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Insurance Plans September 22, 2020
The Oriental Insurance Company Ltd. will provide financial support during the period of insurance if the insured contracts any disease, suffers from any illness, ailment, or sustain any bodily injury through an accident. Under the Oriental Happy Cash-Nischint Rahein policy, you can pay your medical bills, hospitalization expenses without any hassle. The insured just needs to pay a premium amount to avail of the policy benefits. And the insurer will provide you the following discounts:-
Read this page below and know the Oriental Happy Cash-Nischint Rahein plan coverage, exclusion, and other important details.
Table of Contents
This Oriental Health Insurance Policy will cover the insured and any one or more family member as per the details mentioned below:-
Daily Cash Benefit
If the insured person is hospitalized, the insurer will give a Daily Cash Benefit as per the policy schedule. This benefit is payable as per each continuous and completed period of 24 hours hospitalization. The company will pay for any number of hospitalizations during the policy period, which is subject to any single hospitalization not exceeding the Daily Cash Benefit period. However, in case the insured is hospitalized more than once for the same disease or accident, the aggregate number of days of hospitalization payable in the policy would be limited to the Daily Cash Benefit Period which is 30 to 60 days as selected by the Insured.
Note: Ayurvedic, Homeopathic, Unani treatments are payable in this policy only if the insured is hospitalized in a Government Hospital or a hospital associated with a Medical College.
If a single hospitalization continues for a period exceeding the Daily Cash Benefit period, a lump sum amount becomes payable towards convalescence,
The company isn’t liable to make any payment if the insured person is hospitalized in connection with or in respect of any pre-existing disease, which is excluded for 48 months since the policy begins. Pre-existing diseases are covered only if the policy continues for 48 months. The insurer will apply this condition after considering the date of inception of the first hospital cash policy. However, the renewals should have been continuous without any break in this period, subject to portability condition. The pre-existing exclusion is applied also to any complication(s) that are arising out of any pre-existing diseases. That is why the policy subject to the following exclusions to ensure whether or not the person is suffering from hypertension, diabetes, or both hypertension and diabetes at the time of the proposal.
Any disease which is contracted by the insured person during the first 30 days since the policy inception is not covered. However, it may not apply in case the insured is hospitalized for injuries due to an accident.
Note: If the policy continuity is not maintained, the subsequent cover will be treated as a fresh policy and the pre-existing exclusion will apply afresh. Similarly, if the Daily Cash Benefit is enhanced after the inception, the pre-existing exclusion will apply afresh for the enhanced portion.
Have a look at some of the other exclusions from Oriental Happy Cash-Nischint Rahein policy below.
You need to submit an immediate notice of claim with the company or TPA by Fax or Email if the insured is hospitalized. Submit the particulars like Policy Number, ID Card No., Name of the admitted insured person, Nature of the disease or injury, and Name and Address of the attending medical practitioner, Hospital or Nursing Home, etc. The notice should be given to the company or TPA within 48 hours of admission and also before getting discharged from the Hospital or a Nursing Home unless it is waived in writing by the company official.
The following are the documents you need to submit along with a duly filled claim form within 15 days of discharge from the Hospital or Nursing Home.
The photocopies of the documents are accepted in case the hospitalization expenses are claimed from other sources (Employer, an insurance company, etc). For this, a written confirmation from such a source having received the claim documents is required. All documents must be duly attested by the insured person or claimant.
Note: Waiver is provided under the circumstances in which the insured or any other family member is unable to give such notice or file a claim within the prescribed time limit. Otherwise, the company will reject the claim. The company will settle the claim within 30 days of the receipt of the last ‘necessary’ document, except where fraud is suspected.
Disclaimer:- If the company shall disclaim liability and communicate in writing (either through the TPA or by itself) to the Insured in respect of any claim and such claim has not been made a matter of a suit in a Court of law within 12 calendar months from the date of such disclaimer, the claim shall for all purposes be deemed to have been abandoned and cannot be recovered thereafter.
The company can cancel the Oriental Happy Cash-Nischint Rahein policy at any time on the grounds of the fraudulent claim and any malicious acts by the insured or their beneficiaries by sending a 30-day notice to the insured registered address. And in such an event, no refund can be made. The insured can also cancel this policy any time, and in such an event, the company will give a refund if no claim has been made during the policy period up to the date of cancellation. Check out the pointers below to know about it.
The policy will provide you four options of Daily Cash Benefits – INR 500, 1,000, 2,000 and 3,000. Different insured persons may opt for different Daily Cash Benefits under this policy. For females, the Daily Cash Benefit is automatically increased by 25% without any extra premium.
Oriental Happy Cash-Nischint Rahein Policy provides you two options of Daily Cash Benefit Period of 30 days and 60 days per hospitalization. You get options of deductibles under the policy which are no deductible, 1 day and 2 days deductible. The deductible is applicable as per the hospitalization of the insured.
Note: All the insured persons under this policy must have identical Daily Cash Benefit Period and Deductibles. The Daily Cash Benefit, Daily Cash Benefit period and Deductible will be changed only at the time of policy renewal at the discretion of the company.
Under this policy, you get a free look period that is applicable at the inception of the fresh policy where the insured is allowed to review the terms and conditions of the policy and return the same, if not acceptable, within 15 days from the date of receipt of the policy. If the insured has not made any claim during the free look period, he/she will be entitled to the following:
Note: The free look period is not applicable in the case of policy renewal
You can renew your Oriental Happy Cash-Nischint Rahein policy before 30 days of its maturity. The company is not responsible for non-renewal in the case of non-receipt, delayed receipt of the premium, proposal form, medical practitioners’ report, or due to any other reasons. The decision to accept or reject the coverage of any person upon renewal of this policy will be done by the company.
The company, after getting approval from the authority, may revise the policy premium rates and the terms & conditions. Renewal is not automatic; and the due premium must have been paid by the insured before the due date. Any revision or modification in the policy will be notified to the insured three months in advance.
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