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 of 1 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
| Sl no. | Name of Disease | Max Limit |
| 1 | Accidental Injury | 100% of Sum Insured |
| 2 | Knee Replacement | 70% of Sum Insured |
| 3 | Cardio Vascular Diseases | 50% of Sum Insured |
| 4 | Chronic Renal Failure | 50% of Sum Insured |
| 5 | Cancer 50% of Sum Insured | 50% of Sum Insured |
| 6 | Hepato-BilliaryDisorders | 50% of Sum Insured |
| 7 | Chronic Obstructive Lung Diseases | 20% of Sum Insured |
| 8 | Stroke | 20% of Sum Insured |
| 9 | Benign Prostrate | 15% of Sum Insured |
| 10 | Orthopaedic Diseases | 15% of Sum Insured |
| 11 | Ophthalmic Diseases | 10% of Sum Insured |
- 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
