Insurance Plans September 22, 2020

Oriental Happy Cash-Nischint Rahein

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:-

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  1. A family discount of 5% (if more than one person is covered) and 7.5% (if more than 2 persons are covered).
  2. A loyalty discount of 10% (for the insured who is covered under Oriental’s health insurance policy before the inception of the policy). To be eligible for this discount on renewal, such a policy should be in force at the time of renewal.
  3. A staff discount of 33% (for the employees of the Oriental Insurance Company Ltd.)

Read this page below and know the Oriental Happy Cash-Nischint Rahein plan coverage, exclusion, and other important details.

List of Covered Benefits Under Oriental Happy Cash-Nischint Rahein

This Oriental Health Insurance Policy will cover the insured and any one or more family member as per the details mentioned below:-

  1. Legally wedded spouse
  2. Dependent children (whether own or legally adopted child of 3 months to 18 years. Of age). A boy child can be covered up to the age of 25 years if he is a bonafide regular student and financially dependent on the insured. The Girl Child can be covered until she gets married. Divorced and widowed daughters are eligible for further coverage under the policy, irrespective of age.
  3. Parents
  4. Parents-in-law

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.

Convalescence Benefit

If a single hospitalization continues for a period exceeding the Daily Cash Benefit period, a lump sum amount becomes payable towards convalescence,

  1. An admissible claim under Daily Cash Benefit
  2. It is payable only once per insured during any one policy period
  3. The liability will be mentioned in the policy schedule
  4. The payment is in addition to the payment made under Daily Cash Benefit

Exclusions from Oriental Happy Cash-Nischint Rahein Policy

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.

  1. Diabetic Retinopathy
  2. CerebroVascular accident
  3. Diabetic Nephropathy
  4. Diabetic Neuropathy
  5. Hypertensive Nephropathy
  6. Diabetic Foot or wound
  7. Internal Bleed
  8. Haemorrhages
  9. Diabetic Angiopathy
  10. Coronary Artery Disease
  11. Hyper or Hypoglycemia shocks

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.

  1. Injury or illness due to War, Invasion, an Act of a Foreign Enemy, War like operations, or by nuclear weapons or materials.
  2. Circumcision (Unless treatment is necessary as per the medical practitioner, a surgeon for the covered illness or injury)
  3. Vaccination (Except for dog bite or the bite of any rabid animal)
  4. Inoculation, change of life, cosmetic, or aesthetic treatment of any description
  5. Plastic surgery unless necessitated due to an accident or covered illness
  6. Surgery for correction of eyesight
  7. Any dental treatment or surgery which comes under the category of corrective, cosmetic, or aesthetic procedure. It also includes filling of cavities, crowns, root canal treatment, etc, unless it is necessitated by the medical practitioner for the covered disease or injury treatment.
  8. Convalescence, general debility, “run-down” condition, rest cure, congenital external diseases, defects, anomalies, sterility, any fertility, sub-fertility, assisted conception procedure, venereal diseases, intentional self-injury, suicide, all psychiatric and psychosomatic disorders, diseases, accident due to misuse of drugs and alcohol or any intoxicating substance
  9. Any illness arising out of any condition which is associated with or caused by the following:- Human T-cell Lymphotropic Virus Type III (HTLD – III), Lymphadenopathy Associated Virus (LAV), Mutants Derivative, Variations Deficiency Syndrome , Any syndrome or condition of a similar kind such as AIDS, HIV and their complications including sexually transmitted diseases.
  10. Any illness arising out of pregnancy, childbirth, miscarriage, cesarean, abortion, or complications of any of these and proved by diagnostic life-threatening by the attending Medical Practitioner, if left untreated, except for abdominal operation for extra uterine pregnancy (ectopic pregnancy).
  11. Naturopathy treatment, unproven procedures/treatments, experimental or alternative treatment (Except for Ayurveda, Unani & Homeopathy), and other related treatments like acupressure, acupuncture, and magnetic are excluded from the Oriental Happy Cash-Nischint Rahein policy
  12. Hospitalization for investigation or treatment of an uncovered disease
  13. Genetic disorders treatment and stem cell implantation or surgery
  14. Change of treatment from one system of medicine to another (Unless allowed or recommended by the Medical Practitioner or Consultant under whom the treatment is currently being taken)
  15. Obesity treatment or any condition arising from (including morbid obesity) and weight control program such as services or supplies.
  16. If the insured participates in a hazardous activity like scuba diving, motor racing, parachuting, hang gliding, rock or mountain climbing and similar activities unless agreed and endorsed in the policy.
  17. Convalescent home, convalescent hospital, health hydro, nature care clinic, or similar establishment treatments.
  18. Stay in hospital expenses unless no active regular treatment is given by the specialist
  19. Hormone replacement therapy, Sex change, or any related treatment to sex change
  20. Massages, Steam bathing, Shirodhara, and other Ayurvedic treatment

Notice for the Oriental Happy Cash-Nischint Rahein Policy

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.

  1. Discharge certificate or card from the  Hospital or a Nursing Home
  2. All the documents related to the illness
  3. Doctor’s consultation reports and the insured’s medical history
  4. Pathological and other test reports from a pathologist or radiologist
  5. Attending Consultants, Anaesthetists, Specialist certificate regarding the diagnosis of the illness
  6. MLC, FIR, Post Mortem Report (if required)
  7. Details of previous health insurance policies, if you haven’t shared it with the TPA.
  8. Any other information required by the company or TPA

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.

Oriental Happy Cash-Nischint Rahein Policy Cancellation Clause

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.

  1. Up to 1 month – the risk rate is 1/4th of the annual rate
  2. Up to 3 months – the risk rate is 1/2 of the annual rate
  3. Up to 6 months – the risk rate is 3/4th of the annual rate
  4. Above 6 months – the risk rate is equal to the annual rate

Oriental Happy Cash-Nischint Rahein Policy Benefits

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.

Free Look Period for Oriental Happy Cash-Nischint Rahein Policy

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:

  1. A refund on the premium less medical examination and stamp duty charges
  2. A deduction towards the proportionate risk premium for the covered period if the risk has already commenced
  3. A deduction proportionate to the risk premium in proportion with the risk covered when only a part of the risk is commenced during the free look period

Note: The free look period is not applicable in the case of policy renewal

Oriental Happy Cash-Nischint Rahein Policy Renewal Clause

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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