A protection plan by oriental health insurance intended to provide complete coverage a group of family member or corporate employees. The key benefits are Cost incurred towards Room charges, Boarding and Nursing Expenses to the quantum of 1 % of the Sum Insured or Rs. 5000 /- per day whichever is less. Intensive care unit expenses up to 2 % of the sum insured Rs. 10,000 /- per day whichever is less. Any other expenses related to Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees. Cost incurred towards the purchase of Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during Surgical procedure like pacemaker, Relevant Laboratory / Diagnostic test, X-Ray etc. 1% of the sum insured or Rs 2000/- whichever is less towards Ambulance services. Expense incurred for the hospitalisation of the donor as per the limit of Sum Insured of the Insured Person. Expenses towards any day care treatment availed wherein the patient hadnt be admitted for a period of more than 24 hours in the hospital. For any treatment done as home instead of Hospitalisation with apt reasons, the expenses shall be reimbursed for 3 days subject to maximum limit of 20% of basic sum insured. Optional cover of maternity and new born child can be obtained on payment of 10% of the total basic premium for all the insured persons under the policy. Exclusions Any pre existing disease till 4 years post commencement of the policy shall not be covered under the plan. Any expense towards newly incepted disease within 30 days waiting period post commencement of plan. Claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports/activities. Medical expenses incurred in the treatment of obesity, hormone replacement therapy, sex change , Genetic disorders, stem cell implantation and surgery. Any expense towards the personal comfort and convenience item services shall be refereed as non medical expense and hence not covered under the plan. Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies. Any expenses towards the injury caused in events of nuclear accident, war or any other event as a consequence to War, Invasion, Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc unless arising from disease or injury and which requires hospitalisation for treatment. Treatment for Cataracts, Benign prostatic hypertrophy, Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma, Bronchitis, Ailments for all Psychiatric or Psychosomatic disorders are excluded under this plan Ailments which are generally covered in outpatient department are not covered under this policy, even though covered as day care surgery or as in patient admitted in hospital for more than 24 hours. Oriental Jan Arogya Plan A bespoke protection plan for the lower and middle income families in india which is not only available at a affordable premium but also cast the importance of medical cover for each and every one in the society. The salient features of this plan are The policy covers reimbursement of Hospitalisation / Domiciliary Hospitalisation expenses for illness / diseases or injury sustained. Affordable premium Valid on yearly basis and can be renewed periodically. Free look period for 15 days allowed to review the terms and conditions of the policy and return the same, if not acceptable. Scope of benefit under the plan The cost as mentioned below shall be considered for the reimbursement of the claim under this plan Room, Boarding Expenses as provided by the hospital/nursing home Nursing Expenses. Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees. Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs & Cost of Organs and similar expenses Medical Expenses incurred in the period up to 30 days prior to the date of admission shall be considered under the purview of this plan . Expenses incurred up to 60 days post the date of discharge from hospital , shall also be considered under the scope of benefit under this plan . The maximum Liability for all consolidated claims could be of Rs. 5,000/- per person. Exclusions from the plan Any pre existing disease till 4 years post commencement of the policy shall not be covered under the plan. Any expense towards newly incepted disease within 30 days waiting period post commencement of plan. Claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports/activities. Medical expenses incurred in the treatment of obesity, hormone replacement therapy, sex change , Genetic disorders, stem cell implantation and surgery. Any expense towards the personal comfort and convenience item services shall be refereed as non medical expense and hence not covered under the plan. Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies. Any expenses towards the injury caused in events of nuclear accident, war or any other event as a consequence to War, Invasion, Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc unless arising from disease or injury and which requires hospitalisation for treatment. Treatment for Cataracts, Benign prostatic hypertrophy, Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma, Bronchitis, Ailments for all Psychiatric or Psychosomatic disorders are excluded under this plans Ailments which are generally covered in outpatient department are not covered under this policy, even though covered as day care surgery or as in patient admitted in hospital for more than 24 hours. Oriental Group Mediclaim Plans Oriental Insurance offers its Group Mediclaim Plans in partnership with two of the most reputed government banks offering financial needs to a large section of society. Oriental Bank Mediclaim Plan – An exclusive group protection plan to the account holders of Oriental Bank of commerce account holders. PNB Oriental Royal Mediclaim Plan – This Mediclaim Policy will be available to any Account Holders / Employees of PUNJAB NATIONAL BANK – (PNB) Thana Janta Sahakari Bank Mediplus Plan – This Mediclaim Policy will be available to any Account Holders / Employees of Thana Janta Sahakari Bank – a cooperative society bank registered under the cooperative act of Maharashtra. Salient Features of the plans are This Oriental health insurance plan is available for any account holders or Employees of the bank for whom the policy has been assigned as Available as Individual cover or family cover . Family shall include account holder /employee along with his/her spouse and two children aged between 3 months and 79 years. Scope of Benefits 1% of sum insured of Rs. 5000/- per day whichever is less as Room, Boarding and Nursing Expenses. I.C. Unit expenses @ 2% of the Sum Insured or Rs. 10,000 /- per day whichever is less. Charges for Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists. Expenses incurred towards the purchase of Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during surgical procedure like pacemaker, Relevant Laboratory / Diagnostic test, X-Ray etc Expense for emergency Ambulance services @ 1% of the sum insured or Rs 1000/- whichever is less Cash allowance of maximum Rs. 1000/- during the entire policy period towards incidental expenses during the period of hospitalisation of the Proposer Funeral Expenses @ Rs.1,000 during the policy period in the event of death of the Policyholder . Domiciliary Hospitalisation expenses @ 10% of Sum Insured, Maximum Rs.25000/- during oriental health insurance policy period towards Surgeon, Medical Practitioner, Consultants, Specialists Fees, Blood, Oxygen, Surgical Appliances, Medicines & Drugs, Diagnostic Material and Dialysis, Chemotherapy, Nursing expenses. Exclusions in all the Oriental Health Insurance plans Any pre existing disease till 3 years post commencement of the policy shall not be covered under any of the plans. However many a disease and ailments are excluded on different periodicity and the comprehensive list if available with policy handbook and website. Claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports/activities shall not be considered for claims in any of the above plans. Medical expenses incurred in the treatment of obesity, hormone replacement therapy, sex change , Genetic disorders, stem cell implantation and surgery are excluded in the plans benefits. Any expense towards the personal comfort and convenience item services shall be refereed as non medical expense and hence not covered under the plans. None of the above oriental health insurance plans cover expenses on naturopathy, experimental or alternative medicine, acupressure, and acupuncture, magnetic and similar therapies. Any expenses towards the injury caused in events of nuclear accident, war or any other event as a consequence to War, Invasion, Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc unless arising from disease or injury and which requires hospitalisation for treatment under the above mentioned group plans . Treatment for Cataracts, Benign prostatic hypertrophy, Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma, Bronchitis, Ailments for all Psychiatric or Psychosomatic disorders are excluded under the plans Health of Privileged Elders (HOPE) Plan by Oriental Health Insurance A specialized protection plan for the privileged elder to cover particularly old age disease. Salient features of this plan are Exclusively designed for Citizens aged 60 years and above for hospitalisation in India only. Policy is available for Sum of1 lac, 2 lac, 3 lac, 4 lac and 5 lacs. This Oriental Health Insurance plan covers specified diseases only. Compulsory co-payment of 20% on admissible claim amount. Discount in premium for opting Voluntary Co-payment. No claim discount in premium. Loading for new entrants. Benefit of continuity extended if already insured with any Mediclaim policy of the Company. TPA service available. Cashless Service through TPA only and limited to Rs. 1 lakh. Scope of Cover Oriental Insurance Cover is provided as per the nature of ailment and disease. The disease which are covered under this Oriental health Insurance Plan are Apart from the above mentioned nature of expenses, other treatments are also included in the scope of benefits, however up t o the limit of the sum insured. 1% of sum insured of Rs. 5000/- per day whichever is less as Room, Boarding and Nursing Expenses. I.C. Unit expenses @ 2% of the Sum Insured per day. Charges for Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists. Expenses incurred towards the purchase of Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during surgical procedure like pacemaker, Relevant Laboratory / Diagnostic test, X-Ray etc Rs 1000/- as expense for emergency Ambulance services Exclusions under Oriental Health of Privileged Elder Plan(HOPE) Any pre existing disease till 2 years post commencement of the policy shall not be covered under the plan. Under this Oriental Health Insurance Plan, expenses on treatment of following ailments / diseases / surgeries for first two policy years are not payable. Non infective Arthritis. Cataract. Surgery of benign prostatic hypertrophy. Surgery of gallbladder and bile duct excluding malignancy. Surgery of genito urinary system excluding malignancy. Gout and Rheumatism. Calculus diseases. Joint Replacement due to Degenerative condition. Age related osteoarthritis and Osteoporosis. Circumcision (unless necessary for treatment of a disease included 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, hair transplant, plastic surgery other than as may be necessitated due to an accident or as a part of any illness / disease. Claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports/activities. Medical expenses incurred in the treatment of obesity, hormone replacement therapy, sex change , Genetic disorders, stem cell implantation and surgery. Any expense towards the personal comfort and convenience item services shall be refereed as non medical expense and hence not covered under the plan. Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies. Any expenses towards the injury caused in events of nuclear accident, war or any other event as a consequence to War, Invasion, Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc unless arising from disease or injury and which requires hospitalisation for treatment. Treatment for Cataracts, Benign prostatic hypertrophy, Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma, Bronchitis, Ailments for all Psychiatric or Psychosomatic disorders are excluded under this plan Oriental Pravasi Bharatiya Bima Yojana(PBBY) This plan is based on the directives issued by Ministry of External Affairs, Government of India wherein all the Indian emigrants going abroad for employment purposes with ECR (Emigration Check Required)endorsementon their passport have to compulsorily enroll for this insurance plan . It offers special fortification to such Nonresident Indian who are residing abroad for employment purpose. Being away from home country and working in different geographic conditions, make them prone to various kinds of risks and health hazard. The key features of Oriental Pravasi Bharti Bima Yojana Plan are Capital Sum ofRs. 10.00 lacs in the episode of accidental death or permanent disablement or loss of employment abroad due to injury or temporary or permanent disablement. Add on benefit of medical family floater plan of Rs. 50,000/- for the family of the policyholderresiding in India consisting of spouse and two dependent children up to 21 years of age. One way Economy Class airfare for sudden job loss where the policyholderfalls sick or is declared medically unfit to commence or continue or resume working and the service contract is terminated by the foreign employer within the fist twelve months of taking the insurance cover. In case of death , besides the cost of transporting the dead body , the cost incurred in economy class return air fare for the attendant will be reimbursed. Reimbursement of repatriation or other transport expenses if he /she is not received by the employer or if there is any substantive change in the job /Employment Contract /agreement, to the disadvantage of the policyholder, or if the employment is prematurely terminated within the period of employment from such arrival, for no fault of thepolicyholder. Rs 30, 000 / – as legal expenses reimbursement which the policyholderhas incurred towards filing any legal suit in the country of employment provided the necessity of filing such case is certified by the appropriate ministry of that country against the foreign employer. Under this oriental health insurance plan, medical cover for amount up to Rs. 75,000/- as hospitalisation cover in case the insured while his stay in foreign country during the term, of employment has contract any disease or suffer from any illness or sustain any bodily injury through accident. Maternity benefit expenses to the policyholderWomen Emigrant for an amount up to a maximum limit of Rs. 25,000/ – . Exclusions underOriental Pravasi Bharti Bima Yojana Any pre existing disease till 2 years post commencement of the policy shall not be covered under the plan. Circumcision (unless necessary for treatment of a disease included 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, hair transplant, plastic surgery other than as may be necessitated due to an accident or as a part of any illness / disease. Oriental Health Insurance claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports/activities. Medical expenses incurred in the treatment of obesity, hormone replacement therapy, sex change , Genetic disorders, stem cell implantation and surgery. Any expense towards the personal comfort and convenience item services shall be refereed as non medical expense and hence not covered under the plan. Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies. Any expenses towards the injury caused in events of nuclear accident, war or any other event as a consequence to War, Invasion, Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc unless arising from disease or injury and which requires hospitalisation for treatment. Treatment for Cataracts, Benign prostatic hypertrophy, Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma, Bronchitis, Ailments for all Psychiatric or Psychosomatic disorders are excluded under this plan How to Register a Claim with Oriental Health Insurance? In case you wish to avail cashless treatment, here is the process you need to follow. Procedure to File a Planned or Emergency Hospitalization Cashless Claim In case, a cashless treatment is availed, the claim form must be authorized by the network hospital. The insurance provider will assess the medical information and analyze if the claim is eligible or not. The insurance company will take a look at the medical information and determine whether that particular individual is eligible for the claim. If the insurance company is satisfied by the information, the insured person can avail cashless treatment and the insurance company will settle the medical expenses directly with the hospital. Procedure to File an Emergency Hospitalization Reimbursement Claim If there is an emergency hospitalization, the insurance provider or the Third-Party Administrator must be intimated within 24 hours of admission. The insured person must fill out a claim form, attach original medical documents, and submit them to the insurance provider within 15 days of discharge. According to the terms and conditions of the plan, the insurance provider will approve or disapprove the reimbursement claim. The Documents Required to File a Claim The insured person must submit specific documents for initiating the claim process. Here is the list of the required documents. A duly filled claim form along with a photocopy of policy and premium receipt Hospital discharge report Employer’s leave certificate Medical treatment report Original test reports such as Sonography, X-Rays, EGG etc. Medical recovery report Medical expenses information like cash memos, prescriptions, original bills etc. Registration number of the hospital/ nursing home. If hospital or nursing home isn’t registered, a certificate issued by the doctor-in-charge will have to be provided. This certificate should contain information regarding the number of beds, availability of qualified staff around the clock, the number of doctors and nurses, and the number of fully equipped operation theatres In case of an accident, First Information Report containing the accident’s details
