| 8- Family Floater Coverage -Oriental Insurance Company Limited - Policy Wording |
|
THE ORIENTAL INSURANCE COMPANY LIMITED,
Regd. Office: Oriental House, P.B. No. 7037, A-25/27, Asaf Ali Road, New Delhi- 110 002 |
|
| 5.13 DISCLAIMER OF CLAIM: It is also hereby further expressly agreed and declared that if the TPA/Company shall disclaim liability in writing to the Insured for any claim hereunder and such claim shall not within 12 calendar months from the date of such disclaimer have been made the subject matter of a suit in a court of law, then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder. |
|
| 5.14 PAYMENT OF CLAIM: The policy covers illness, disease or accidental bodily injury sustained by the insured person during the policy period any where in India* and all medical / surgical treatment under this policy shall have to be taken in India and admissible claims thereof shall be payable in Indian currency. |
|
(a)Payment of claim shall be made through TPA to the Hospital / Nursing Home or to the Insured Person in case policy is serviced through TPA.
(b) In non TPA case the claim SHALL be paid to the insured person by the Insurance Company. |
|
| 5.15 Mid term inclusion permitted for NEWLY WED spouse only. Spouse can be included within three months of marriage or at the time of renewal of the policy. |
|
| IMPORTANT |
|
| 6 PERIOD OF POLICY: This insurance policy is issued for a period of one year. |
|
| 7 RENEWAL OF POLICY: |
|
| (a)The Company shall not be responsible or liable for non-renewal of policy due to non-receipt or delayed receipt (i.e. After the due date) of the proposal form or of the medical practitioners report wherever required or due to any other reason whatsoever. |
|
| (b)Notwithstanding this, however, the decision to accept or reject for coverage any person upon renewal of this insurance shall rest solely with the Company. The company may at its discretion revise the premium rates and / or the terms & condition of the policy every year upon renewal thereof. Renewal of this policy is not automatic; premium due must be paid by the proposer to the company before the due date. |
|
| In case the policy is to be renewed for enhanced sum insured then the restrictions as applicable to a fresh policy (condition 4.1, 4.2 & 4.3 SHALL apply to additional sum insured) as if a separate policy has been issued for the difference. |
|
| In case of increase in Sum insured, treatment for pre-existing disease (after specified time) and for a disease / ailment / injury for which treatment has been taken in the earlier policy period, the enhanced sum insured will be applicable only after four continuous renewals with the increased sum insured. |
|
| 8 SUM INSURED: The Company’s liability in respect of all claims admitted in during the period of Insurance shall not exceed the sum insured opted under the policy. |
|
| 9.AUTHORITY TO OBTAIN RECORDS: |
|
| (a) The insured person hereby agrees to and authorises the disclosure to the insurer or the TPA or any other person nominated by the insurer of any and all Medical records and information held by any Institution / Hospital or Person from which the insured person has obtained any medical or other treatment to the extent reasonably required by either the insurer or the TPA in connection with any claim made under this policy or the insurer’s liability thereunder. |
|
| (b)The insurer and the TPA agree that they SHALL preserve the confidentiality of any documentation and information that comes into their possession pursuant to (a) above and SHALL only use it in connection with any claim made under this policy or the insurer’s liability thereunder |
|
| 10. REASONABLE AND NECESSARY EXPENSES: |
|
| (a)For a networked hospital means the rate pre-agreed between Network Hospital and the TPA / Company, for surgical / medical treatment that is necessary for treating the insured person who was hospitalized. |
|
| (b)For any other hospital it shall mean the cost of surgical / medical treatment that is necessary and reasonable for treating the condition for which insured person was hospitalized. |
|
| NOTE: Any expenses other than the above have to be borne by the insured person himself. |
|
|
|
