Overview
The Oriental Insurance Mediclaim policy is a basic health insurance plan offering sum insured options from ₹1 lakh to ₹50 lakhs for individuals aged 18 to 65 years (extendable to 70). The policy includes benefits like daily hospital cash allowance and free health check-ups every three claim-free years. With lifelong renewability and cashless treatment across a wide hospital network (4,000+), it is a budget-friendly option for essential health coverage.
Experts' Review
Written by Nikhil Nair
Senior Writer
The Oriental Insurance Mediclaim policy is a straightforward, affordable health insurance plan suitable for individuals seeking basic coverage without frills. Its USPs include coverage for domiciliary hospitalization, organ donor expenses, and ambulance charges, which are not always standard in entry-level plans. The policy also offers a daily hospital cash allowance after two days of hospitalization and reimburses 50% of pre-insurance medical check-up costs, adding some preventive care benefits.
However, the plan has several limitations. The waiting period for pre-existing diseases is four years, longer than many competitors offering shorter waiting periods, although the specific illness waiting period ranges from 90 days to 3 years before claims can start.
Additionally, there is a 3-year waiting period for any pre-existing disease at the time of purchase. Room rent and ICU charges are capped, which can lead to out-of-pocket expenses if higher room categories are chosen. Maternity and outpatient benefits are not included, limiting its appeal for families. While premiums are competitive, the benefits are not comprehensive, making it less attractive for those seeking extensive coverage.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
No Restoration Benefit, which is a notable gap.
No Bonus for being healthy and not claiming insurance, which could be a drawback for some.
Maternity benefits not offered, which is a key feature.
Oriental Insurance
Key Insights
Founded
1947
Oriental Insurance was established 78 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
94% claims settled in 30 Days
Oriental Insurance settles 94% of all claims it receives demonstrating strong credibility.
Network Hospitals
4,000+
Oriental Insurance has a limited network of 4,000 hospitals, which may restrict access to cashless services for policyholders.
Complaints
7 complaints per 10,000 claims registered
Oriental Insurance maintains a low volume of complaints, reflecting strong customer satisfaction and effective service.
Features
All
Great
Good
Bad
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Customisable
Choose a co-payment between 10% and 20% to reduce premiums.
Room Rent
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for modern treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Personal Accident Cover
Lump sum payout based on the cover chosen, in case the insured encounters total permanent disability, permanent partial disability or accidental death.
Voluntary Co-Payment
Choose a co-payment between 10% and 20% to reduce premiums.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Hormone Replacement Therapy
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 3 years.
Benign ENT disorders and surgeries (e.g. Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty)
Polycystic ovarian diseases
Surgery of hernia
Surgery of hydrocele
Non-infective Arthritis
Waiting Period
30 days Initial waiting period
3 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
No Restoration Benefit.
No Bonus for being healthy and not claiming insurance.
Maternity benefits not offered.
Customer Reviews
A
Aakriti Sharma
Basic health insurance from a PSU, good for those who prefer government insurers.
B
Bhuvan Chandra
Sum insured options up to ₹50 lakhs, decent for basic needs.
C
Chetna Verma
Lifelong renewability is a good feature for long-term peace of mind.
L
Leena Pant
Features are very basic compared to modern private insurance plans.
J
Jhanvi Rawat
Room rent is capped at 1% of sum insured per day, which is very low for good hospitals.
H
Hemant Kumar
Daily hospital cash allowance can help with miscellaneous expenses.
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Frequently Asked Questions
Does Mediclaim Insurance Policy have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 1 to 3-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does Mediclaim Insurance Policy have room rent restrictions?
Does Mediclaim Insurance Policy offer a restoration benefit?
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