Individual Mediclaim Policy

Brief Description:Mediclaim Insurance is a cover for reimbursement of medical expenses following Hospitalization/Domiciliary Hospitalization of the Insured in respect of the following situations: (A) In case of a sudden illness (B) In case of an accident (C) In case of any surgery which is required in respect of any disease which has arisen during the policy period. The major benefit for taking a Group Mediclaim policy is that the insured gets a Group discount, hence the premium per person is lower. Covered Risks:It is a hospitalization cover for reimbursement of the medical expenses incurred in respect of covered disease /surgery while the insured was admitted in the hospital as an in-patient. The cover also extends to pre- hospitalization and post- hospitalization for periods of 30 days and 60 days respectively. Salient Features Product name - Individual Mediclaim Policy Coverage amount - Rs. 1,00,000 Premium (cost of coverage) - Rs. 5,196/ Policy term (years) 1 year Cashless facility - Yes Coverage Hospitalization expenses Yes Daycare hospitalization Yes Pre hospitalization expenses 30 days Post hospitalization expenses - 60 days Cost of health check up Yes

Eligibility Medical test - After 45 years Max. entry age (years)- 55 years Eligibility conditions - Indian National only. No coverage for treatment outside India Benefits Income tax benefit Yes Sub-limits applicable- Yes Sub-limits description - The following provisions for reasonable & customary expenses, which are reimbursable under the policy have been introduced: Room, Board and Nursing Expenses as provided by the Hospital /Nursing Home not exceeding 1 % of the Sum Insured or Rs. 5000/- per day whichever is less. ICU expenses not exceeding 2 % of the Sum Insured or Rs. 10,000/- per day whichever is less (Room stay plus I.C.U. stay should not exceed total number of admission days). Ambulance services - 1% of the sum insured or Rs 2000/whichever is less shall be reimbursable where the patient has to be shifted from residence to hospital in case of admission in Emergency Ward / I.C.U. or from one Hospital / Nursing home to another Hospital / Nursing Home for better medical facilities. These expenses are payable only when registered ambulance is used. Pricing Family discount - Yes Cumulative bonus - Yes No Claim bonus Yes Other Details Provider type - PSU Companies List of permanent exclusions - i-Benign ENT disorders and surgeries i.e. Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty etc. 1 year Polycystic ovarian diseases - 1 year Surgery of hernia- 2 years Surgery of hydrocele- 2 years Non infective Arthritis- 2 years

 Un-descended testes-2 Years Cataract.2 Years Surgery of benign prostatic hypertrophy- 2 Years Hysterectomy for menorrhagia or fibromyoma or myomectomy or prolapse of uterus -2 Years Fissure / Fistula in anus-2 Years Piles- 2 Years Sinusitis and related disorders-2 Years Surgery of gallbladder and bile duct excluding malignancy- 2 Years Surgery of genitor- urinary system excluding malignancy-2 Years Pilonidal Sinus-2 Years Gout and Rheumatism-2 Years Hypertension - 2 Years Diabetes-2 Years Calculus diseases-2 Years Surgery for prolapsed inter vertebral disk unless arising from accident-2 Years Surgery of varicose veins and varicose ulcers - 2 Years Congenital internal diseases -2 Years Joint Replacement due to Degenerative condition - 4 Years Age related osteoarthritis and Osteoporosis - 4 Years

Individual mediclaim policy

Brief Description : Mediclaim Insurance is a Health cover which takes care of medical expenses Hospitalisation/Domiciliary Hospitalisation of the Insured in respect of the following situations: (A) In (B) In case case of of a sudden an following

illness accident

(C) In case of any surgery which is required in respect of any disease which has arisen during the policy period. Individual Mediclaim policy will be available to any individual between the age of 18 to 80 years for treatment taken in India. An individual can also get his family cover by way of family package cover. Now you can buy and renew policies Online. Buy a new Health Insurance policy, Renew an existing Oriental Insurance Mediclaim Health Insurance policy or renew policies bought from any other general insurance

company by registering yourself on our Portal and paying online through your debit card / credit card or Netbanking. To check out various online facilities available, you may login on the Portal. Top The salient features of the policy are: Inpatient hospitalization expenses in India due to disease / accident. This health policy covers citizens aged from 3 months to 80 years. The sum insured available ranges from Rs.50000/- to Rs.500000/ Pre-existing diseases are covered from the fifth year policy provided the renewals are done without break in insurance and all the renewals are with Oriental Insurance Company. Cashless facility for claim settlement available in network hospitals if the services of Third Party Administrators are availed. A proposer can take the policy for himself and or for his family members. Wherever family members are covered, a discount of 10% in premium is available. Pre acceptance medical examination is not required if the beneficiaries are below 45 years of age. The premium under the policy is eligible for Income Tax benefit under section 80D. Covered Risks: This Health cover is a hospitalisation cover and reimburse the medical expenses incurred in respect of covered disease /surgery while the insured was admitted in the hospital as an in patient. The cover also extends to prehospitalsation and post- hospitalisation for periods of 30 days and 60 days respectively Major Exclusions: Any pre-existing disease, any expense incurred during first 30 days of cover except injury due to accident, all expenses incurred in respect of any treatment relating to pregnancy and child birth. Treatment for Cataracts, Benign prostatic hypertrophy,Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma,Bronchitis, All Psychiatric or Psychosomatic disorders are excluded from the scope of the cover.

Oriental Insurance Individual Mediclaim Policy

This is a basic health insurance policy which covers medical expenses incurred by a person due to any illness, injury or accident and requires sudden or planned hospitalization for treatment or surgery.

Key Features of Oriental Insurance Individual Mediclaim Policy

Mediclaim insurance cover for treatment against illnesses

Also Covers for accidental injuries and surgery requirement Covers planned and unplanned hospitalization expenses till the sum assured coverage amount

What is covered in Oriental Insurance Individual Mediclaim Plan?

Medical expenses incurred during hospitalisation for treatment of illness, injury or surgery Expenses incurred 30 days prior to hospitalisation Treatment expenses up to 60 days after being discharged from the hospital

Additional Benefits of Oriental Insurance Individual Mediclaim Plan

No medical check up for individuals below the age of 45 years

Eligibility and Restrictions of Oriental Insurance Individual Mediclaim Policy

Minimum Coverage Amount (in Rs.) Policy Term (in years) Entry Age (in years) Renewable till Age (in years) 50,000 1 5 Maximum 5,00,000 1 70 80

Tax Benefits in Oriental Insurance Individual Mediclaim Policy

Exemption under income tax (80D of Income Tax Act) for Premium paid by cheque will be offered to the policyholders

Exclusions - What is not covered in Oriental Insurance Individual Mediclaim Policy?

Pre-existing diseases are not covered under this plan There is an initial waiting period of 30 days within which no claim will be admitted except any injuries due to accident Maternity related expenses, pregnancy and child birth is not included

Treatment for certain diseases like Fistula of anus, Piles, Cataract operation, Benign prostatic hypertrophy, Hysterectomy, Menorrhagia or Fibromyoma, Hernia, Sinusitis, Asthmatic complications, Bronchitis, etc are not covered

All Psychiatric or Psychosomatic disorders are also excluded from this policy.

Alternate health insurance plans from other insurance companies

National Insurance Mediclaim Policy Reliance Mediclaim Policy New India Assurance Mediclaim

Other Health Insurance plans from Oriental Health Insurance

Oriental Insurance Personal Accident Policy Oriental Insurance Universal Health Insurance Scheme

MEDICLAIM INSURANCE POLICY (INDIVIDUAL) PROSPECTUS 1. Salient Features of the policy. 1.1 Individual Mediclaim policy will be available to any individual between the ages of 18 to 80 years for treatment taken in India. An individual can also get his family cover by way family package cover. DEFINATION OF FAMAILY: a) Self (Primary Insured) b) Legal Spouse. c) Dependent Children (i.e. legitimate or legally adopted children) up to the age of 21 years. If the child above 18 years is employed or if the girl child is married, he or she shall cease to be covered under the policy and no claim shall be admissible. However male child can be covered up to the of 26 years if he is a bonafide regular student and fully dependent primary insured. Female child can be covered until she is unmarried. d) Dependent parents / parents-in-law

Family Discount: A discount of 10% in the total premium will be allowed comprising the insured and all his family members mentioned above. (if new member are to be added then new member will be treated under exclusion NO. 4.1, 4.2 and 4.3 as if new policy has been taken for such member.) Early Entry Discount: If a person taken Mediclaim Policy before reaching the age of 45 years and renews it continuously without break then for each renewal 5% discount subject to maximum of 25% will be given on above revised rates Such years will be counted prior to 45 years of age and such discount will continue for age up to 55 years. 1.2 The Policy reimburses reasonable. customary and necessary expenses of Hospitalization and / or Domiciliary Hospitalization expenses as detailed below only for illness / diseases contracted or injury sustained by the insured Persons during the policy period up to the limit of Sum insured. a) Room, Boarding and Nursing Expenses as provided by the Hospital / Nursing Home not exceeding 1% of the sum insured or Rs 5000/- per day whichever is less. b) I.C Until expenses not exceeding 2% of the Sum Insured or Rs. 10,000/- per day whichever is less. (Room stay including I.C.U stay should not exceed total number of admission days.) c) Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees. d) Anaesthesia, Blood, Oxygen, Operation Theater Charges, Surgical Appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during surgical Procedure like pacemaker. Relevant Laboratory / Diagnostics test, XRay etc. e) Ambulance services 1% of the sum insured or Rs. 2000/- whichever is less. 1.3 Cash less Facility: This facility is available in the Network Hospitals through the appointed TPAs of the company a discount of 5% will be given on the scheduled premium if the proposer opts out of the facility.