Oriental Group Mediclaim Plan
A protection plan by oriental health insurance intended to provide complete coverage a group of family member or corporate employees.
The key benefits are
- Cost incurred towards Room charges, Boarding and Nursing Expenses to the quantum of 1 % of the Sum Insured or Rs. 5000 /- per day whichever is less.
- Intensive care unit expenses up to 2 % of the sum insured Rs. 10,000 /- per day whichever is less.
- Any other expenses related to Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees.
- Cost incurred towards the purchase of Anesthesia, 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.
- 1% of the sum insured or Rs 2000/- whichever is less towards Ambulance services.
- Expense incurred for the hospitalisation of the donor as per the limit of Sum Insured of the Insured Person.
- Expenses towards any day care treatment availed wherein the patient hadn’t be admitted for a period of more than 24 hours in the hospital.
- For any treatment done as home instead of Hospitalisation with apt reasons, the expenses shall be reimbursed for 3 days subject to maximum limit of 20% of basic sum insured.
- Optional cover of maternity and new born child can be obtained on payment of 10% of the total basic premium for all the insured persons under the policy.
Exclusions
- Any pre existing disease till 4 years post commencement of the policy shall not be covered under the plan.
- Any expense towards newly incepted disease within 30 days waiting period post commencement of plan.
- 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
- Ailments which are generally covered in outpatient department are not covered under this policy, even though covered as day care surgery or as in patient admitted in hospital for more than 24 hours.
