Oriental group mediclaim insurance policy

Oriental group mediclaim insurance policy

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Number of Employees

*Value should be between 2 and 500

20
  • 2
  • 100
  • 200
  • 300
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  • 500

Total estimated yearly premium

*only basic terms and conditions applied

100,000

₹ 5,000 per life

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Claim settlement ratio (2019-20)

93.96%

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Network hospitals

4,300+

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Total GHI lives insured (2020-21)

69.3 Lakhs

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Total GHI claims incurred (2020-21)

Rs 312 Crores

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TPA External

TPA

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About Oriental group health insurance

The Oriental Insurance Company Ltd. was established in 12th September 1947 at Mumbai. All shares of the Oriental Health Insurance Company held by the General Insurance Corporation of India were transferred to the Central Government in 2003.

The company consists of a highly trained and motivated workforce covering various disciplines with vast expertise. Oriental specializes in devising special covers for large projects. For eg: power plants, steel, chemical and petrochemical plants. The Oriental health insurance company also has a technically qualified and competent team of professionals who render the best customer service to create a seamless experience for its customers. 

With Pazcare, you can upgrade your Oriental group health insurance experience. While we get you the best group health insurance quotes for your employees at the best prices, the HR/Admin can administer the Oriental group health insurance in one place using our tech-enabled Pazcare dashboard. Also, the employer dashboard can also be integrated with the HRMS tools. 

How to buy Oriental group health insurance at Pazcare?

These simple steps allow you to purchase Oriental group health insurance online at Pazcare.

  1. Visit https://www.pazcare.com/ and click on the products drop down and choose group health insurance
  2. Fill in the information - your name, work email, phone number, company name and the number of employees you wish to insure in the form. 
  3. After submitting this form, our health insurance consultant will contact you within 24 hours. Tell us your requirements for the tailor-made group health insurance policy. These include the type of policy, sum insured, and many more.
  4. After this we will get back to you with competitive quotes from Oriental health insurance and a few other insurers.
  5. After you decide on the insurer and accept the terms and conditions of the policy, you process the payment.
  6. The onboarding process is carried out within 24 hours of making the payment. 

For further information, write to us at support@getpaz.com or call our customer care at +91 78291 11300. Alternatively, connect with us on Whatsapp using the number +91 81973 79596.

Types of Oriental group health insurance plans

The Oriental group health insurance has 2 plan types. They are

  1. Oriental Group Mediclaim Plan

Oriental Group Mediclaim Plan is a group health insurance policy that provides coverage to a group of family members or corporate employees. 

  1. Group Mediclaim Plans for Bank account Holder/Employee

In partnership with two of the most reputed government banks offering financial needs to a large section of society, Oriental Insurance offers its Group Mediclaim Plans.

Oriental Bank Mediclaim Plan is an exclusive group protection plan. It is provided to account holders of Oriental Bank of commerce account holders.

PNB Oriental Royal Mediclaim Plan is available to any account Holders or employees of Punjab National Bank.

Thana Janta Sahakari Bank Mediplus Plan is available to any account holders or employees of Thana Janta Sahakari Bank. It is a cooperative society bank registered under the cooperative act of Maharashtra.

Why choose Oriental group health insurance as your insurance partner?

Here is why you have to choose the Oriental group health insurance plan from Pazcare.

Best Claim Settlement Ratio

The oriental group health insurance has a very good claim-settlement ratio record. Currently at 93.96%, Oriental makes sure that you have the best insurance experience!

Over 4,300 Hospitals

With a presence in around 4300 cashless network hospitals, Oriental health insurance has a large healthcare network. 

70+ years of Industry Experience 

Oriental health insurance has more than 70 years of industry experience. It does not only make the company reliable but also more knowledgable. More experience builds more trust. 

Products Available in Digilocker App 

All the products of the Oriental health insurance can be found in the Digilocker App which belongs to the government of India. It doesn’t only make the products easily accessible but also makes them reliable and secure. 

Oriental group health insurance claim settlement ratio

A health insurance claim settlement ratio (CSR) is the ratio between the number of claims settled to the number of claims made or requested in a financial year by the health insurance company. 

Hence, a CSR ratio can be calculated as

Claim settlement ratio = Number of claims settled/Number of claims made*100

Financial Year Claim settlement ratio
2019-20 93.96%
2018-19 94.28%

Also Read: Claim Settlement Ratio- Definition, Significance & Types

Network hospitals of Oriental group health insurance

The health insurance companies have a list of network hospitals or cashless hospitals through which one can claim cashless treatment. Oriental group health insurance has around 4,300+ network hospitals located in pan India. This makes sure that you can get high-quality treatment near your location without having to travel long miles for a cashless claim.

Claim Oriental group health insurance

Oriental group health insurance cashless claim

With Oriental group health insurance you can make a cashless claim using the following steps.

  1. Find the nearest network hospital

The cashless claim facilities are available at a network hospital only. Hence, get to the nearest network hospital for treatment.

  1. Identity confirmation

The next step is to confirm your identity using the health insurance ID card or policy number, a valid photo ID like an Aadhar card, voter ID, driving license, etc and the company ID at the hospital.

  1. Fill out and submit the pre-authorisation form

Once the above proof is verified, the next step is to submit the pre-authorization form to Oriental health insurance. For emergency hospitalization, the form is submitted within 48 hours of hospitalisation. In the case of planned hospitalisation, it is submitted 3 days before the hospitalisation. 

  1. Request reviewing

After the form submission, Oriental health insurance will review the cashless claim request and the network hospital will be notified about the claim decision. You will be notified through an email or a message.

  1. Settlement of the claim

Once all of this is done and the insurer accepts your claim request. The claim is settled directly with the network hospital according to the terms and conditions of your policy.

Oriental group health insurance reimbursement claim

In case you get hospitalised at a non-network hospital, the reimbursement claim from Oriental group health insurance can be carried out by the following steps.

  1. Intimate your insurance company

The first step is to inform your insurer about the hospitalisation. In case of emergency hospitalisation, inform the insurer within 48 hours of hospitalisation. Whereas, in case of a planned hospitalisation inform at least 3 days before the hospitalisation.

  1. Settle all the bills at the hospital

After you get treated at a non-network hospital, settle all the bills out of your pockets at the hospital.

  1. Collect all the relevant documents

After you settle all the bills, make sure you have all the original copies of all the required documents to file for a reimbursement claim. 

  1. Submitting the documents

After collecting all the relevant documents, submit them to the nearest Oriental health insurance branch within 15 days of discharge. 

  1. Processing of the claim

Once the documents are submitted, the insurer will review your documents and reject or approve the reimbursement claim request. This will be done as per the terms and conditions of your policy. Once approved, the claim will be settled in your bank account. You will be notified about the claim approval/rejection via SMS or your registered email.

You can also contact us at support@pazcare.com, to guide you through the whole process. We provide 24X7 claim assistance for your employees. 

Oriental group health insurance renewal process

The Oriental group health insurance can be renewed easily with Pazcare at end of your policy term. Here are the steps to renew your Oriental group health insurance plan.

Step 1: Get in touch with Pazcare. Submit a form containing details like your name, name of the company, number of employees you wish to insure, work email address and phone number.

Step 2: Once the form is submitted, our consultants will get in touch with you. Since this is not a fresh policy, you will have to submit the following documents.

  • Active data of the employees - name, age, gender
  • Claim analysis report
  • Claim dump report from the insurer/TPA
  • Policy copy

Step 3: You can choose additional add-ons to your existing policy like dental insurance riders, maternity insurance riders to your existing policy. Furthermore, with Pazcare one can choose additional health and wellness add-ons to your Oriental group health insurance. These add-ons include wellness and therapy sessions, unlimited doctor consultations, comprehensive check-ups, and many more.

Step 4: Our consultants will get back to you with the competitive quotes for your Oriental group health insurance.  Based on your claims report and the add-ons you choose, your health insurance premium may vary from the previous financial year.

Step 5: The next step is to agree to the terms and conditions of the policy and pay the premium for your Oriental group health insurance policy. The policy will be usually valid for a year after the renewal.

Step 6: In case, you are purchasing your Oriental group health insurance for the first time with Pazcare, the onboarding process will be carried out in 24 hours. During this period, our associate will get in touch with you and provide you with all the essential information to get started with your group health insurance. 

We make sure that your Oriental group health insurance experience will be seamless using our Pazcare dashboard. Your employees can access their policy using Pazcare’s employee app which is available on both the app store and the play store. 

What is covered under your Oriental group health insurance?

Your group health policy is tailor-made according to your preferences. Here is what your Oriental group health insurance covers.

Room charges and domiciliary treatments

The oriental group health insurance covers hospital room charges including nursing and boarding expenses. It also provides domiciliary charges in case of home hospitalisation. 

ICU and additional expenses

ICU expenses are covered in the Oriental group health insurance policy. Additional charges like surgical expenses, blood, anaesthesia, etc are also covered. 

Expenses for Pre and post-hospitalisation 

Oriental group health insurance provides cover for your pre and post-hospitalisation expenses which can be claimed 30 to 60 days respectively before getting hospitalised.

Daycare treatment

Expenses incurred due to daycare treatment are included under the Oriental group health insurance. 

Maternity benefits

An optional maternity benefit including cover for a newborn child is covered under the Oriental group health insurance. 

Accidental hospitalisations coverage

In case of any hospitalisation expenses due to accidents, your group health insurance policy covers these medical expenses. These hospitalisations must be for more than 24 hours and coverage is limited to India only.

What is not covered under your Oriental group health insurance?

Injuries due to participation in dangerous sports

In case of participation in any dangerous sports and incurred injuries, the Oriental group health insurance policy does not cover the same. 

Pre-existing diseases

Under the Oriental group health insurance plan, any pre-existing diseases till the 4 years of commencement of the policy with not be covered. 

Newly incepted disease

Any newly incepted diseases 30 days from the commencement of the Oriental group health insurance policy is not covered. 

Treating obesity

The Oriental group health insurance policy does not cover any expenses incurred due to the treatment of obesity. 

Oriental group health insurance benefits 

Benefit of portability

Oriental Health Insurance policy provides a benefit of portability. This means that in case you are unhappy with your current health insurance provider, you can always switch to oriental health insurance without losing any perks or benefits. These perks and benefits might include no claim bonus, waiting period benefits, etc. 

Wide Range of Options for Sum Insured 

Fulfilling varied requirements of different sections of the country, Oriental Health Insurance plans offer a wide range of sum insured options. Plans start from Rs 1 lakh to Rs 30 Lakhs. 

Benefits of Lifetime Renewability 

As long as you pay your premiums on time, Oriental group health insurance provides a lifetime renewability benefit. You can enjoy the perks and benefits for a lifetime using Oriental health insurance plans. 

Restoration of Sum Insured

If your sum insured is reduced due to claims that were made during the policy term, it gets restored. 

Oriental group health insurance premium

The Oriental group health insurance premium is directly proportional to the risks involved. Make sure you use Oriental group health insurance premium calculator to estimate cost for your policy. There are also certain factors which influence the premium for your group health insurance policy is calculated. They are

Average age 

The premium is calculated based on the average age of the people insured. The younger the age, the lower the premium. This is because the younger generation poses lesser health risks. 

Type of plan opted

Different types of group health insurance policies opted are employee only (E), employee+spouse+children (ESC) and employee+spouse+children+parents (ESCP) plans. The number of people covered under the ESCP plan is higher than the ones covered in the E plan. Hence, the premium will be higher when the scope of coverage is higher.

Nature of the job

The nature of the job one performs is also a factor considered to decide the annual premium. Jobs associated with more risks will have a higher premium compared to the lower-risk jobs. For instance, employees working in a factory will have higher group health insurance premiums than the ones working in the IT industry.

Sum insured

Sum insured is the maximum amount that an insurance company will pay you in case of any hospitalisation in a particular year. If the hospital expenses cross the sum insured, it will be paid by the policyholder itself. So the higher the sum insured, the higher the premiums paid towards the group health insurance policy.

Add-ons opted

The add-ons opted for say, maternity insurance riders, dental insurance riders along with the existing group health insurance policy will increase your group health insurance premium. The premium increases depending on the type of add-ons opted for.

Claims history

In the case of a group health insurance policy renewal, the claim history is considered to calculate the premium for that particular financial year. If the number of claims raised in a previous financial year is higher, then the premium towards the policy will increase during the policy renewal.

For instance, let a company named XYZ wants to renew their Oriental group health insurance policy for 2022. The premiums paid by them for 2021 were ₹35,000. If the number of claims raised during 2021 is higher than that of 2020, then the premiums for 2022 will be greater than ₹35,000.

Check Out: Kotak Mahindra Group Health Insurance

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Oriental group health insurance claim process

1

Intimate your insurer

Intimate your claim to the insurer within 48 hours, in case of an emergency and at least 3 days prior in case of a planned hospitalisation.

2

Verify your identity

Provide the proof of identity - policy number/health insurance ID card, company ID and a valid unique govt. ID card.

3

Submit the pre-authorization form

Fill out the pre-authorization form and hand it over to the hospital.

4

Claim settlement

Once the details are verified. The claim will be settled directly at the network hospital.

5

Contact us for assistance

For any questions or assistance contact Pazcare at support@getpaz.com or call us at +91 78291 11300.

1

Intimate your insurer

Intimate your claim to the insurer within 48 hours, in case of an emergency and at least 3 days prior in case of a planned hospitalisation.

2

Settle your bills

Settle all your bills and collect the original copies of hospital bills, doctor consultation reports and other essential documents.

3

Submit the documents

Submit these original documents along with the claim form to the insurer.

4

Claim settlement

Once verified, the claim will be settled in your bank account directly.

5

Contact us for assistance

For any questions or assistance contact Pazcare at support@getpaz.com or call us at +91 78291 11300. We will guide you through the process.

Oriental group health insurance cashless network hospitals

Oriental group health insurance reviews

4.1 / 5

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Rating based on
(6596 reviews)

Aveek

5 / 5

5 / 5

The claims settlement process was super quick and hassle-free. Truly an amazing experience.

Rahul

5 / 5

5 / 5

Enjoyed all the wellness sessions. Also, the customer support team is really amazing. Good experience overall.

Kartik

5 / 5

5 / 5

Loved the customer support experience. Team helped us in each and every step. Good job guys!

Kantamneni

5 / 5

5 / 5

The claims settlement process was super smooth. Thanks team Pazcare.

Kshitij S

5 / 5

5 / 5

The policy offerings are very transparent and were explained clearly. Overall, great experience.

Mahima P

5 / 5

5 / 5

The customer support executives answered our questions regarding the claim process quickly. Great job guys!

4.6 / 5

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Rating based on
(3023 reviews)

Aveek

5 / 5

5 / 5

The claims settlement process was super quick and hassle-free. Truly an amazing experience.

Kantamneni

5 / 5

5 / 5

The claims settlement process was super smooth. Thanks team Pazcare.

4.4 / 5

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Rating based on
(2193 reviews)

Kartik

5 / 5

5 / 5

Loved the customer support experience. Team helped us in each and every step. Good job guys!

Mahima P

5 / 5

5 / 5

The customer support executives answered our questions regarding the claim process quickly. Great job guys!

4.8 / 5

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Rating based on
(913 reviews)

Kshitij S

5 / 5

5 / 5

The policy offerings are very transparent and were explained clearly. Overall, great experience.

4.2 / 5

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Why buy a group health insurance
policy online from Pazcare?

  • Choose the suitable policy with our consulting approach
  • Custom-made plan with health and mental wellness add-ons
  • The tech-enabled Pazcare dashboard to manage endorsements
  • Integrate the dashboard with your HRMS tool
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Oriental group health insurance customer care number

For any queries or assistance, reach out to us at any time. We provide 24X7 customer assistance.

Oriental group health insurance

Frequently asked questions around Oriental group health insurance

How can I renew my Oriental group health insurance?

To renew your Oriental group health insurance, here are the steps to follow. Firstly, get in touch with Pazcare. Fill out a basic form containing details like your name, contact number, work email id and the number of employees you wish to cover. Once submitted our group health insurance experts will get in touch with you within 24 hours and provide you with the necessary details about the Oriental group health insurance renewal.

What is the customer care number of Oriental group health insurance?

The customer care number of Oriental group health insurance is 1800 118 485. The policyholders can use the email id csd@orientalinsurance.co.in  for any customer support.

How can I access the Oriental group health insurance premium calculator?

Use the Oriental group health insurance premium calculator here. The premium for your group health insurance is mostly calculated based on factors like the average age of the employees, the number of employees covered, the type of policy opted, the sum insured preferred, and many other factors like add-ons opted, and risks involved in the job.

What is the claim settlement ratio of Oriental group health insurance?

The claim settlement ratio of Oriental group health insurance for the financial year 2019-20 is 93.96%.