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| Senior Citizens Health Insurance (Mediclaim Policy) in India |
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| 6- Senior Citizens Mediclaim Policies - The Oriental Insurance Co. Ltd. |
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| SENIOR CITIZEN SPECIFIED DISEASES INSURANCE |
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| Salient features: |
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- Exclusively designed for Citizens aged 60 years and above
- Policy is available for Sum Insured 1 lac, 2 lac, 3 lac, 4 lac and 5 lacs.
- Covers specified diseases only.
- Compulsory co-payment of 20% on admissible claim amount.
- Discount in premium for opting Voluntary Co-payment.
- No claim discount in premium.
- Loading for new entrants.
- Benefit of continuity extended if already insured with any mediclaim policy of the Company.
- TPA service available.
- Cashless Service through TPA only and limited to Rs. 1 lakh.
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This Policy is available to any Indian citizen who is aged 60 years and above and for hospitalisation in India only.
The proposer has to submit any of the following documents as age proof:
(a) Birth Certificate
(b) Matriculation Certificate
(c) School Leaving Certificate
(d) Photo Voter Identity Card
(e) Driving Licence
(f) PAN Card
(g) Passport
The Policy reimburses the payment of hospitalisation and / or domiciliary hospitalisation expenses for the specified diseases contracted or injury sustained by the insured persons. The settlement of the claim will be done by the TPA either to the network hospital or to the insured. |
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| SCOPE OF COVER |
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Only the following Specified Diseases / illness/ injury are covered under the policy and the maximum liability of the Company in respect thereof shall be as follows: |
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| Sr. No. |
Name of Disease |
Maximum Limit of Liability per illness (including domiciliary hospitalisation benefit, if any) |
| 1. |
Accidental Injury |
100% of Sum Insured |
| 2. |
Knee Replacement |
70% of Sum Insured |
| 3. |
Cardio Vascular Diseases |
50% of Sum Insured |
| 4. |
Chronic Renal Failure |
50% of Sum Insured |
| 5. |
Cancer |
50% of Sum Insured |
| 6. |
Hepato-Biliary Disorders |
50% of Sum Insured |
| 7. |
Chronic Obstructive Lung Diseases |
20% of Sum Insured |
| 8. |
Stroke |
20% of Sum Insured |
| 9. |
Benign Prostrate |
15% of Sum Insured |
| 10. |
Orthopaedic Diseases |
15% of Sum Insured |
| 11. |
Ophthalmic Diseases |
10% of Sum Insured |
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| Note: Company’s Liability in respect of all claims admitted during the Period of insurance shall not exceed the Sum Insured per Person mentioned in the Policy / Schedule.
REASONABLE & NECESSARY EXPENSES UPTO THE FOLLOWING limits ARE PAYABLE / REIMBURSABLE UNDER THE POLICY, FOR the Specified Diseases / illness/ injury only, WITHIN THE OVERALL LIMIT AS SPECIFED ABOVE:
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- Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing Home not exceeding 1% of the Sum Insured per day.
- I.C. Unit expenses not exceeding 2% of the Sum Insured per day.
(Stay in the Room and the stay in I.C.U., if required, should not exceed total number of days of admission in the hospital).
- Ambulance Services Charges per illness by registered ambulance – Actual Expenses or Rs 1000/- whichever is less shall be reimbursable in case patient has to be shifted from residence to hospital in case of admission in Emergency Ward / I.C.U. Or from one Hospital / Nursing home to another Hospital / Nursing Home for hospitalisation.
- Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees.
- Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during surgical procedure like pacemaker, Relevant Laboratory / Diagnostic test, X-Ray etc..
Note: Only reasonable and necessary expenses based on the severity (minor / medium / major) of the Specified Diseases / illness/ injury will be payable under the policy but not exceeding the maximum limit irrespective of the expenses incurred by the insured. |
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