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Oriental Happy Family Floater Policy
250+ Plans 18 Insurance Companies
₹ 5 Lakh Coverage @ ₹ 10/day
7 Lakh+ Happy Customers

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply

Oriental Happy Family Floater Policy

With its foundation laid on 12th September 1947, Oriental Insurance Company Ltd. which is a subsidiary of Oriental Government Security Life Assurance Company limited provides a mega range of insurance products for the rural and urban population of India. It has a countrywide presence with 31 regional offices and 1800 pus operating offices in the country. Oriental Happy Family Floater Policy is one of its popular products that cater to the insurance needs of a family.

What’s Oriental Happy Family Floater Policy?

The Oriental Happy Family Floater Policy covers affordable and customized plans, medical expenditures and other contingency charges with respect to hospitalization, domiciliary hospitalisation and medical costs owing to any ailment, injury or accident for treatment that is medically necessary for Illnesses, contracted diseases or suffered or sustained an injury by the policyholder. Providing comprehensive health coverage to individual and whole family, which comprises of self, spouse, children, parents, and parents-in-law during the tenure of the policy, up to the specified limit of the basic sum insured, as mentioned in the policy terms and conditions.

Happy Family Floater Policy is available in three different variants, namely Silver, Gold, and Diamond, which can be taken by the policyholder as per the budget and convenience. Each variant comes under a customized sum insured offering a unique and distinct coverage option like in-patient expenses, domiciliary expenses, pre and post hospitalization expenses and additional riders or value-added service like sum insured auto restoration, Life Hardship Survival Benefit, personal accident cover etc. can also be amalgamated with the original Oriental Happy Family Floater Policy.

Features of the Oriental Happy Family Floater Plan

Some of the key features of this policy include:

Sum Insured

• Rs 2 lakh to Rs 20 lakh

• Existing Insured Persons – may continue with Rs 1 lakh Sum Insured

• Existing policyholders covered for Sum Insured of Rs 1.5 lakh can opt for Sum Insured of Rs 1 lakh

Plans available

Silver, Gold and Diamond

Basis of the policy

A family floater policy which covers the insured and his family under one sum Insured in one policy

Maximum Entry Age

65 years but can be extended to 70 years under certain conditions

Medical screening

For Silver and Gold Plans, it is required for aged 60 years and above.

For Diamond Plan – it is required for persons aged 55years and above

Term of the plan

1 year

Renewability

Lifelong

Pre-existing illnesses

After 4 consecutive years of the initiation of the plan

Free Look Period

15 days

Savings (all savings are as per the IRDAI approval. Standard T&C apply)

• 5.5% in premium if TPA services are not opted for.

• 5% savings is allowed on premium if the policy is purchased online, and no broker or agent is involved. Also available on renewals if no broker is involved.

Additional Benefits

Personal Accident Cover, diseases like cancer (IV) stage, End-stage Renal Disease, Stroke leading to Paralysis or paraplegia and Life Hardship Survival Benefit available at an extra premium

Tax Benefits

Tax exemptions available under Section 80D of the Income Tax Act, 1961. Individual Insured can claim a maximum exemption on a tax of Rs 25,000 annually on the premium paid towards health insurance premiums. In contrast, senior citizens can claim exemptions up to Rs 30,000 in a financial year. (Tax benefit is subject to changes in tax laws)

Network Hospitals

4300 plus

Incurred Claims Ratio

113.86%

Claim Settlement Ratio

99.48%

Room Rent

1% of sum Insured or Rs 10,000 + 0.5% of sum Insured depending on the plan

Co-Payment

Mandatory Co-payment of 10% up to 70 years of age and Additional 20% above 70 years

Restoration Benefit

The option of 50% or 100% restoration on payment of additional premium

Ayush Coverage

In the case of Ayurvedic, Siddha, Homeopathic or Unani treatment, hospitalization expenses are allowed if treatment is taken in a Government Hospital or a recognized Institute

Benefits of the Oriental Happy Family Floater Plan

The policy comes with multiple benefits, which can be availed through 3 plan options, namely Silver, Gold and Diamond. The scope of coverage can be categorized as below:

Parameters

Silver Plan

Gold Plan

Diamond Plan

Sum Insured

1 - 5 lakh

6 - 10 lakh

12, 15, 18, 20 lakh

Cash Allowance - (Daily Hospital)

NA

0.1% of the basic sum Insured (Rs 600 – Rs 1000) each day of In-patient hospitalisation for 10 days

0.1% of Basic Sum Insured (Rs 1200 - Rs 2000) each day of Inpatient-hospitalisation for 10 days

Allowance for Attendant

NA

Rs 500 each day of In-patient hospitalisation to a maximum of 10 days

₹1000/- each day of in-patient hospitalization to a maximum of 10 days

 

Benefit of the Organ Donor

10% - basic sum insured

10% - basic sum insured

10% - basic sum insured

Authorized Second Opinion (Medical) for 11 specified illnesses

Rs 5000 in policy tenure

Rs 10000 in policy tenure

Rs 15000 in policy tenure

Maternity Expenses (waiting period of 24 months)

NA

Not Applicable

Delivery or legal abortion of up to 2 in number with a waiting period of 24 months - 2.5% of the basic SI.

New-born Baby cover

Not Applicable

Not Applicable

Up to the age of 90 days for 2.5% of the basic sum insured

Restoring the Basic Sum Insured for SI varying between ₹3 lakhs - 10 lakhs

Options available:

a) 50% of the Basic Sum Insured

b) 100% of the Basic Sum Insured

Options available:

a) 50% of the Basic Sum Insured

b) 100% of the Basic Sum Insured

NA

Compulsory co-payment

10% - every claim

Not Applicable

Not Applicable

Maximum Entry

65 years of age

65 years of age

65 years of age

Extension - Maximum Age of Entry

Up to 70 years, with Co-payment of 20% for every claim.

Up to 70 years, with Co-payment of 20% for every claim.

Not Applicable


Premium to be Paid for Optional and Add-on Coverage

The below shows the various premium options to be paid towards optional and additional covers:

Coverage

Sum Insured

Premium to be paid

Restoration of Sum Insured- Only for Sum Insured between Rs 3 lakhs – Rs 10 lakh

50% of the sum Insured

 

100% of the sum Insured

 

15% of Total Premium

25% of Total Premium

Personal Accident

Ranging between Rs 1 lakh – Rs 20 lakh per Insured person

• 60 per lakh per person.

• Family savings of 10% if more than one member is covered

Life Hardship Survival Benefit

Plan A

Plan B

3% of Total Premium

5% of Total Premium


Inclusions of the Oriental Happy Family Floater Plan

This Oriental health insurancek policy considers the below expenses to be covered under its list of inclusions:

  • Room, Boarding and Nursing Expenses
  • Intensive Care Unit (ICU) Expenses
  • Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees
  • Expenses on Artificial Limbs and similar expenses, Anaesthesia, Surgical Appliances and Medicines & Drugs, surgeries and therapies like Chemotherapy and Radiotherapy, Blood, Oxygen and Operation Theatre Charges along with Diagnostic Material and X-Ray, Dialysis, Cost of Pacemaker and much more
  • Ambulance service charges
  • Pre and Post Hospitalisation Expenses
  • Domiciliary Hospitalisation
  • Geographical Extension to SAARC Countries (Expenses will be reimbursed, no Cashless Treatment)
  • Major Illnesses covered under critical illness cover -
  • Cancer
  • Renal Disease
  • Stroke resulting in Permanent Symptoms
  • Coma
  • All Cardiac conditions or surgeries
  • Major Organ or Bone Marrow transplantation
  • Paralysis of Limbs
  • Motor Neurone disease
  • All Brain related conditions or surgeries
  • Multiple Sclerosis
  • Liver failure
  • Asthma
  • Bronchitis
  • Chronic Nephritis
  • Diarrhoea and Dysenteries
  • Diabetes Mellitus or Insipidus
  • Epilepsy or Hypertension
  • Influenza, Viral, Cold and Cough
  • All Mental Disorders
  • Pyrexia lower than ten days
  • Tonsils and URT Infection and Laryngitis & Pharyngitis
  • Arthritis, Rheumatism and Gout.
  • Other Value Adds:
  • -Eye Cover
  • -Dental Cover
  • -Maternity Cover

Exclusions under the Oriental Happy Family Floater Plan

The policy doesn’t offer policy coverage for the below medical conditions:

  • Any disease/illness or hospitalization within 30 days of the policy period
  • Self-inflicted injury or attempted suicide
  • Illegal activity or use of alcohol or drug
  • Pregnancy, childbirth, miscarriage, and abortion
  • Congenital disease
  • Infertility and in vitro fertilization
  • Hospitalization due to war, riot, strike and nuclear weapons
  • Pre-existing diseases covered from 4th year onwards
  • Life hardship benefit for 180 or 270 days of survival after discharge
  • Medical issues pertaining to AIDS and mental illnesses not covered

Eligibility Criteria to Buy the Oriental Happy Family Floater Plan

The minimum eligibility criteria to buy this policy are:

 

Minimum

Maximum

Entry Age

5 years, 91 days for children

70 years

Number of Members

Max 4 adults and 4 children

7

Sum Insured

Rs 50000

Rs 10 lakh

Tenure of the Policy

1 year

1 year


Claim Process of the Oriental Happy Family Floater Plan

In order to experience a smooth claim settlement process with Oriental health insurance, the policyholder needs to follow the below claim steps without fail:

Step 1 - Notify the Claim: Immediate written or verbally informed notice of claim through the email or customer care helpline number with particulars and details relating to the policy like number, ID Card no., Name of the insured person, his personal details, nature of disease, injury or illness or injury, report from the treating doctor etc. should be sent to the insurer through the appropriate mode of communication. Even the claim can be registered by visiting the nearest branch within 48 hours of admission of the insured or before getting discharged from the hospital or nursing home.

Step 2 – To follow the complete procedure for availing cashless services in a network hospital or a nursing home:

If only the treatment of the insured is taken place at one of the network hospitals as provided in the policy documents or terms and condition of the document.

The insurance company has the right to reject or cancel any claim made by the insured on the basis of irrelevant information, false details, fraudulent statements or inappropriate medical details as provided by the insured to the insurance company or TPA. In such circumstances, the denial of Cashless Access shall not be construed as a denial of liability.

Authorization of the cashless facility may be withdrawn or put on hold if the insurance company requires additional documentation or if the registered details and documents submitted need further verification investigation, authorization and required approvals.

Step 3 - Claim Documents: Final claim form along with the relevant documents stated in the policy, should be submitted to the insurer within 15 days of discharge from the Hospital.

Step 4 - Payment Of Claim: All medical treatment for the purpose of availing claims by the insurance company will have to be taken in India with an exception where the policy has been extended to SAARC countries and all claims shall be payable in Indian currency only.

Required Documents to Process the claim

The following documents are required for claiming the policy:

  • A claim form which is properly filled and signed, along with ID proof and a copy of the policy and premium document
  • Hospital discharge report
  • Report of the doctors and the medical report, original reports of tests, x-rays, sonography etc.
  • Medical recovery report along with the prescription of the doctor
  • FIR in case of an accidental injury or death

How to Purchase the Oriental Happy Family Floater Plan?

The applicant can purchase the policy by visiting the nearest branch of the insurance company or contact a third-party representative or agent to help him find the best policy.

The easiest and most convenient way to purchase a policy is through online methods which are very simple and easy to follow. Online payment towards the policy can be made through paisawiki.com as well, and the relevant documents can be posted and received through email as a soft copy of the document. One just needs to visit Paisawiki website, go to the ‘health’ option, select the ‘buy policy’ tab, provide necessary information and buy the policy as suggested.

Documents Required to Purchase a New Policy

To buy this oriental health insurance policy, one has to furnish the following document:

  • Age Proof
  • Identity proof
  • Medical Certificate (If Required)
  • Address Proof

Renewal of Oriental Happy Family Floater Plan

The policy renewal option is a lifetime feature applicable for all customers, after gaining the apt approval from the insurer.

Renewal can be done online or through any of the registered offices of the Insurance company or an official website. One can also renew the policy through paisawiki.com by following the renewal steps on the website.

FAQs

Written By: Paisawiki - Updated: 12 February 2021

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