List of Coverage Under Group Family Mediclaim Insurance Policy
By The Oriental Insurance Co. Ltd.
The insurance under this policy is subject to conditions, clauses, warranties and exclusions which are available on the policy terms and conditions.
In the event of a claim under the policy exceeding Rs. 1 lakh or a claim for refund of premium exceeding Rs. 1 lakh, the insured will comply with the provisions of the AML policy of the Company. The AML policy is available in all our operating offices as well as the Company's website.
Family Floater Coverage
Family Floater Cover: 1 + 3 (Employee + Spouse + 2 Children up to the age of 25 years)
Sum Insured: Rs. 2.00 Lakhs per family
Mid-Term Addition of Dependents: Allowed only in case of New Born Baby and Spouse in case of Marriage
All above terms and conditions are as per expiring policy terms and conditions.
22 Critical Illnesses
The critical illnesses listed below are covered up to the approved amount, subject to a maximum limit of ₹2 lakh only.
- Cancer
- Heart Attack
- Coronary Artery Disease
- Coronary Artery Bypass Surgery
- Heart Valve Surgery
- Surgery to Aorta
- Fulminant Hepatitis
- Kidney Failure
- End-Stage Renal Disease
- End-Stage Lung Disease
- End-Stage Liver Failure
- Coma
- Major Burns, Accidents and Infections
- Organ / Bone Marrow Transplantation
- Multiple Sclerosis
- Cerebro-Vascular Diseases / Stroke
- Motor Neuron Disease
- Bacterial / Viral Meningitis
- Terminal Illness
- Primary Pulmonary Hypertension
- Paralysis
- Aplastic Anemia
Coverage Details
Daily Room Rent Restriction
Normal Room: 1% of Sum Insured
ICU: 2% of Sum Insured
If the insured occupies a room with a room rent limit other than his eligibility as per the insurance policy, then all the other charges shall be limited to the charges applicable for the eligible room rent or actuals, whichever is lower.
Admissibility of all related expenses shall be on the basis of entitled room rent category vis-à-vis opted higher room rent except for Medicines / Pharmacy Bills and Body Implants.
Important Policy Condition
Warranted that in case the person covered under the policy has lodged any claim under the previous policy and the sum insured is enhanced under the current policy, for a further claim for the same disease during the current policy, the earlier limit of sum insured shall be applicable and not the enhanced sum insured.