Oriental Bank Mediclaim Policy

Oriental Bank Mediclaim Policy was introduced on 3rd October 2011. Oriental Bank of Commerce and The Oriental Insurance Company together signed an agreement to sell mediclaim policies to its customers. The policy is designed exclusively for the account holders of Oriental Bank of Commerce. The Mediclaim policy is available in all OBC branches across the nation.

Oriental Bank Mediclaim policy takes care of different medical and hospitalisation expenses of the policyholder during the policy tenure. The company reimburses the medical expenses incurred against the treatment received by the insured. The Oriental Bank Mediclaim Policy is health insurance that also comes with a family floater option.

• Cashless Treatment: Policyholders can avail cashless treatment in network hospitals. When you get hospitalised at network-listed hospitals, you get to enjoy the cashless treatment facility.

• Pre and Post Hospitalization: 30-day policy cover is available for expenses incurred before hospitalisation and 60 days policy cover is offered for medical expenses incurred post hospitalisation.

• Ambulance Charges: Reimbursement up to maximum Rs.1000 in any Policy period allowed towards ambulance expenditure.

• No Claim Bonus: The Company offers a no claim bonus in terms of increase up to any available Sum Insured is allowed.

• Medical Check- Up: No medical check-up is required. However, if the Proposal Form reveals adverse Medical History in respect of any proposed individual, the individual may be subject to pre-insurance Medical tests.

• Tax Benefits: Tax benefits are available under Section 80D of the Income Tax Act, 1961. Premiums paid up to Rs. 25,000 per year can be claimed as tax deduction for policyholders. In case of senior citizens, premiums paid up to Rs. 50,000 can be claimed as tax deduction.

• Plan Option: This plan does not have any options.

• Reimbursement: For any treatment done at home instead of hospitalisation with a valid reason, the company reimburses the expenses for 3 days subject to10% of Sum Insured, Maximum Rs. 25000/- during the Policy period.

• Pre-Existing Disease: All pre-existing diseases are covered after three years of uninterrupted premium payment towards the health insurance policy.

• Sum Insured: For Oriental Bank Mediclaim, the minimum sum insured is Rs. 1,00,000, whereas the maximum amount is Rs. 10 lakhs. This policy can be taken either for the self alone or along with the family with Sum Insured on floater basis.

• Coverage: Oriental bank Mediclaim Policy is formulated after considering the various insurance needs of individuals. The company offers comprehensive insurance coverage that meets pre and post hospitalisation needs, ambulance charges, daily cash allowance, day care expenses, and cashless treatment at network hospitals.

• Premium Charges: Oriental Bank Mediclaim premium charges are as follows-

Premium shown above is in Indian rupees. Premium is to be charged based on the age of the proposer Accountholder. Taxes as applicable shall be extra. Above Premium is irrespective of the family size of up to five members.

Day care procedures covered: 116 Day care treatments are covered under this policy, which does not require a hospital stay for 24 hours because of advancement in medical techniques. These treatments are generally referred to as day care treatments are specified procedures are covered under this policy.

Organ Donor Benefits: In the case of organ donation, the donor charges are covered under the policy.

Waiting Period:

• Initial waiting period – Any diseases contracted within the first 30 days from the policy inception, except those arising due to accidents.
• Specific waiting period – The waiting period of specific treatments as mentioned in the policy document range from 1 year to 3 years of continuous coverage.
• Pre-existing disease waiting period – A waiting period of 36 months is applied before providing coverage for the pre-existing diseases.

Oriental Bank Mediclaim Policy provides much needed financial cushion in the case of sudden or planned hospitalisation. Here are some value-added benefits of the policy:

• Avail cashless treatment at the network hospitals

• No medical check-up required.

• The claim settlement process is quick. The company offers a smooth, easy and hassle-free claim settlement process to its customers.

• The policy offers lifelong renewability. No matter how old you are, you can renew your Oriental Bank Mediclaim policy.

• The daily cash benefit is provided to meet the non-medical costs

• The policy includes maternity coverage for infant and mother

• Reimbursement of funeral expenses, if the insured dies during the policy term

• Hospital room, boarding and nursing expenses as provided by the hospital are included, but should not exceed 1% of the total sum insured per day.

• ICU expenses as provided by the hospital are included subject to not exceeding 2% of the total sum insured per day.

• Surgeon, anaesthetist, medical practitioner, consultant and specialists’ fees are included as per the sum insured.

• Expenses arising due to X-ray, anaesthesia, oxygen, blood, medicine and drugs, diagnostic material, dialysis, radiotherapy, cost of a pacemaker, chemotherapy, surgical appliances, operation theatre charges, and related expenses are included as per the limits of the sum insured.

• Ambulance service charges are included in the policy for the entire policy tenure actual or 1% of the sum insured or Rs. 1000, whichever is less.

• Hospital cash: The Company reimburses the incidental expenses during the period of hospitalisation, which is subject to a maximum of Rs. 1000 during the entire policy period.

• In the event of the death of the insured during the policy period, the company shall reimburse the funeral expense subject to a maximum of Rs. 1000.

• Domiciliary hospitalisation: Expenses arising due to oxygen, blood, medicine and drugs, diagnostic material, dialysis, radiotherapy, chemotherapy, Surgeon, Medical Practitioner, Consultants and Specialists Fees are included, subject to 10% of the sum insured and a maximum of Rs. 25,000 during the policy tenure.

(“Domiciliary hospitalisation” means medical treatment for illness or disease which in the normal course would require treatment at a hospital, but is taken care at home under specific situations)

Exclusions under Oriental Bank Mediclaim policy are,

• According to the plan, pre-existing diseases will be covered after a waiting period of 3 years of continuous renewal of the insurance policy.

• Any injuries caused by civil war, invasion, revolution, the act of foreign enemies, nuclear energy, radiation, etc. are excluded.

• Surgery for correction of eyesight, contact lenses, cost of spectacles hearing aids are excluded.

• Any type of dental treatment including corrective, cosmetic, filling of cavity, root canal, wear and tear, is excluded.

• HIV/AIDS and related diseases

• Steam bathing, massage, Shirodhara and similar treatments under Ayurveda are excluded.

• Any treatment received in convalescent hospital or home, health hydro, nature care clinic or similar establishments are excluded.

• Treatment due to pregnancy, miscarriage, caesarean, childbirth, abortion or complications of any of these is excluded.

• Damages arising out of alcohol, drug abuse and abuse of intoxicant are excluded.

• Expenses arising out of the treatment of obesity and any other weight control program or supplies are excluded.

It is important to note that the Oriental Bank Mediclaim policy is available only for the customers of Oriental Bank. Following is the list of documents required to purchase the health insurance policy.

You can renew Oriental bank Mediclaim policy in three easy steps.

Step 1: Visit the online portal of Oriental Insurance

Step 2: Enter your previous policy number, insurance code and the policy expiry date.

Step 3: You can make payment via debit card, credit card or net banking facility to complete the purchase.

It is important to note that renewal is allowed after a policy year is completed. The policyholders have 30 days grace period to opt for policy renewal.

The notice should be given to the insurance company by fax or email with the details related to policy number, ID card number, name, nature of the disease, etc. The notice should be given to the insurance company within 48 hours of the admission or before taking discharge from the hospital, unless it is mentioned in writing.

Claim Procedure to Avail Cashless Service

• Cashless services can be availed at network hospitals, and it will be through TPA provided admissions and is subject to pre-admission authorisation.

• Upon receiving the related medical information from the policyholder, the network hospital shall verify that the policyholder is eligible to claim under the Oriental bank Mediclaim Policy.

• The company will issue a pre-authorisation letter to the hospital, mentioning the sum insured as payable, and also the aliment of which the person is seeking medical attention.

• The TPA may deny pre-authorisation if the hospital or the insured is unable to provide the relevant information and medical details as suggested by the TPA.

• In such event, the insured person may obtain treatment and later on submit the claim documents to the TPA for reimbursement within seven days from the discharge from the hospital.

• In case TPA finds any information misleading, the authorisation of cashless claim may be withdrawn.

Below is the list of documents that should be submitted to the company within 7 days of the discharge from the hospital to make a claim.

• Individual Mediclaim Policy

• Oriental Happy Family Floater Mediclaim Plan

• Oriental Overseas Mediclaim Plan

• Oriental Group Mediclaim Plan

• Jan Arogya Plan

• Group Mediclaim Plans For bank account holders and employees

• The health of Privileged Elders

• Pravasi Bhartiya Bima Yojana

Conclusion

Oriental bank Mediclaim Policy provides the much-needed financial support in case of sudden or planned hospitalisation. The plan includes some key features to meet the different health insurance needs of people. Only the account holders and employees of the Oriental Bank of Commerce can take advantage of this insurance policy. It is a helpful insurance scheme for them as the coverage provided is high and at an affordable price. It is a great health insurance policy for those who want comprehensive coverage with lifetime renewability.

Review of Oriental Bank Mediclaim Policy

Oriental Bank Mediclaim Policy is available across the bank's national network. Oriental Mediclaim policy is an insurance cover which takes care of a number of medical expenses following a sudden illness, hospitalisation due to an accident, or in case the policyholder needs to undergo a surgery for any condition arising during the policy tenure. The Oriental insurance company reimburses the treatment expenses borne by the policyholder. The sum insured that a customer can opt for varies between Rs. 1 lakh and 10 lakhs.

• Policyholders are eligible to get cashless treatment at network hospitals. Moreover, the policyholders are eligible to receive tax benefits under Section 80D of the Income Tax Act, 1961.

• The unique feature of Oriental Bank Mediclaim policy is that it can be availed only by the bank customers and employees under the age of 79 years. The policyholders are not required to undergo any medical check-up or screening and can also opt for a family floater plan to extend the coverage and provide health insurance to the family members.