Individual Mediclaim Policy
  • AYUSH Benefits Covered
  • Inclusions and Exclusions
  • Lifetime Renewability
Oriental Individual Mediclaim Health Insurance Policy
Network hospitals

Network hospitals

4000+

Incurred claim ratio

Incurred claim ratio

95.49%

Sum insured

Sum insured

Up to 2 Crores

No. of Plans

No. of Plans

1

Solvency Ratio

Solvency Ratio

0.6

Pan India Presence

Pan India Presence

1,000+

Customized Health Insurance Plan for you.

Get upto 15% Online Discount*

Select Members You Want To Insure

Age of Eldest Member

Individual Mediclaim Policy

Oriental Individual Mediclaim by Oriental Health Insurance is an affordable health insurance policy that is designed to take care of all your medical expenses related to the Hospitalization/Domiciliary hospitalization of the policyholder in the following conditions:

  • Sudden illness
  • Accident
  • Surgery to treat any disease that arises during the policy period.

The comprehensive health insurance plan provides coverage on hospitalization expenses, domiciliary costs, organ donors, and much more for individuals between the ages of 18 to 65 years for treatment in India. You can also include your family under the same policy. Let's discuss the plan in detail.

Individual Mediclaim Policy Specifications

To understand Individual Mediclaim Policy Insurance in detail, take a look at the below table:

Entry Age

18 to 65 Years

Policy Type

Individual

Sum Insured

1 L | 2 L | 3 L | 4 L | 5 L | 10 L | 15 L | 20 L | 25 L | 35 L | 50 L

Initial Waiting Period*

30 Days

Renewability

Lifetime

Policy Term

1 Year

*Initial Waiting Period is the time period between the issuance of the policy and the time it starts actively. During this period, a policyholder has to wait to avail of the benefits offered under a health insurance plan.

Read more specifications in the brochure.

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Choose Your Individual Mediclaim Policy

With wide coverage options available, Individual Mediclaim Policy Insurance Plan allows you to choose your ideal coverage as per your family’s health requirements. Take a look at the coverage under every SI option available and choose your ideal coverage:

In-patient & Out-patient coverage

Room Rent

Covered

ICU Charges

Covered

Pre-Hospitalization

Covered

Post-Hospitalization

Covered

Domiciliary Hospitalization

Covered

Daycare Treatment

Covered

OPD Charges

Covered

Coverage Terms

COVID-19 Treatment

Covered

Cataract

Covered

No Claim Bonus

Not Covered

Automatic Restoration

Not Covered

Daily Hospital Cash

Covered

Organ Donor

Covered

Maternity Cover

Covered

New Born Baby Cover

Covered

Alternative Treatments

AYUSH Treatment

Covered

IVF Treatment

Not Covered

Modern Treatment

Covered

Emergency Coverage

Ambulance

Covered

Air Ambulance

Covered

Compassionate Travel

Not Covered

Global Coverage

Not Covered

Wellness Programmes

E-Consultation

Covered

Health Check-Up

Not Covered

Second Medical Opinion

Covered

Vaccination

Not Covered

Limitations

Co-payment

Covered

Sub-limits

Covered

What is Room Rent?

The room rent limit is the maximum bed charge you can claim if you are hospitalised. Common Room categories covered under room rent are all kinds of rooms including single, private and AC rooms (except suite).

What are ICU Charges?

It is a special hospital department where patients with serious medical conditions are treated.

What is Pre Hospitalization?

Medical expenses incurred before hospitalisation of the policyholder.

What is Post Hospitalization?

Medical expenses incurred after the discharge of the policyholder from the hospital.

What is Domiciliary Hospitalization?

Domiciliary hospitalization or home care treatments are the arrangements for an insured individual due to the unavailability of medical amenities in hospitals, or in a case where an insured member can not be admitted to the hospital due to an inability. The treatment should last equal to or more than 72 hours to get financial coverage.

What is Daycare Treatment?

Treatments that can be completed within 24 hours of hospitalization like blood dialysis, cataracts, etc.

What are OPD charges?

Covers the cost of doctor consultations and prescribed medical tests that may not require hospitalization. .

What is COVID-19 Treatment?

It includes the treatment cost for COVID-19 with a confirmative diagnosis from a government-approved centre.

What is Cataract Treatment?

A common eye condition in which your vision gets blurred due to cloudy formation in your eyes.

What is a No-Claim Bonus?

For every claim-free year, insurance companies reward policyholders with an increase in the sum insured amount as a no-claim bonus or cumulative bonus on policy renewal. However, in the case of a claim, this bonus amount either lapses or is reduced by a certain percentage varying from one plan to the other.

What is Automatic Restoration?

It is a benefit in which an insurance company restores the amount of sum insured completely or up to a certain percentage after it gets fully exhausted in treatments. This restoration amount may vary from one plan to the other.

What is Daily Hospital Cash?

Daily hospital cash or Hospicash is a cash amount that you receive each day during the time of hospitalization to cover your non-medical expenses.

What is an Organ Donor Cover?

It is a cover that includes the cost of the procedure for removing the damaged or malfunctioning organs from the body. In most of the cases, the insurer pays for the hospitalization and transplant expenses for both the parties i.e. the donor and the receiver.

What is a Maternity Cover?

It refers to the cover that includes expenses for normal and c-section deliveries.

What is a New Born Baby Cover?

It takes care of the medical expenses that arise due to the hospitalisation of the newborn baby in case of any childbirth complications, medical challenges, and so on. Some of the common treatments that are covered under the newborn cover and these common treatments can vary from plan to plan:

  • Congenital anomaly (conditions since birth)
  • Acute condition
  • Chronic condition
  • Premature delivery
  • Birth asphyxia
  • Daycare treatment
What is AYUSH Treatment?

Refers to the cost of medicines and procedures used under AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy) treatment.

What is IVF Treatment?

In Vitro Fertilization (IVF) is a method of assisted reproductive technology. The common expenses incurred under IVF and infertility treatments are settled or reimbursed for:

  • Full infertility
  • No fertility
  • Infertility diagnosis
  • Infertility diagnosis and limited fertility treatment
  • Medication (which may or may not include fertility drug prescriptions)
What is a Modern Treatment?

Medical treatments that demand the use of modern technology and advanced machinery such as robotic surgeries, stem cell therapy, etc.

What is an Ambulance Cover?

An ambulance is used to move the patient from home to the hospital, transfer them to another hospital, and take them for different tests outside the hospital.

What is an Air Ambulance?

Air ambulances are specially prepared planes that transfer the patient from one place to another in case of a health emergency.

What is Compassionate Travel?

Refers to the travelling expenses of a family member who’s visiting the hospital to look after the patient when the policyholder gets admitted to a hospital outside his/her residential city.

What is Global Coverage?

Any kind of medical/health emergency when you are outside of India is covered for hospitalization expenses, modern and specific treatments, etc.

What is E-Consultation?

If a policy offers e-consultation it allows policyholders to connect with a doctor for medical consultation through video chat, audio call, or chatbot.

What is a Health Checkup?

A facility where the policyholder can avail of free health check-ups after fulfilling the company's eligibility criteria. In most cases, the insured member/s gets an annual health check-up cover.

What is a Second Medical Opinion?

If the policyholder wants, they may opt for a second medical opinion wherein the policyholder can consult another doctor within the company’s network of medical practitioners.

What is Vaccination cover?

Coverage against the expenses incurred on vaccinations of either the newborn baby, for an animal bite, etc is provided by the insurance companies.

What is Co-payment?

In the co-payment clause, policyholders have to pay a preset amount (either compulsorily or voluntarily) of the hospitalisation expense on their own and the insurer will pay the rest of the medical bill amount.

What is the Sub limit?

Sub limit is a condition in which the insurer will have to pay the medical expense up to a certain percentage and the remaining amount will have to be paid by the policyholder. For instance, if your policy covers room rent for upto 20% of the sum insured, but the expense of the same is more than 25%, you will have to pay the rest amount, i.e. 5%, for your room rent.

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Oriental Individual Mediclaim Sample Premium

For a better understanding of how much premium you need to pay under the Oriental Individual Mediclaim Insurance, we at PolicyX.com have calculated the premium amount for different sum insured options based on different family sizes. Refer to the table below:

For 1 Adult

Sum Insured (Rs.) 5 L 10 L 15 L 20 L 50 L
Premium Payable 6,450 9,352 12,403 14,778 22,057

Oriental Individual Mediclaim Policy Exclusions

Permanent Exclusions

Permanent diseases or health conditions that are not included under Oriental Mediclaim Insurance Policy (Individual) are:

Hospitalization out of war, riot, strike, and nuclear weapons

Intentional self-injury

AIDS

Miscarriage, and Abortion

Congenital disease

Infertility and in vitro fertilization

Coverage after Waiting Period

Certain diseases and treatments are covered under this plan after a certain period. Read the details below:

Polycystic Ovarian diseases 1 year

Calculus diseases 2 year

Diabetes 2 year

Gout and Rheumatism 2 year

Piles 2 year

Hypertension 2 year

Undescended Testes 2 year

Hydrocele surgery 2 year

Congenital Internal diseases 2 years

Joint Replacement 2 years

Sinusitis and its related disorders 2 years

Osteoarthritis and Osteoporosis due to age 2 years

Surgeries related to gallbladder and bile duct 2 years

Surgeries related to the genitourinary system 2 years

Cataract 2 year

Hernia Surgery 2 year

Explore other Oriental Health Insurance

To cater to the different medical needs of an individual & their family, Oriental Health Insurance offers several Health Plans ranging from senior citizen plans to specialized plans for autistic children, to health insurance for cardiac patients, and many more.Take a look below to Oriental Health Insurance plans explore more:

Group Health Insurance

Oriental Bank Saathi Policy

Oriental Bank Saathi Policy

Oriental Health Insurance Bank Saathi Policy, a group policy by Oriental Insurance Company, is designed to provide indemnity to insured individuals an...

Unique Features

  • 2 Plan Variants
  • Newborn Baby Cover
  • Modern Treatment

Oriental Bank Saathi Policy (Pros)

Oriental Bank Saathi Policy
  • Maternity & newborn cover
  • Medical second opinion
  • Mental illness cover

Oriental Bank Saathi Policy (Cons)

Oriental Bank Saathi Policy
  • Illegal activities
  • Alcoholism
  • Adventure sports

Oriental Bank Saathi Policy (Other Benefits)

Oriental Bank Saathi Policy
  • Tax benefits
  • AYUSH treatment
  • Modern treatments

Oriental Bank Saathi Policy (Eligibility Criteria)

Oriental Bank Saathi Policy
  • Min entry age: 18 Years
  • Max entry age: 65 Years
  • Initial Waiting Period: 30 Days
  • Sum Insured: Up to 25 L

Accident Health Insurance

Oriental Personal Accident Policy

Oriental Personal Accident Policy

The human body is mortal such that we all can not avoid an accident that could lead us to lose our lives or any part of the body like limbs, or major ...

Unique Features

  • Covers you globally
  • Optional medical cover
  • Accidental loss compensation

Oriental Personal Accident Policy (Pros)

Oriental Personal Accident Policy
  • Accidental death
  • Injury
  • Permanent total disability

Oriental Personal Accident Policy (Cons)

Oriental Personal Accident Policy
  • Obesity
  • Illegal activities
  • Cosmetic Procedures

Oriental Personal Accident Policy (Other Benefits)

Oriental Personal Accident Policy
  • Permanent partial disability
  • Temporary total disability
  • Worldwide accidental cover

Oriental Personal Accident Policy (Eligibility Criteria)

Oriental Personal Accident Policy
  • N/A

Individual and Family Health Insurance

Oriental Happy Family Floater Policy

Oriental Happy Family Floater Policy

Oriental Family Floater Policy offers versatile coverage options to their policyholders. Oriental Health Insurance designed the plan to align wit...

Unique Features

  • International Cover
  • Multiple Discount Benefits
  • E-Consultation Available

Oriental Happy Family Floater Policy (Pros)

Oriental Happy Family Floater Policy
  • Domiciliary hospitalization
  • Pre and post-hospitalization
  • Newborn baby expenses

Oriental Happy Family Floater Policy (Cons)

Oriental Happy Family Floater Policy
  • Illegal activities
  • Alcoholism and drug abuse
  • Obesity

Oriental Happy Family Floater Policy (Other Benefits)

Oriental Happy Family Floater Policy
  • Tele consultation
  • Telemedicine
  • Accidental death benefit

Oriental Happy Family Floater Policy (Eligibility Criteria)

Oriental Happy Family Floater Policy
  • Min entry age: 18 Years
  • Max entry age: 65 years
  • Initial waiting period: 30 days
  • Sum Insured: Up to 50 L

Individual and Family Health Insurance

PNB Oriental Royal Mediclaim Insurance Policy

PNB Oriental Royal Mediclaim Insurance Policy

PNB Oriental Royal Mediclaim policy introduced by Oriental Health Insurance provides comprehensive coverage to the account holders of Punjab National ...

Unique Features

  • Individual and Family Floater
  • AYUSH Cover
  • Check the Eligibility Criteria

PNB Oriental Royal Mediclaim Insurance Policy (Pros)

PNB Oriental Royal Mediclaim Insurance Policy
  • Covers family
  • High sum insured
  • Ambulance cover

PNB Oriental Royal Mediclaim Insurance Policy (Cons)

PNB Oriental Royal Mediclaim Insurance Policy
  • Illegal activities
  • Alcoholism and drug abuse
  • Obesity

PNB Oriental Royal Mediclaim Insurance Policy (Other Benefits)

PNB Oriental Royal Mediclaim Insurance Policy
  • Pre and post-hospitalization
  • Multiple variants
  • Daily hospital cash

PNB Oriental Royal Mediclaim Insurance Policy (Eligibility Criteria)

PNB Oriental Royal Mediclaim Insurance Policy
  • Min entry age: 18 Years
  • Max entry age: 79 Years
  • Initial waiting period: 30 Days
  • Sum insured: Up to 10 L

Individual

Individual Mediclaim Policy

Individual Mediclaim Policy

Oriental Individual Mediclaim by Oriental Health Insurance is an affordable health insurance policy that is designed to take care of all your medical ...

Unique Features

  • AYUSH Benefits Covered
  • Inclusions and Exclusions
  • Lifetime Renewability

Individual Mediclaim Policy (Pros)

Individual Mediclaim Policy
  • Family discount
  • Voluntary co-payment
  • Daily hospital cash

Individual Mediclaim Policy (Cons)

Individual Mediclaim Policy
  • Alcoholism and drug abuse
  • Obesity
  • Cosmetic procedures

Individual Mediclaim Policy (Other Benefits)

Individual Mediclaim Policy
  • Personal accident cover
  • Medical second opinion
  • Multiple SI options

Individual Mediclaim Policy (Eligibility Criteria)

Individual Mediclaim Policy
  • Min entry age: 18 Years
  • Max entry age: 65 Years
  • Initial Waiting Period: 30 Days
  • Sum Insured: Up to 50 L

Oriental Individual Mediclaim Health Insurance Policy: FAQs

1. Does the Oriental individual Mediclaim policy offer any additional coverage?

Yes, the plan offers a Personal Accident Cover that covers death and permanent disability. The rider is available for the sum insured in multiples of Rs, 2,00,000 up to Rs. 10,00,000 above the age of 18 years. For less than 18 years of age - Maximum coverage of 4 lakhs is applicable.

2. Do I need to undergo a medical checkup to buy the Oriental Individual Mediclaim policy?

No, you do not need to go for the medical examination up to the age of 55 years.

3. What is voluntary Co-payment in the Oriental Mediclaim Policy?

Under this optional benefit, one can opt for a co-payment of 10% or 20%, wherein they will get an eligible premium discount of 10% and 20% respectively.

4. Can I increase my coverage at the time of renewing my Oriental Mediclaim policy?

Yes, you can increase the coverage. However, as per the terms and conditions of the plan maximum increase allowed at each renewal is Rs. 2 Lakhs per insured person up to the age of 45 years. After that, the maximum increase allowed at each renewal is Rs.1 Lakhs per insured person.

5. Am I eligible for any discounts under the Oriental Mediclaim Policy?

Yes, the plan offers family discounts of 10% if more than one person is covered under the policy.

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Written By: Naval Goel

Naval Goel is the Founder and CEO of PolicyX.com (IRDA- Approved Insurance Comparison Website). He is a CFA charter holder (USA) and FRM (GARP). He holds an MBA from IIFT, Delhi, and is also an Associate from the Insurance Institute of India. Naval is an avid investor and entrepreneur who has a deep understanding of the Indian equity market and insurance sector. He has been investing for more than 10 years now and is a CFA charter holder.

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