Objective

A basic health insurance policy that aims to cover medical expenses, incurred as an inpatient due to illness or accident. Individuals upto 45 years of age can buy this policy online through company's website.

Suited for

It is suitable for anyone looking for a basic medical cover.

What does it do?

The policy pays a benefit in case the insured person gets hospitalised. It also covers domiciliary treatment availed at home on advice of medical practitioner, organ donor's hospitalisation expenses and day care procedures which can be treated without hospitalisation. The policy will provide for a health check-up after four continuous claim-free years.

Pros

This policy can be bought online from company's website.
Premium paid towards this policy is eligible for Income Tax benefit under Section 80D.

Cons

This policy does not offer lifelong renewal.
There are sub-limits on room rent, boarding and ICU charges.

Our View

While buying a health insurance policy, it is necessary to look at exclusions and waiting periods. Certain diseases or illnesses mentioned in the policy document will be covered after stated waiting periods. Sub-limits imposed on certain expenses is another drawback. Though the policy features good coverage, you must look out for other plans which do not carry any sub-limits and offer lifelong renewal as well.

Eligibility

Entry Age (years)

Minimum

18

Maximum Policy Renewal Age (years)

80

Coverage Type

Individual

Policy Term (years)

1

Sum Insured (Rs)

Maximum

500000

Minimum

50000

Discount

5% on premium if Third Party Administrator (TPA) services are not availed

Pre Policy Medical Check Up

Not required for persons below 45 years of age

Policy Termination

Insurance company may cancel the policy by giving a 30 days notice period. Insurance company in such a case will repay the pro-rata premium to the insurer if claim has not been made. Insurer may also cancel the policy at any time.

Customer Service

Address

Oriental House,
A-25/27, Asaf Ali Road,
New Delhi - 110002

Mail to

csd@orientalinsurance.co.in

Call to

1800 11 8485 (toll free), 011-33208485(non toll free)

Scope of Cover

Cashless facility

available if treatment availed in a network hospital

Reimbursement facility

available if treatment availed in a non-network hospital

Pre and post hospitalisation

covers expenses incurred during 30 days prior to hospitalisation and 60 days after discharge from hospital

Inpatient hospitalisation

covered

Room, boarding and nursing expenses

covered upto lower of 1% of sum insured or Rs 5000 per day

I.C.U charges

covered upto lower of 2% of sum insured or Rs 10000 per day

Surgeon, anaesthetist, medical practitioner, consultants, specialist fees, blood, oxygen, chemotherapy, Radiotherapy, Artificial limbs, Cost of prosthetic devices implanted during surgical procedure like pacemaker etc., X-Ray

covered

Other benefits

Domiciliary treatment

covered

Ambulance services

reimburses upto 1% of sum insured or Rs 2000 whichever is less

organ donor's hospitalisation expenses

medical expenses for treatment of organ donor in case of major organ transplant is covered

Day care procedures

covers those treatments which do not require an overnight stay in the hospital due to technological advancement

Cost of health check-up

reimburses an amount upto maximum of 1% of average basic sum insured once after every 4 claim free years

Exclusions and Waiting Period

Pre-existing illnesses

will be covered after 4 years of continuous renewal with the company

No claim period

initial 30 days from inception of the policy

Waiting period

certain illnesses such as Hernia, Piles, Cataract, Hypertension, Diabetes etc, will be covered after a waiting period of 2 years.Joint Replacement due to degenerative condition and Age related osteoarthritis, and Osteoporosis will be covered after a period of 4 years.

General Exclusions

AIDS or related diseasesMental or related illnessesCosmetic or beauty treatment