Oriental Group Health Insurance

Oriental Insurance Company Limited was incorporated on 12th September 1947 in Mumbai. All the shares of Oriental Group Health Insurance Company were transferred to the Central Government in 2003 by the General Insurance Corporation of India.

The company consists of highly trained and motivated employees covering various disciplines with wide expertise. Oriental specializes in customizing covers for large projects. For example power plants, steel, chemical, and petrochemical plants. Oriental Health Insurance Company also has a technically qualified and competent team of professionals who provide superior customer service to create a seamless experience for its customers.

Oriental Mediclaim Insurance Policy (Group): Key Highlights

Policy TypeGroup
Tenure1 year
Maternity CoverOptional
Pre-existing Illness CoverAfter 48 months
ICU expenseUp to 2%

Features of the Oriental Mediclaim Group Insurance Policy

Some salient features of this policy are cited below:

  • This plan is available for a group of 50 or more families or people.

  • It also offers maternity benefits as an optional cover.

  • Dialysis, radiotherapy, chemotherapy, expenditures of the implantation of the prosthetic devices, etc. are covered.

  • Surgical processes that include a diagnostic test, pacemaker, X-ray, relevant laboratory, etc. are covered.

Oriental group health insurance benefits

Benefit of Portability

Oriental Health Insurance policy offers the benefit of portability, which indicates that if you are dissatisfied with your existing health insurance provider, you can always switch to oriental health insurance without losing any benefits or perks. These benefits and perks might have waiting for period benefits, no claim bonus, etc.

Wide Range of Options for Sum Insured

Catering to the diverse requirements of different sections of the country, Oriental Health Insurance plans offer a wide range of sum-assured options. Plans begin from Rs 1 lac to Rs 30 Lacs.

Benefits of Lifetime Renewability

As far as your premium payments are on time, Oriental group health insurance offers a lifetime renewability benefit. By availing Oriental Health Insurance Plan you can enjoy lifetime benefits and benefits.

Restoration of Sum Insured

If your sum assured is reduced due to claims made during the policy term, it is reinstated.

Coverage offered

  • Hospitalization Charges – If you purchase an Oriental Group Mediclaim Insurance policy, you will be reimbursed for the expenditures incurred in the hospitals.

  • Pre-Hospitalization Expenditures Cover – You can claim pre-hospitalization expenditures for 30 days prior to hospitalization.

  • Post-Hospitalization Expenditures Cover – The insured is also able to get reimbursement for post-hospitalization expenditures for 60 days.

  • ICU Charges – These charges are taken care of Rs 10,000 per day or a maximum of 2% of the Sum Insured, whichever is lower.

  • Surgeon or Specialist Fees – You can also claim the amount paid for surgeon or specialist fees under Oriental Health Insurance.

  • Maternity Cover – This is an optional cover under which maternity expenditures are covered up to 10% of the total premium paid.

Why Oriental group health insurance is good as your insurance partner?

Here’s why you should go for the Oriental Group Health Insurance Scheme.

Best Claim Settlement Ratio

Oriental Group Health Insurance has a very satisfactory claim-settlement ratio (CSR) record. Currently at 93.96%, Oriental ensures you have the best insurance experience!

Over 4,300 Hospitals

With a presence in around 4300 cashless network hospitals, Oriental Health Insurance has a vast healthcare network.

70+ years of Industry Experience

Oriental Health Insurance has over 70 years of industry experience. It makes the company not only reliable but also more knowledgeable. More experience creates more confidence.

Products Available in Digilocker App

All products of Oriental Health Insurance can be found in the DigiLocker App which is owned by the Government of India. It not only makes the products easily accessible but also makes them reliable and secure.

Oriental Group Health Insurance Claim Settlement Ratio

Health insurance claim settlement ratio (CSR) is the ratio between the number of claims made or requested by a health insurance company in a financial year and the number of claims settled.

Therefore, the CSR ratio can be computed as

Claim settlement ratio (CSR) = Number of claims settled/Number of claims made/filed*100

Financial YearClaim settlement ratio

Network hospitals of Oriental group health insurance

Health insurance companies have a list of cashless hospitals or network hospitals through which an individual can claim cashless treatment. Oriental Group Health Insurance has around 4,300+ network hospitals spread across India. This ensures that you can get high-quality treatment near your location without having to travel long miles for a cashless claim.

Inclusions of the Oriental Mediclaim Group Insurance Policy

Under this policy, the following expenditures are covered:

  • Room charges, including the boarding expenditures and nursing.

  • Costs incurred in the ICU.

  • Cost of services like oxygen, surgical charges, blood, anesthesia, operation theater charges, drugs, and medicines.

  • Expenditures incurred for the hospitalization of the donor.

  • Expenditures incurred for the daycare treatment.

  • Domiciliary treatment expenditures.

  • Optional cover for maternity and cover for newborn babies.

Exclusions of the Oriental Mediclaim Group Health Insurance

The plan does not offer coverage for the following:

  • Any pre-existing diseases will not be covered for 4 years from the policy inception.

  • Expenses incurred for any new disease within 30 days of commencement of the scheme.

  • Any accidental injury caused by participating in any dangerous sports activities is not covered.

  • Medical expenditures incurred for the treatment of obesity are excluded.

To get a complete list of exclusions, please refer to the policy document.

Eligibility Criteria

To purchase this policy, the following eligibility conditions can be followed:

Minimum Entry Age3 months
Maximum Entry AgeNo Limit
Number of people covered50 individuals or 50 families
Residential StatusIndian Citizens and Residents

Cancellation Terms of the Policy

The insured can cancel the policy within the free look period and the entire premium amount will be refunded.

If the policy is canceled within 1 month, 1/4th of the yearly premium will be charged, if canceled within 3 months, 1/2 of the yearly premium will be charged and 3/4th of the yearly premium will be charged if the policy is canceled within 6 months and the entire annual premium will be charged if the policy is canceled after 6 months.

Claim Oriental Group Health Insurance

1. Oriental group health insurance cashless claim

With Oriental Group Health Insurance you can claim cashless using the following steps:

1. Find the nearest network hospital

Cashless claim facilities are available only in network hospitals. Hence, go to the closest network hospital for treatment.

2. Identity confirmation

The next step is to verify your identity using the health insurance ID card or policy number, a valid photo ID like a driving license, Aadhar card, voter ID, etc, and the company ID at the hospital.

3. Fill out and submit the pre-authorization form

Once the above evidence is verified, the next step is to submit the pre-authorization form to Oriental health insurance. For urgent hospitalization, the form is submitted within 2 days of hospitalization. For planned hospitalization, it is submitted 3 days before the hospitalization.

4. Request reviewing

After submitting the form, Oriental Health Insurance will review the cashless claim request and the network hospital will be notified of the claim decision. You will be informed by email or message.

5. Settlement of the claim

Once all this is done and the insurer accepts your claim request. Claims are settled straight with network hospitals as per the terms and conditions of your policy.

2. Oriental Group Health Insurance Reimbursement Claim

If you are hospitalized in a non-network hospital, a reimbursement claim from Oriental Group Health Insurance can be handled through the following steps.

1. Intimate your insurance company

The first step is to notify your insurer about the hospitalization. In case of emergency hospitalization, inform the insurer within 2 days of hospitalization. Whereas, in case of planned hospitalization, notify at least 3 days prior to hospitalization.

2. Settle all the bills at the hospital

After you get treated at a non-network hospital, pay all the bills with your own money at the hospital.

3. Collect all the relevant documents

After you have settled all the bills, ensure you have all the original copies of all the required documents to file for the reimbursement claim.

4. Submitting the documents

After gathering all the relevant documents, submit them to the closest Oriental health insurance branch within 15 days of discharge.

5. Processing of the claim

Once the documents are submitted, the insurer will check your documents and reject or approve the reimbursement claim request. This will be done in accordance with the terms and conditions of your policy. After approval, the claim will be settled in your bank account. You will be informed about claim approval/rejection via SMS or your registered email.

Oriental Group Health Insurance Premium

The Oriental group health insurance premium is directly proportionate to the risks involved. You must use the Oriental group health insurance premium calculator to calculate the cost of your policy. There are also specific factors that affect the premium for your group health insurance policy which are as follows:

Average age

The premium is calculated based on the average age of the insured. The lower the age, the lower the premium. This is because the younger generation has fewer health risks.

Type of plan opted

Different types of group health insurance policies are selected including Employee only (E), Employee+Spouse+Children (ESC), and Employee+Spouse+Children+Parents (ESCP) schemes. The number of individuals covered under the ESCP scheme is more than those covered under the E scheme. Hence, when the scope of coverage is more the premium will be higher.

Nature of the Job

The nature of the job a person does is also a factor in determining the annual premium. Jobs involving more risk will have higher premiums than jobs with less risk. For instance, employees working in factories will have higher group health insurance premiums than employees working in the IT industry.

Sum Insured

Sum Assured is the maximum amount that the insurance company will pay you in case of any hospitalization in a specific year. If the hospital charges exceed the sum assured, it will be paid by the policyholder himself. So the higher the sum assured, the higher the premium paid for the group health insurance policy.

Add-ons Opted

The add-ons opted for say, dental insurance riders, or maternity insurance riders along with the current group health insurance plan will raise your group health insurance premium. The premium raises depending on the type of add-on selected.

Claims History

In case of renewal of a group health insurance policy, the claim history is considered to calculate the premium for that particular financial year. If the number of claims raised in the previous financial year is high, the premium towards the policy will increase during policy renewal.

For example, a company named XYZ wants to renew its Oriental Group health insurance policy for the year 2022. The premium paid by the company for the year 2021 was ₹35,000. If the number of claims raised during the year 2021 is more than in the year 2020, the premium for the year 2022 will be more than ₹35,000.

FAQs-About Oriental Group Health Insurance

1. Does Oriental Insurance cover Hospital expenditures related to Ayurvedic treatment?

Ans: Hospital expenditures related to ayurvedic treatment are acceptable only in the case of inpatient hospitalization. The treatments include naturopathy, Unani, homeopathy, etc.

2. Are maternity benefits covered under Oriental Insurance?

Ans: You can choose maternity benefits as an additional cover in your Oriental group health insurance plan.

3. How to cancel an Oriental Insurance Policy?

Ans: You can cancel your Oriental Insurance policy by contacting the toll-free number – 1800118485 or 011-33208485.

4. What is the perfect age to obtain an Oriental Mediclaim Insurance policy?

Ans: You need to get health insurance at the earliest to avoid any kind of medical emergency. These medical emergencies can occur anytime and anywhere. Health insurance takes care of the heavy expenditures incurred in case of serious illnesses or accidents.

5. How to decide on insurance coverage?

Ans: The amount of insurance coverage depends on many factors like age, lifestyle, city of residence, and yearly income.

6. How much maternity cover does the Oriental Mediclaim Insurance policy provide?

Ans: The Oriental Mediclaim Insurance policy offers 2.5% of the sum insured as maternity coverage.

7. What does family package cover mean?

Ans: This cover refers to a family floater scheme that covers the insurance requirements of the whole family. This includes self, children, spouse, parents, and in-laws.

8. Does Oriental Insurance Company offer cashless benefits?

Ans: Yes, you get a cashless facility from Oriental Insurance Company Limited. There is a list of network hospitals under the insurance company, and if you get treatment in any of them, you can get the cashless benefit.