Health Insurance 727 views February 12, 2021

Oriental Insurance Jan Arogya Policy will provide reimbursement of hospitalization or domiciliary hospitalization expenses in case of illness, diseases, or injury during the policy period. The company shall pay the amount for illness or injury treatment if it is considered reasonable and necessary, but such claim amount should not exceed the policy sum insured in any insurance period. If you want to know more further about the Oriental Insurance Jan Arogya Policy coverage and exclusion, read this page below.

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Coverage Under Oriental Insurance Jan Arogya Policy

Oriental Insurance Jan Arogya Policy will pay for the following expenses –

  1. Room and boarding expenses of hospital/nursing home
  2. Nursing expenses
  3. Pre-hospitalization expenses up to 30 days
  4. Post-hospitalization expenses up to 60 days
  5. Surgeon, anesthetist, medical practitioner, consultants, specialists fees
  6. Cost of anesthesia, blood, oxygen, operation theatre, surgical appliances
  7. Medicines & Drugs
  8. Diagnostic materials and x-ray, dialysis, chemotherapy, radiotherapy cost
  9. Pacemaker, artificial limbs and the cost of organs

Note – The company’s liability of all claims admitted during the period of insurance will not be more than the sum insured of INR 5,000/- per person.

Exclusion from Oriental Insurance Jan Arogya Policy

The company will not be liable to pay for the following: under this policy –

  1. Any diseases that are in existence at the time of submitting the insurance proposal form (pre-existing diseases). This includes any condition, ailment or injury for which the insured had signs or symptoms. It won’t be covered for up to 48 months.
  2. Any hospitalization cost incurred during the first 30 days from the commencement date of insurance. This won’t apply in case of injury due to an accident.
  3. In the first policy year, the expenses on treatment of diseases such as cataract, benign prostatic hypertrophy, hysterectomy for menorrhagia or fibromyoma, hernia, hydrocele, congenital internal diseases, fistula in anus, piles, sinusitis and related disorders will not be covered.
  4. Injury or disease arising from or attributable to war, invasion, an act of foreign enemy or warlike operations
  5. Circumcision unless necessary for an illness or injury treatment
  6. Vaccination or inoculation
  7. Change of life, cosmetic or aesthetic treatment like plastic surgery
  8. Cost of spectacles and contact lenses, hearing aids
  9. Dental treatment or surgery (unless requiring hospitalization)
  10. Convalescence, general debility, “run-down” condition or rest cure
  11. Congenital external disease/defects /anomalies
  12. Sterility
  13. Venereal disease
  14. Intentional self-injury
  15. Use of intoxicants such as drugs/alcohol
  16. Human T- Cell Lymphotropic Virus type III (H.I.L.B-III), Lymphadenopathy Associated Virus (LAV), Mutants Derivative, Variations Deficiency Syndrome or any Syndrome referred to as AIDS.
  17. Hospital or nursing home charges for diagnostic tests, if it is not incidental to the diagnosis and treatment of the positive existence or presence of any ailment, sickness or injury.
  18. Vitamins and tonics expenses unless they are a forming part of treatment for injury or disease
  19. Injury or disease caused by or contributed to nuclear weapons/materials
  20. Treatment traceable to pregnancy, childbirth including the caesarian section
  21. Voluntary medical termination of pregnancy
  22. Naturopathy treatment

Eligibility for Oriental Insurance Jan Arogya Policy

You can purchase the Oriental Insurance Jan Arogya Policy if your age is between 5 years and 70 years. And children between the age of 3 months and 5 years of age can be covered under this policy, provided one or both parents are covered concurrently.

Free Look Period of Oriental Insurance Jan Arogya Policy

You will have a free look period of 15 days from the date of receipt of the policy within which you can read its terms and conditions and return the same if not acceptable.

Note:- The free look period will apply in case of fresh policies only.

Claim Procedure of Oriental Insurance Jan Arogya Policy

You need to send a preliminary notice of claim to the company with particulars like policy number, name of the insured person who is admitted, nature of illness/injury, name and address of the attending medical practitioner’s clinic, hospital or nursing home. And this notice should be sent within seven days from the date of hospitalization, injury or death.

And along with the duly filled claim form, you need to submit the following documents to the company –

  1. Hospital Receipts
  2. Bills/Cash Memos
  3. And other documents as listed in the claim form

You should submit the above-mentioned documents to the company within 30 days from the date of discharge from the hospital. All claim payments shall be in INR only. Also, all the medical treatments for this insurance policy must be taken in India only.

NOTE – Waiver of the time limit in case of claim may be considered in extreme cases of hardship where it is proved to the company that there are circumstances in which the insured can’t send the claim notice within the prescribed time limit.

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