| 8- Family Floater Coverage -Oriental Insurance Company Limited - Policy Wording |
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THE ORIENTAL INSURANCE COMPANY LIMITED,
Regd. Office: Oriental House, P.B. No. 7037, A-25/27, Asaf Ali Road, New Delhi- 110 002 |
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| 3.15 DAY CARE PROCEDURE: means the course of Medical treatment / surgical procedure listed at 2.3 (A) and 2.3 (C) carried out, in Network hospitals or network specialised Day Care Centre which is fully equipped with advanced technology and specialised infrastructure and where the insured is discharged on the same day after treatment. |
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| 3.16 LIMIT OF INDEMNITY: means the amount stated in the schedule which represents maximum liability for any and all claims admissible during the policy period in respect of that insured family. |
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| 3.17 ANY ONE ILLNESS: Any one illness SHALL be deemed to mean continuous period of illness and it includes relapse within 105 (one hundred and five) days from the date of discharge from the Hospital / Nursing Home / Day Care centre from where the treatment was taken. Occurrence of the same illness after a lapse of 105 (one hundred and five) days as stated above SHALL be considered as fresh illness for the purpose of this policy. |
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| 3.18 PERIOD OF POLICY: This insurance policy is issued for the period as shown in the schedule. |
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| 3.19 DAILY HOSPITAL CASH ALLOWANCE: When an insured member of the family is hospitalized and a claim is admitted under the GOLD plan of the policy, then the insured person SHALL be paid a daily cash allowance as specified in section 1.2 A f of the policy. |
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| 3.20 Attendant allowance: When an insured member of the family aged between three months to 10 years is hospitalized and a claim is admitted under the GOLD plan of the policy, a sum as mentioned in the table of benefit under 1.2 A g will become payable under the policy. |
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| 3.21 LIFE HARDSHIP SURVIVAL BENEFIT: If this benefit is opted for (under the GOLD plan only), and if a claim for the specified diseases listed hereunder is admitted under section 1.2 A of the policy, then a survival benefit as mentioned hereunder, SHALL be paid the insured. |
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Diseases covered:
Cancer - metastasis (stage IV)
End Stage Renal Disease (ESRD)
Stroke leading to paralysis or paraplegia |
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| Benefits: |
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| Plan |
Total amount payable |
Amount payable on survival for 180 days and above from the date of discharge from the hospital (the first discharge date in case of more than one hospitalisations are involved). |
Amount payable on survival for 270 days and above from the date of discharge from the hospital (the first discharge date in case of more than one hospitalisations are involved). |
| A |
15 % of Sum Insured under the policy |
5% of the sum insured |
10% of the sum insured |
| B |
25 % of Sum Insured under the policy |
10% of the sum insured |
15% of the sum insured |
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| The limit of liability SHALL be applicable for all the insured persons severally or jointly. The benefit under this section shall be paid only once under this policy or subsequent renewals for the same disease for the same person. |
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| 3.22.PERSONAL ACCIDENT COVER: (WORLD – WIDE) |
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| SCOPE OF COVER: |
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| If at any time during the currency of the policy the insured sustains any bodily injury resulting solely and directly from accident caused anywhere in the world by external, violent and visible means, then the Company undertakes to pay the insured or his/her legal personal representative, as the case may be, the following sums : |
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| BENEFIT COVERED |
DESCRIPTION |
AMT. PAYABLE |
| 1. |
Accidental Death only |
100 % of CSI |
| 2. |
Loss of Two entire limbs, or sight of two eyes or one entire limb and sight of one eye. |
100 % of CSI |
| 3. |
Loss of one entire limb or Sight of one eye |
50 % of CSI |
| 4. |
Permanent Total Disablement resulting in The insured becoming in engaging in any
Employment or occupation whatsoever. |
100 % of CSI |
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| The overall liability in the event of one or more of the eventualities occurring SHALL be restricted to the CSI. |
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| CSI means capital sum insured opted for the personal accident section |
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