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For Comparative Insurance Quote: Om Plaza, 430/7, 1st Floor, Sant Nagar, East of Kailash, New Delhi-65
Phone: 011-41324957, 41623784, Mob:+91-8447757651 & 53 Email: ria1@surekhae.com
Senior Citizens Health Insurance (Mediclaim Policy) in India
 
(1) Senior Citizen Mediclaim Policy over 60 years   (2) Premium Comparative Chart of Senior Citizens
(3) Policy Wording/ Proposal Form/ Brochure Senior Citizens   (4) Senior Citizens Policy Coverage
(5) Required Medical Test List (Pre Acceptance Health Checkup)      
(6) Product details of Various Companies for Senior Citizens Health Insurance
 
General/ Health Insurance Companies Products
6- Senior Citizens Mediclaim Policies - The Oriental Insurance Co. Ltd.
SENIOR CITIZEN SPECIFIED DISEASES INSURANCE
3.20 REASONABLE AND NECESSARY EXPENSES: shall mean the cost of surgical / medical treatment that is reasonably and necessarily incurred for treating the disease / illness / injury for which insured person is hospitalized. In the case of a networked hospital this shall be as per the pre-agreed rate between Networked Hospital and the TPA. Any additional expenses have to be borne by the insured.
3.21 Compulsory Co-Payment: Insured has to bear 20% (Twenty Percent) of admissible claim amount in each and every claim.
3.22 Voluntary Co-Payment: The insured may opt to bear a part of the claim amount (after application of compulsory co-payment) for which following discounts are applicable, subject to a maximum of 50% (Fifty percent)
    Discount available on renewal premium payable after one (or the first) claim free annual policy 5%
    Discount available on renewal premium payable on second continuous claim free renewal of annual policy 10%
    Discount available on renewal premium payable on third continuous claim free renewal of annual policy 15%
    Discount available on renewal premium payable on fourth continuous claim free renewal of annual policy 20%
No Claim Discount shall become ‘nil’ once a claim is paid or becomes payable under the policy, irrespective of the amount of claim.

For No Claim Discount, renewal of this particular policy shall only be considered and no benefit of any other insurance policy shall be allowed.

At the discretion of the Company where policy is renewed within 7 (Seven) days from the expiry date, the renewal is permissible with the applicable No Claim Discount.
3.24 Break in Insurance: Break in insurance upto 7 (seven) days may be condoned at the discretion of the Company, and in such cases the No Claim Discount and Health Check Up Benefit shall be unaffected.
4. Exclusions / Terms & Conditions
The Company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any Insured Person in connection with or in respect of:
4.1 Any disease / health condition / illness / ailment or any condition arising therefrom other than those specified in the policy as covered.
4.2 Pre-existing health condition or disease or ailment / injuries: Any ailment / disease / injuries / health condition which are pre-existing (treated / untreated, declared / not declared in the proposal form), when the cover incepts for the first time are excluded upto 2 (two) years of this policy being in force continuously.
For the purpose of applying this condition, the date of inception of the Mediclaim policy taken from the Company shall be considered, provided the renewals have been continuous and without any break in period.
This exclusion shall also apply to any complications arising from pre existing ailments / diseases / injuries. Such complications shall be considered as a part of the pre existing health condition or disease. To illustrate if a person is suffering from hypertension or diabetes or both hypertension and diabetes at the time of taking the policy, then policy shall be subject to following exclusions.
Diabetes Hypertension Diabetes & Hypertension
Diabetic Retinopathy Cerebro Vascular accident Diabetic Retinopathy
Diabetic Nephropathy HypertensiveNephropathy Diabetic Nephropathy
Diabetic Foot /wound Internal Bleed/ Haemorrhages Diabetic Foot
Diabetic Angiopathy Coronary Artery Disease Diabetic Angiopathy
Diabetic Neuropathy   Diabetic Neuropathy
Hyper / Hypoglycaemic shocks   Hyper / Hypoglycaemic shocks
    Coronary Artery Disease
    Cerebro Vascular accident
    Hypertension Nephropathy
    Internal Bleeds/ Haemorrhages
4.3 Any disease covered under the policy other than those stated in clause 4.4, contracted by the Insured person during the first 30 (Thirty) days from the commencement date of the policy except treatment for accidental injuries.
4.4 The expenses on treatment of following ailments / diseases / surgeries for first two policy years are not payable.
    i Non infective Arthritis.
    ii Cataract.
    iii Surgery of benign prostatic hypertrophy.
    iv Surgery of gallbladder and bile duct excluding malignancy.
    v Surgery of genito urinary system excluding malignancy.
    vi Gout and Rheumatism.
    vii Calculus diseases.
    viii Joint Replacement due to Degenerative condition.
    ix Age related osteoarthritis and Osteoporosis.
If the continuity of the renewal is not maintained with the Company then subsequent cover shall be treated as fresh policy and clauses 2, 3, 4 shall apply afresh unless agreed by the Company and suitable endorsement is passed on the policy.
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