| 8- Oriental Insurance Company Limited - Family Floater Policy Wording |
|
| Source: Website of The Oriental Insurance Company Limited |
|
| 4.21 Massages, Steam bathing, Shirodhara and like treatment under Ayurvedic treatment. |
|
| 4.22 Any kind of Service charges/Surcharges, unless payable to the Govt. Authority, levied by the hospital. |
|
| 4.23 Compulsory Co-Payment: Under the SILVER plan the insured has to bear 10% of admissible claim amount in each and every claim. |
|
| 5 CONDITIONS |
|
5.1 ENTIRE CONTRACT: the policy, SCHEDULE, proposal form, prospectus and declaration given by the insured shall constitute the complete contract of insurance. Only insurer may alter the terms and conditions of this policy/ contract. Any alteration that may be made by the insurer shall only be evidenced by a duly signed and sealed endorsement on the policy. |
|
5.2 COMMUNICATION: Every notice or communication to be given or made under this policy shall be delivered in writing at the address of the policy issuing office/ Third Party Administrator as shown in the Schedule. |
|
5.3 PAYMENT OF PREMIUM: The premium payable under this policy shall be paid in advance. No receipt for premium shall be valid except on the official form of the Company signed by a duly authorized official of the company. The due payment of premium and the observance and fulfilment of the terms, provisions, conditions and endorsements of this policy by the Insured Person in so far as they relate to anything to be done or complied with by the Insured Person shall be condition precedent to any liability of the Company to make any payment under this policy. No waiver of any terms, provisions, conditions and endorsements of this policy shall be valid, unless made in writing and signed by an authorised official of the Company. |
|
5.4 NOTICE OF CLAIM: Immediate written notice of claim with particulars relating to Policy Number, ID Card No., Name of insured person in respect of whom claim is made, Nature of disease/ illness/ injury and Name and Address of the attending medical practitioner/ Hospital/Nursing Home etc. should be given to the Company/ TPA while taking treatment in the Hospital/ Nursing Home by Fax, Email. Such written notice should be given within 48 (forty eight) hours of admission or before discharge from Hospital/ Nursing Home, whichever is earlier unless waived in writing. |
|
5.5 CLAIM DOCUMENTS: Final claim along with originals of hospital Bills/ Cash memos/ reports, claim form and list of documents as listed below should be submitted to the Company/ TPA within 7 (seven) days of discharge from the Hospital/ Nursing Home. |
- Original bills, receipts and discharge certificate/ card from the hospital.
- Medical history of the patient recorded by the Hospital.
- Original Cash-memo from the hospital (s)/ chemist (s) supported by proper prescription.
- Original receipt, pathological and other test reports from a pathologist/ radiologist including film etc supported by the note from attending medical practitioner/ surgeon demanding such tests.
- Attending Consultants’/ Anaesthetists’/ Specialists’ certificates regarding diagnosis and bill/ receipts etc. in original.
- Surgeons’ original certificate stating diagnosis and nature of operation performed along with bills/ receipts etc.
- Any other information required by TPA/ the Company.
|
| All documents must be duly Attested by the insured person. |
|
| In case of post hospitalisation treatment all supporting claim papers/ documents as listed above should also be submitted within 7 (seven) days after completion of such treatment to the Company/ T.P.A. In addition, insured should also provide to the Company/ TPA such additional information and assistance as the Company/ TPA may require in dealing with the claim |
|
| NOTE: Waiver of the condition may be considered in extreme cases of hardship where it is proved to the satisfaction of the Company that under the circumstances in which the insured was placed it was not possible for him or any other person to give such notice or file claim within the prescribed time limit. Otherwise Company/ TPA has a right to reject the claim. |
|
|
|
