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For Health Insurance India Enquiries Contact: Ria Insurance Brokers Pvt Ltd, 449 Kailash Tower -2, East Of Kailash,
New Delhi, India-110065, Phone. 011-26417566,46581566,24525374 Mob. 9810090853 Email:- ibidelhi@gmail.com |
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Oriental Insurance Company : Happy Family Floater Policy  |
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| Oriental Insurance Company Comprehensive Health Cover for Family - Policy Wording |
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THE ORIENTAL INSURANCE COMPANY LIITED,
Regd. Office: Oriental House, P.B. No. 7037, A-25/27, Asaf Ali Road, New Delhi- 110 002 |
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| 1.1 WHEREAS the insured named in the Schedule hereto has by a proposal and declaration dated as stated in the Proposal (which shall be the basis of this Contract and is deemed to be incorporated herein) has applied to THE ORIENTAL INSURANCE COMPANY LIMITED (hereinafter called the Company) for the insurance hereinafter set forth in respect of person(s) named in the Schedule hereto (hereinafter called the INSURED PERSON (S) and has paid premium to the Company as consideration for such insurance to be serviced by Third Party Administrator (hereinafter called the TPA) or the Company as the case may be. |
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| NOW THIS POLICY WITNESSES that subject to the terms, conditions, exclusions and definitions contained herein or endorsed or otherwise expressed hereon, the Company undertakes that, if during the period stated in the Schedule any insured Person(s) shall contract or suffer from any of the diseases /illness / ailment (hereinafter called ‘DISEASE’) or sustain any bodily injury through accident (hereinafter called ‘INJURY’) |
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| AND |
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| If such disease or bodily injury shall require any such insured person(s) upon the advice of a duly qualified Physician / Medical Specialist/Medical Practitioner (hereinafter called MEDICAL PRACTITIONER) or of a duly qualified Surgeon (hereinafter called ‘SURGEON’) to incur (a) hospitalisation expenses for medical/surgical treatment at any Nursing Home/Hospital in India as herein defined (hereinafter called ‘HOSPITAL’) as an inpatient OR, (b) domiciliary treatment in India under Domiciliary Hospitalisation Benefits as hereinafter defined, the TPA shall reimburse to the Hospitals (only if treatment is taken at Network Hospital(s) with prior written approval of TPA) or to the insured person(s) (if payment to the hospital is not agreed to or the insured person(s) opts for reimbursement of the claim) the amount of such expenses as are reasonably and necessarily incurred in respect thereof by or on behalf of such insured person(s) up to the limit of liability specified in the policy and or schedule of the policy but not exceeding the sum insured in any one period of insurance for one or all the family member(s) stated in the schedule hereto. In the event the policy is not serviced by the TPA such expenses shall be reimbursed to the insured person(s) by the Company. |
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| The benefits under this policy are available under either of the two plans, viz Silver or Gold as opted by the proposer in the proposal form. |
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| 1.2 COVERAGE UNDER THE POLICY |
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| The following reasonable and necessary expenses (subject to limits) are payable under the policy for various benefits: |
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| A |
HOSPITALISATION BENEFITS |
| BENEFIT |
SILVER PLAN
(Limit of Reimbursement ) |
GOLD PLAN
(Limit of Reimbursement) |
| (a) |
Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing Home. |
Not exceeding 1 % of the Sum Insured per day |
Not exceeding 1 % of the Sum Insured per day. |
| (b) |
Intensive Care(IC) Unit Expenses as provided by the Hospital /Nursing Home. |
Not exceeding 2% of the Sum Insured per day. |
Not exceeding 2% of the Sum Insured per day. |
| No of days of stay under a and b above should not exceed total number of days of admission in the hospital. |
| (c) |
Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees |
As per the limits of the sum insured. |
As per the limits of the sum insured. |
| (d) |
Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Diagnostic Material and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs & and similar expenses. |
As per the limits of the sum insured. |
As per the limits of the sum insured. |
| (e) |
Ambulance services charges as defined hereinafter under 2.5 |
Rs.1,000/- per illness and limited to maximum 1% of the sum insured or Rs. 3,000/- whichever is less, for the entire policy period. |
Rs.2,000/- per illness and limited to maximum 1% of the sum insured or Rs. 6,000/- whichever is less, for the entire policy period. |
| (f) |
DAILY HOSPITAL CASH ALLOWANCE, AS DEFINED HEREINAFTER under 3.19 |
NIL. |
0.1% of sum insured per day per illness subject to a maximum compensation for 10 days per illness. The overall liability of the Company during the policy period will be limited to 1.5% of the sum insured. |
| (g) |
Attendant allowance as hereinafter defined under 3.20 |
NIL. |
Rs.500/- per day of hospitalisation per illness and upto 10 days per illness. The overall liability of the Company during the policy period will be limited to compensation for 15 days of hospitalisation. |
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