Oriental Health Insurance

Network Hospitals:
Claim Settlement
Ratio: 93.96%
PED Coverage
Covered after 3 Year
Save Tax Under
Section 80D

About Oriental Health Insurance

Oriental Insurance Company, a prominent public sector general insurance company in India, was established in Mumbai in 1947. The company offers a diverse range of insurance solutions to cater to the insurance needs of different segments of society. These solutions encompass health insurance, motor insurance, personal accident insurance, shopkeeper insurance, aviation insurance, marine insurance, trader insurance, industry insurance, animal/bird insurance, and agriculture/poultry insurance. With its headquarters in New Delhi, Oriental Insurance Company operates through 29 regional offices and over 1,800 operating offices across the country.

Among its offerings, health insurance stands out as one of the most popular products. Oriental Health Insurance plans provide individuals and families with a crucial financial safety net during medical emergencies. These plans offer comprehensive coverage, safeguarding policyholders against various healthcare expenses resulting from illness, disease, injury, or sickness. With a highly trained and motivated workforce boasting extensive experience in the sector, Oriental Insurance Company continues to be a dynamic and leading general insurance provider in India.

Oriental Health Insurance Plans Summary

Oriental Health Insurance presents a range of health insurance plans designed to safeguard individuals against various health conditions. Below are the top 5 Oriental Health Insurance plans, along with their features, to help you make an informed decision:

  • Oriental Individual Mediclaim Policy: This policy offers coverage for individuals and their family members, including spouse, children, parents, parents-in-law, and dependent unmarried siblings. With a maximum entry age of 65 years, the policy provides sum insured options ranging from Rs. 1 lakh to Rs. 10 lakh. It covers in-patient hospitalization, domiciliary hospitalization, pre and post-hospitalization expenses, road ambulance, and daily hospital cash allowance.
  • Oriental Super Health Top-Up Policy: This policy acts as a top-up coverage when the sum insured of an existing policy is exhausted. With sum insured options ranging up to Rs. 30 lakh and deductibles from Rs. 3 lakh to Rs. 20 lakh, the policy provides additional coverage. It covers in-patient hospitalization, maternity and newborn expenses, daycare procedures, pre and post-hospitalization, AYUSH treatments, and organ donor expenses.
  • Oriental Happy Family Floater Policy: Designed for families, this floater policy covers individuals aged 91 days to 65 years. It offers three variants (Silver, Gold, Diamond) with sum insured options from Rs. 2 lakh to Rs. 20 lakh. The policy includes in-patient hospitalization, pre and post-hospitalization, daily hospital cash allowance, critical illness cover, attendant allowance, ambulance expenses, organ donor expenses, maternity, newborn expenses, and optional covers such as life hardship and survival benefit.
  • Oriental Arogya Sanjeevani Policy: This low-cost plan provides coverage for medical expenses resulting from illness, sickness, disease, or accidents. It offers coverage for individuals aged 3 months to 65 years, with sum insured options from Rs. 1 lakh to Rs. 5 lakh. The policy covers in-patient hospitalization, pre and post-hospitalization, new-age treatments, daycare procedures, road ambulance, and AYUSH treatment.
  • Oriental Health of Privileged Elders (HOPE) Policy: Specifically designed for senior citizens, this policy covers specified diseases, accidental injuries, and treatments such as knee replacement, cardiovascular diseases, chronic renal failure, cancer, stroke, and more. It covers in-patient hospitalization, ambulance expenses, domiciliary hospitalization, and other related costs.

These Oriental Health Insurance plans offer comprehensive coverage and aim to provide financial security and peace of mind in times of medical emergencies.

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Why Choose Oriental Health Insurance?

Oriental Health Insurance is committed to providing unparalleled customer satisfaction. Here are the reasons that make it a preferred choice for many:

  • Excellent Claim Settlement Ratio: With an impressive Claim Settlement Ratio of 93.96%, Oriental Health Insurance has earned its place among the top 5 insurance companies known for their efficient claim settlement processes.
  • Wide Range of Health Insurance Plans: Oriental Health Insurance offers a diverse range of plans catering to individuals, families, senior citizens, disease-specific coverage, and super top-up policies. The availability of multiple plan options, including variants, provides customers with a wide selection.
  • Products Available on Digilocker App: Oriental Health Insurance's products are conveniently accessible through the Digilocker app, a secure cloud platform provided by the Government of India for document storage, issuance, and verification.
  • Over 70 Years of Industry Experience: Established in 1947, Oriental Health Insurance has accumulated over 70 years of industry experience. This extensive experience has enabled the insurer to gain a deep understanding of the insurance sector, resulting in specialized and tailored product offerings.
  • Cashless Hospitalization at 4,300+ Network Hospitals: Oriental Health Insurance boasts an extensive network of over 4,300 hospitals where policyholders can enjoy the convenience of cashless hospitalization. This means that policyholders can receive medical treatment without having to pay out-of-pocket expenses at these network hospitals.

These factors contribute to Oriental Health Insurance's reputation as a trusted insurer, offering a wide range of plans, efficient claim settlement, digital accessibility, industry expertise, and a vast network of hospitals for cashless hospitalization.

Key Benefits of Oriental Health Insurance

Oriental Health Insurance plans provide numerous benefits to policyholders. Here is a summary of some key advantages:

  • Wide Range of Sum Insured Options: Oriental Health Insurance plans cater to diverse requirements by offering a wide range of sum insured options. Policyholders can choose coverage starting from as low as Rs. 1 lakh and going up to Rs. 30 lakh, enabling them to select a suitable coverage amount based on their needs.
  • Lifetime Renewability Benefit: Oriental Health Insurance plans come with the valuable feature of lifetime renewability. This means that policyholders can continue to avail the benefits of their Oriental Health Insurance plan throughout their lifetime, as long as they pay the renewal premium on time. This ensures uninterrupted coverage and peace of mind.
  • Portability Benefit: Oriental Health Insurance offers the convenience of portability, allowing policyholders to transfer their existing health insurance policy to an Oriental Health Insurance plan without losing any accrued benefits like No Claim Bonus or waiting period benefits. This seamless transition ensures a hassle-free renewal process.
  • Restoration of Sum Insured: Oriental Health Insurance policies include the benefit of sum insured restoration. In the event that the sum insured is exhausted due to claims made during the policy term, Oriental Health Insurance will restore the coverage amount, allowing policyholders to continue receiving financial protection for any subsequent medical expenses.

These benefits provided by Oriental Health Insurance plans demonstrate their commitment to meeting the evolving needs of policyholders. The flexibility of portability, wide range of sum insured options, lifetime renewability, and restoration of sum insured enhance the overall value and convenience of Oriental Health Insurance coverage.

Oriental Health Claim Settlement Ratio

The Claim Settlement Ratio of a health insurance company represents the percentage of claims successfully settled by the company compared to the total number of claims received during a financial year. It serves as an important indicator of an insurance company's efficiency in handling customer claims.

As a prudent health insurance buyer, it is essential to consider the Claim Settlement Ratio of an insurer before purchasing a plan. Here are the Claim Settlement Ratios for Oriental Health Insurance in the last two financial years:

Financial Year | Claim Settlement Ratio

FY 2018-2019 | 94.28%
FY 2019-2020 | 93.96%

These figures demonstrate the insurer's commitment to efficiently settling claims and providing timely support to policyholders when they need it most. Oriental Health Insurance stands out as a reliable and trustworthy option for individuals seeking comprehensive health coverage.

Dedicated Whatsapp Claim Assistance

Oriental Health Claim Process

Oriental Health Insurance ensures a smooth, efficient, and transparent claim settlement process for its policyholders. There are two types of claims that can be made under Oriental Health Insurance plans: cashless claims and reimbursement claims. The processes for both are explained below.

Cashless Claim Process

  • Get Hospitalized at a Network Hospital: Choose a network hospital and get admitted for treatment. Inform the Third-Party Administrator (TPA) of the hospital about your hospitalization. It is important to inform the insurer within 48 hours of planned or emergency hospitalization.
  • Fill the Pre-Authorization Form: Complete the pre-authorization form provided by the hospital's TPA desk. Submit the form along with other relevant documents required by the hospital.
  • Document Verification: The TPA will verify your documents and inform the insurer about the details of the claim.
  • Claim Settlement: If the claim is in accordance with the terms and conditions of your policy, the insurer will settle the claim directly with the hospital.

Reimbursement Claim Process

Get Hospitalized at a Non-Network Hospital: Choose a non-network hospital of your preference and receive the required treatment.
Settle the Bills for Treatment: Pay the bills for the treatment expenses incurred at the hospital.

Collect Relevant Documents from the Hospital: Obtain original bills, medical reports, prescriptions, and other necessary documents from the hospital.

Documents Required for Reimbursement Claim Settlement:
You need to submit the following documents for a reimbursement claim under Oriental Health Insurance:

  • Duly filled Claim Form
  • Copy of claim intimation provided to the insurer, along with a copy of the policy and premium receipt
  • Original discharge report from the hospital
  • Original test reports such as ECG, X-rays, and Sonography reports
  • Medical recovery report
  • Original bills, prescriptions, and cash memos for medical expenses incurred

Claim Settlement: The insurer will review your claim and reimburse you for the eligible medical expenses incurred during your treatment, provided the claim complies with the terms and conditions of your health insurance policy.

By following these step-by-step processes, policyholders can easily make either cashless or reimbursement claims under Oriental Health Insurance plans.

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Oriental Health Insurance

Network Hospitals:
Claim Settlement
Ratio: 93.96%
PED Coverage
Covered after 3 Year
Save Tax Under
Section 80D
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