- Self (Primary insured)
- Legal Spouse
- Dependent Children (i.e. legitimate or legally adopted children upto the age of 21 years (subject to Note in 3 above).
- Dependent parents and / or dependent parents-in-law. All members of the family must be covered under one policy (Refer para 12 and 13 also).
- SUM INSURED: Minimum sum insured shall be Rs. 50,000/- and can be increased in multiple of Rs. 25,000/- upto Rs.2 lacs and in multiples of Rs. 50,000/- upto Rs.5 lacs. The sum insured must be identical for primary insured and the dependents. However, the children may be covered for 50% Sum Insured as per item no 4 (a) above.
- INTRODUCTION OF SUB-LIMITS: The following provisions for reasonable & customary expenses, which are reimbursable under the policy, have been introduced:
a. Room, Board and Nursing Expenses, as provided by the Hospital/Nursing Home not exceeding 1% of the Sum Insured or Rs. 5000/- per day whichever is less. I. C.unit expenses not exceeding 2% of the Sum Insured or Rs. 10,000/- per day whichever is less? (Room stay plus I.C.U. stay should not exceed total number of admission days.)
b. Ambulance Services - 1% of the sum of insured or Rs. 2000/- whichever is less shall be reimbursable where the 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 better medical facilities. These are payable only when registered ambulance is used.
However,
c. Company's liability in respect of all claims admitted during the Period of insurance shall not exceed the sum of Insurance per person mentioned in the Schedule.
d. Hospitalization expenses incurred in respect of the donor (excluding cost of organ if any) during the course of organ transplant will also be payble. However, the liability of the Company will be limited to cover all Sum Insured of the Insured Person , receiving the donated organ.
e. CUMULATIVE BONUS : This provision has been withdrawn.
However
As a onetime exercise, Oriental's expiring policies may be renewed with enhanced Sum Insured (to include earned cumulative bonus) this new Sum insured be fixed in the appropriate revised sum Insured slab (i.e..,if Sum Insured falls between two slab options then higher Sum Insured shall be selected as illustrated below .) The corresponding difference in premium shall be waived. On subsequent renewal, the insured shall pay the premium as per the revised sum insured slab.
