. However, this is not applicable to any emergency hospitalization occurring due to an accident. This 30 day waiting period is not applicable when the policy is renewed. Some specific ailments have a specific waiting period of one or two years. Some of the covers have specific waiting periods.

A pre-existing disease is any condition, ailment or injury or related condition(s), for which the insured person had signs or symptoms, and /or were diagnosed, and / or received medical advice / treatment within 36/48 months prior to 1st health insurance policy issued by Us under which the insured person was covered.

Under Individual Healthline Insurance, the age, the amount of cover (Sum Insured) and the plan of benefits that you choose are the factors that decide the premium. Usually, younger people are considered healthier and thus pay lower annual premium. Older, people pay a higher Health Insurance premium as their risk of health problems or illness is higher.

The premium paid on a health insurance policy is eligible for deduction under Section 80D of the Income Tax Act. So save with your policy now!

A deductible is a cost-sharing requirement. It states that the insurer will not be liable for a specified amount in case of indemnity policies. This is applicable for a specified number of days/hours in case of hospital cash policies which apply before any benefits are payable by the insurer. Remember that a deductible does not reduce your sum insured.

In planned hospitalization the treatment is planned well in advance. The intimation of such hospitalization and authorization from us has to be taken minimum 3 days prior to the date of hospitalization. E.g. Cataract, pace maker implantation, total knee replacement etc are examples for which the hospitalisation can be planned.The insured person should at least 3 days prior to admission to the hospital approach the network provider for hospitalization for medical treatment.

In emergency hospitalization the patient is admitted to the hospital in an emergency situation, for e.g. Severe abdominal pain, accident, heart attack etc. In such event, we should be intimated within 48 hours of admission to the hospital.

You should carry the health card provided by the company with this policy, along with a valid photo identification proof (voter id card / driving license / passport / pan card / any other identity proof as approved by the company).

It refers to payment of the Medical Expenses incurred by the insured while undergoing Specified Day Care Procedures/ Treatment (as mentioned in the Day Care Surgeries list), which require less than 24 hours Hospitalization.

Co-payment is a cost-sharing requirement under a health insurance policy, where the Policy Holder / insured will bear a specified percentage of the admissible costs

A 'Free Look Period' is a period of 15 days from the date of receipt of the policy that a policyholder, in this case you, have to review the entire health insurance plan. If you disagree with any of the terms or conditions mentioned in the policy, you have the option of returning the policy by stating the reasons for the objection. Following this, you are entitled to a refund of the premium paid, provided no claim has been made under this mediclaim insurance policy (subject only to a deduction of the expenses incurred by the company on medical examination and the stamp duty charges). Please note that this facility is not applicable on renewal and portability cases.

Sub limit defines the capping of insurance amount, for specific surgeries and medical procedures, which reduces the premium of the plan. You can also opt for an add on cover by paying extra premium to remove the sub- limits under the policy.

TPAs are licensed entities which are registered with the Insurance Regulatory and Development Authority to provide health services. The services of a TPA would usually include: For details you may kindly refer to the TPA Health Service Regulations 2016:
  • Member enrolment and issuance of health card
  • Hospitalisation Service and Pre-authorization for cashless treatment
  • Reimbursement Claim Processing
  • Call center service and SMS Services
  • Investigation Service and Fraud and Abuse Management Service
  • Customer Relation and Contact Management Service and Grievance Management Service
  • Health Check up services and Services in Wellness & Health promotion
  • management service Legal Assistance and other specified services buy the insurer
The role of TPA begins after policy issuance by insurance company.

The entire process followed in current TPA allocation exercise was duly uploaded on company’s portal and was kept in public domain for any representation, observation, grievance and objection for redressal by specially constituted Appellate Committee. You can access the notice on the noted url: url

A claim is registered, processed and finally paid within 30 days of the receipt of the last necessary document by the TPA/Insurer, as per terms and conditions of the policy. Exception is made for settlement and final payment for 45 days in case a claim warrants an investigation.

Insurance companies have tie-up arrangements with several hospitals which are called network hospitals. Under a health insurance policy, a policyholder can take treatment in any of the network hospitals without having to pay the hospital bills as the payment is made to the hospital directly by the insurance company. TPA helps in organizing cashless treatment to the member. However, expenses beyond the limits or sub-limits as per terms and conditions of the insurance policy or expenses not covered under the policy have to be paid by customer directly to the hospital. Preauthorization, however, is not available if treatment is taken in a nonnetwork hospital.

Preauthorization is facilitated by TPA at network Hospitals.
  • Patient should contact an Empanelled Hospital for treatment.
  • Hospital would then send the duly filled preauthorization request to the servicing TPA prior to planned hospitalizations.
  • For emergency cases preauthorization process can be initiated within 24 hours of hospitalization.
  • Servicing TPA would then process the pre-authorization based on policy terms and convey its decision on admissibility to the Hospital. If the cashless is extended, patient is required to pay only for the Non Payable Expenses.
  • If the Preauthorization is denied, patient pays the hospital bill, collects original receipts and other documents at the time of discharge from the Hospital and files for reimbursement claim later on and the same is scrutinized as per terms and conditions of the policy for finalization of claim.

Cashless facility can be availed at any of the network hospitals listed with the servicing TPA (List available on website) or insurance company website. The insured has a choice to go to any of the hospitals/nursing homes which are part of the Insurer/TPA network; it can also be confirmed through call center toll free numbers. It is useful and requested to confirm before seeking admission because network of hospitals is continuously updated with new additions and deletions. In the absence of network hospital of choice or due to any other reason, insured can get treated at the hospital of choice which means the entire bill is paid by the policy holder and claim for reimbursement of expenses. The claim shall then be processed as per policy terms and conditions.

You may write / email to us giving details of your grievance at csd@orientalinsurance.co.in or TPAs call centre or grievance department. We assure you that our grievance department will address the issue within 72 hours

Types of Health Insurance Policies Provided by Oriental Insurance

Key Features:
  • The benefits under this Policy are available under three plans, viz Silver, Gold & Diamond as opted by the Insured in the proposal form. The policy covers reasonable and customary charges in respect of Hospitalisation and / or Domiciliary Hospitalisation for medically necessary treatment only for illness / diseases contracted or injury sustained by the Insured Person(s) during the policy period, upto the limit of Sum Insured.
Key Features:
  • The Policy covers reasonable and customary charges in respect of Hospitalisation and / or Domiciliary Hospitalisation for medically necessary treatment only for Illnesses / diseases contracted / suffered or Injury sustained by the Insured Person(s) during the Policy Period, upto the limit of Sum Insured, as detailed in the Policy Terms and conditions.

Key Features:
  • Critical Illness Insurance Policy can help in reducing financial burden and concentrate on getting better treatment on diagnosis with Critical Illness. This is an ideal plan for individuals already having an individual or group health insurance plan provided by the individual’s employer.



Key Features:
  • The Policy covers Hospitalisation Expenses for In-Patient Care or Day Care Treatment incurred for treatment of an Illness contracted/ Injury sustained during the Policy Period.
Key Features:
  • This policy is available to any Indian citizen who is aged 60 years and above and for hospitalisation in India only.


Key Features:
  • Oriental Happy Cash-Nishchint Rahein is designed to give extra protection in case insured/ family gets hospitalized for the disease/ailment contracted and injuries sustained during the period of policy.
Key Features:
  • Maximum Entry age for any member is 65 years, without any medical examination.

Key Features:
  • Age means age of the Insured person on last birthday as on date of commencement of the Policy.

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Oriental Health Insurance useful links

How to buy online?

You can buy insurance online by using a credit/debit card, direct funds transfer using NEFT or RTGS or by using a cheque

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Network hospitals

Oriental Network hospitals list. Cashless & Hassle-free direct claim settlement with us at 4,300+ Hospitals

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Health insurance benefits

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Portability

Portability Information for Mediclaim Insurance in India.


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    InstantCover Insurance Web Aggregator Private limited
    710, 6th B Cross, 16th Main Road, Koramangala 3rd Block, Bangalore - 560 034.

  • +91-(80)-41744345
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CIN: U66000KA2018PTC117713 | IRDAI Web aggregator License Code Number: IRDAI / INT / WBA /53/ 2018, Valid till 07/08/2022
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