Medical Insurance - From THE ORIENTAL INSURANCE COMPANY

Sl.No Coverage  Definition in Details New Terms  Additional Benefit compared to previous years
1 Family Definition A family floater policy is a health insurance plan which covers the entire family on the payment of a single annual premium. The sum assured covers the entire family and can be used in case of multiple hospitalizations in the family 1+ 5 Self + Spouse + 4 children OR Parents or inlaws (cross section allowed)  & Siblings upto 30 yrs (size of the family should not be more than 1+5) Siblings & Children upto 30 yrs
Only dependent and unmarried children & Siblings upto 30 years covered. Rest - 99 years.   
2 Sum Insured family floater basis The sum insured is the maximum value for a particular year that the insurance company can pay if hospitalized. Any amount exceeding the sum insured will have to be borne by employee. Agreed amount on the sum insured will be the maximum amount will receive in case of medical treatment or hospitalization. 5 lacs , 10 lacs , 25 lacs & 30 Lacs You can select the coverage as per your family's requirment
3 Room Rent Restrictions  Sub-limit on room rent would mean that the insurer defines the maximum amount it will pay towards the room rent.  Normal Room Rent For 5 lacs - 6k, 10 lacs - 8k, 25 lacs -12.5k & 30 lacs - 15k
All other charges in accordance with the Room Rent restriction
4 30 days , 1st, 2nd ,3rd & 4th Year waiting 1.Coverage of Pre-existing Conditions without any waiting period.                                                     2. Waiver of the exclusions relating to the first 30 days of the Policy period. Waived 
5 Maternity Day 1 No waiting period for Maternity  Normal & Csec 1.5 lacs Increased from Rs. 70,000 to Rs. 1.5 lacs
6 Pre & Post Natal expenses Pre- and post-natal expenses would mean costs pertaining to ultrasound, regular checkups, doctor's consultation fee, medicines and so on. These are similar to pre- and post-hospitalisation expenses that are admissible under a standard health insurance policy. Pre - Within Maternity limits , Post within full Sum insured  
7 New born Baby Cover Cover Medical Expenses towards the medical treatment of the Insured Person's New Born Baby while the Insured Person is Hospitalised for Inpatient Care for delivery. Covered within Family Floater SI from Day 1 No additional premium required for new born bay
8 Pre-existing Disease Covered - day 1 Any condition, ailment or injury or related condition(s) for which you had signs
or symptoms, and / or were diagnosed, and / or received medical advice / treatment within 48 months prior to the first policy issued by the insurer.
Covered for all Members 
9 Pre & Post Hospitalization period The Policy pays the Medical Expenses incurred as
defined for an ailment / disease / Injury not different from the one for which hospitalization was
necessary during the Pre and Post Hospitalization period.
60 & 90 days 
10 Domiciliary hospitalisation Domiciliary hospitalization means medical treatment for a
period exceeding three days for such an illness/disease/injury which in the normal course would require care
and treatment at a hospital but is actually taken while confined at home under any of the following circumstances:
- the condition of the patient is such that he/she is not in a condition to be removed to a hospital, or
- the patient takes treatment at home on account of non availability of room in a hospital. 
10% of SI  New benefit
11 Emergency Ambulance charges / Air fare Expenses for utilizing Ambulance service for
transporting Insured Person to Hospital in case of an emergency or from one hospital to another
if medical services required are not available.
Emergency amb. charges - air fare - Max of Rs 10 k - emergency. Air amb charges - Max Rs 2 lacs. Incl/ Commercial Airlines
12 External congenital The Policy is extended to provide coverage for surgical treatment on in-patient basis for External congenital disease/s in life threatening situation upto the limit specified in the Policy Schedule towards this benefit. Covered Under Life threatening conditions
13 Co-pay clause However capped aliment like cataract will not attaract any Co-pay 20% Co Pay on Parental Claims, No Co pay on others  No co-pay for member, spouse, children and sibilings
11 Cataract A cataract is a cloudiness or opacity in the normally transparent crystalline lens of the eye. Cataract surgery is a procedure to remove the lens of your eye and, in most cases, replace it with an artificial lens.  Cataract INR 70,000 per eye From Rs. 30,000 to Rs. 70,000
12 Cochlear Implant treatment  A cochlear implant is a small electronic device that electrically stimulates the cochlear nerve (nerve for hearing) Restricted to 40% of Sum Insured 
13 Cyber Knife treatment and stem cell tplt. The CyberKnife — one of the most advanced forms of radiosurgery — is a painless, non-invasive treatment that delivers high doses of precisely targeted radiation to destroy tumors or lesions within the body. It uses a robotic arm to deliver highly focused beams of radiation. Covered with 40% Co-pay 
14 Corporate Buffer Corporate Buffer limit to take care of
any defined emergencies which exceed the individual/ Family limit of the Sum Insured specified
under the Policy. This additional limit is available basis Per person/ family limit subject to the overall corporate buffer limit specified in the Policy Schedule selected for the full policy period. The Corporate
Buffer will not be available for diseases /procedures / treatments where specific sub-limit/s is /are
applicable in the Policy.
Rs. 50 Lacs - Equivalent to family SI - For Critical illness
15 Day Care procedures We will pay the Medical expenses incurred for the Day care procedures
which do not require 24 hours Hospitalization due to technological advancement .This excludes
all procedures or treatment taken in Out-patient departments.
Covered as per Insurer standard coverage list   
16 Terrorism Related Hospitalization   Covered
17 LGBTQ Cover/ Live In partner  Medical insurance to same-sex partners/ 1 live in partner  Covered
18 Oral chemotherapy Oral chemotherapy is a cancer-fighting drug given by mouth in tablet, capsule, or liquid form. It is prescribed by your doctor, nurse practitioner, or physician's assistant, and has the same benefits and risks as chemotherapy given by infusion. Today, many cancer patients receive oral chemotherapy as a treatment. Covered for all members
19 OPD Expenses @ 10k Per Family  The Policy is extended to include consultations, pharmacy,
diagnostics, medical and surgical procedures taken on an Out-Patient basis upto the amount as stated in
the Policy.
( Health check - 4,000/ Dr., Dental , Vision Consultation, Cost of lens -3500/ Medicines with dr. Prescription 3000/- )  New benefit
20 Lasik Surgery This extension covers charges incurred towards
correction of refractive errors by using lasik surgery in case of compound myopic astigmatism in
both eyes to the level of (- )7.5D and above.
 If power of eye is above +/- 7.5, is payable
21 Special conditions for new joiners   9 months waiting period Applicable for maternity For exisitng members not applicable
3  months Waiting period Applicable for all planned surgeries/ treatments/ any aliment incl covid
22 In case of Death of Member   Continued cover of dependants, No co pay or deductions on claims 
    PREMIMUM DETAILS    
SUM INSURED 5 LACS  10 LACS SI 25 LACS SI 30 LACS SI
PREMIUM INCL GST ₹ 62,745.00 ₹ 70,500.00 ₹ 79,947.00 ₹ 85,943.03
  This Premium is applicable only for members who have taken the policy wef 20th June 2021.  Premium is for a family of self + any 5 members as per the coverage (SUM INSURED)you would like to select For any new enrollment premium will be on pro-rata basis, pls share your family details to get the premium calculated from the Insurance Co.