Floater Policy

THE ORIENTAL INSURANCE COMPANY LIMITED(A Government of India Undertaking)

HAPPY FAMILY FLOATER – THE HEALTH INSURANCE

FEATURES:• Single Sum Insured for entire family on Floater basis in one policy• The Sum Insured floats among all the beneficiaries under the policy • Policy available for the Ages between 3 months to 80 years at low premium• No pre-acceptance of Medical reports for persons till the age of 60 years• Cashless benefit in Networking Hospitals by appointed TPAs of the Company• Coverage for pre-existing conditions after 4 consecutive renewals with us • No cap/limit for per/Illness, per/Hospitalization, per/Person in a family• 5% No claim discount for each claimless year, subject to a maximum of 20% • Income tax exemption benefits under Sec-80D on premium paid upto Rs.15000• Cover available for Self, Spouse, Dependent Children, Parents or Parents-in-law• Facility for Mid-term inclusion of newly born children and newly married spouse• Migration permitted from our existing Mediclaim which protects policy experience• Various plans are available i.e., Silver, Gold, Gold with Hardship Plans A and B• Silver Plan is subject to 10% of co-pay and Sum insured ranging from 1 to 5 Lacs• Gold Plan with Sum insured 6 - 10 Lacs with Daily cash, Attendant Allow benefits • Gold Plan with Life Hardship Survival benefit upto 180 & 270 days – as per cover• Worldwide PA Cover: Accidental Death, Loss of Limbs/Eyesight & PTD - Addon Cover• 15% Discount under Overseas Medical Insurance (Travel) when this policy is taken

COVERAGES:· Room, Boarding and Nursing Expenses upto 1% of Sum Insured per day· Intensive Care Unit (ICU) Expenses upto 2% of Sum Insured per day· Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees· Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances· Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs· Cost of Prosthetic devices implanted during surgical procedure like pacemaker· Pre/Post-hospitalization benefits - 30/60 days - before/after hospitalization· Relevant Laboratory/Diagnostic test, X-ray etc · Domiciliary Hospitalization and Ambulance Service Charges - as per plan opted for

EXCLUSIONS:Pre-existing Diseases:· Any ailment/disease/injuries/health condition which are pre-existing, when the cover incepts for the

first time are excluded upto 4 years, under this policy being in force continuously · Any complications arising from any pre-existing ailment/diseases/injuries will also excluded· To apply this condition, the date of inception of this Mediclaim Policy taken from “Oriental” shall be

considered, provided the renewals have been continuous, without any break in periodSpecific Period:· During the coverage period, the expenses on treatment of following ailments/diseases/ surgeries for

specified periods are not payable, if contracted, during the commencement:Exclusions for 1 Year: · Benign ENT disorders and surgeries i.e., Tonsillectomy, Adenoidectomy· Polycystic Ovarian Diseases, Mastoldectomy, Tympanoplasty etcExclusions for 2 Years: · Surgery of Hernia, Hydrocele and Non Infective Arthritis and Undescendent Testes · Cataract operation and Surgery of benign prostatic hypertrophy · Hysterectomy of menorrhagia or fibromyoma or mymectomy or prolapse of uterus· Fissure/fistula in anus, Piles, Sinusitis and related disorders· Surgeries of gallbladder & bile duct, genitor urinary system, excluding malignancy· Pilonidal Sinus, Gout and Rheumatism, Hypertension and Diabetes, Calculus diseases· Surgery for prolapsed inter vertebral disk unless arising from accident· Surgery of varicose veins and varicose ulcers and Congenital internal diseasesExclusions for 4 Years:· Joint replacement due to Degenerative condition· Age related Osteoarthritis and Osteoporosis

First 30 Days:· Any disease other than those mentioned above, contracted by the Insured, during the first 30 days

from the commencement date of policy, except treatment for accidental external injuries

G.LINGACHARI, Cell:98856 32211 - for further details and purchase of this policy please contact immediately

P.T.O

OTHER EXCLUSIONS:

· Injury or disease arising from war, invasion, act of foreign enemy and the warlike operations· Circumcision, vaccination, inoculation or change of life or cosmetic or aesthetic treatment· Cosmetic surgery for correction of eyesight, cost of spectacles, contact lenses, hearing aids etc· Plastic surgery other than as may be necessitated due to any accident or as part of any illness· Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal

including wear and tear etc unless arising from disease or injury and which requires hospitalization for treatment· Convalescence, general debility, run down condition or test cure, congenital external diseases or defects or

anomalies sterility, any fertility, sub-fertility or assisted conception procedure, venereal diseases, intentional selfinjury/suicide, all psychiatric and psychosomatic disorders and diseases/accident due to and or use, misuse orabuse of drugs/alcohol or use of intoxicating substances or such abuse or addiction etc

· All expenses related to HIV - AIDS and sexually transmitted diseases· Expenses incurred not related to the active treatment for ailment/disease/injury· Expenses on vitamins and tonics unless certified by the attending physician related to treatment· Any treatment arising from/or traceable to pregnancy, childbirth, miscarriage, caesarean, abortion or

complications of any of these incl. changes in chronic condition as a result of pregnancy· Treatment of obesity or related weight control programme, services, supplies etc· Massages, steam bathing, shirodhara and alike treatment under Ayurvedic Treatment· Any kind of service charges/surcharges/Admission fees/Regn charges etc levied by hospital

Rest of all coverage, ratings, terms, conditions and exclusions of this policy are as per HAPPY FAMILY FLOATER policy/scheme of the companyMEDICAL REPORTS: (Above 60 Years)

► Physical Examination ► Urine (Micro albumin Urea) ► Glycocylated, Hemoglobin ► Ultra-sonography (Whole Abdomen and Pelvis) ► X-ray both knee (Ante posterior and lateral) ► Complete Eye Test, including Fundus etc ► Stress Test (TMT)

PREMIUM RATES: (The following premium rates are inclusive of Service Tax @ 10.30%)

Plan Sum Insured Primary Member’s Premium Dependent family Members’ Premium21-35 36-45 46-55 3M-20 21-35 36-45 46-55 56-60 61-70 Abv 70

Silv

er

Pla

n

1,00,000 1,456 1,743 2,724 265 287 353 540 772 1,445 1,9411,50,000 2,140 2,559 4,015 386 430 507 805 1,147 2,140 2,9012,00,000 2,746 3,287 5,206 496 552 662 1,037 1,489 2,791 3,8052,50,000 3,287 3,938 6,309 596 662 783 1,257 1,809 3,397 4,6663,00,000 3,838 4,588 7,423 695 772 915 1,489 2,129 4,015 5,5373,50,000 4,313 5,151 8,427 772 860 1,026 1,688 2,438 4,588 6,3424,00,000 4,787 5,714 9,442 860 960 1,147 1,886 2,735 5,162 7,1584,50,000 5,261 6,287 10,456 949 1,048 1,257 2,096 3,033 5,736 7,9755,00,000 5,736 6,850 11,471 1,037 1,147 1,368 2,294 3,331 6,320 8,791

Go

ld P

lan

6,00,000 7,875 9,398 15,674 1,423 1,577 1,875 3,133 4,544 8,603 11,9797,00,000 9,177 10,953 18,277 1,655 1,831 2,195 3,651 5,294 10,037 13,9648,00,000 10,479 12,508 20,869 1,886 2,096 2,504 4,169 6,055 11,471 15,9609,00,000 11,769 14,063 23,472 2,118 2,349 2,813 4,699 6,806 12,905 17,95710,00,000 13,071 15,607 26,075 2,349 2,614 3,121 5,217 7,567 14,339 19,942

Ha

rdsh

ip –

A

6,00,000 8,107 9,684 16,148 1,467 1,621 1,930 3,232 4,677 8,857 12,3437,00,000 9,453 11,284 18,828 1,710 1,886 2,261 3,761 5,449 10,335 14,3838,00,000 10,798 12,883 21,497 1,941 2,162 2,581 4,291 6,232 11,813 16,4359,00,000 12,122 14,482 24,178 2,184 2,416 2,901 4,842 7,015 13,291 18,49710,00,000 13,468 16,071 26,858 2,416 2,691 3,210 5,372 7,798 14,769 20,538

Ha

rdsh

ip –

B

6,00,000 8,273 9,872 16,457 1,489 1,655 1,974 3,287 4,776 9,034 12,5747,00,000 9,640 11,504 19,192 1,743 1,919 2,305 3,838 5,559 10,545 14,6598,00,000 11,008 13,137 21,917 1,985 2,206 2,625 4,379 6,353 12,045 16,7559,00,000 12,354 14,769 24,641 2,228 2,471 2,956 4,930 7,147 13,556 18,85010,00,000 13,721 16,391 27,376 2,471 2,746 3,276 5,482 7,942 15,056 20,935

Please contact immediately for further details and purchase of this policy - G.LINGACHARI, Cell:98856 32211


Head Office: Oriental House, PB No: 7037, Asaf Ali Road, New Delhi – 110 002

HAPPY FAMILY FLOATER – PROPOSAL FORM

● Proposal Form and Self Declaration Form to be filled in Block Letters and in Duplicate● Please attach two stamp size photographs of each insured person● The Company will not be on risk until the proposal has been accepted by the Company and communication of

the acceptance has been given to the proposer in writing on receiving full payment of premium● The insured above 60 Years of age has to undergo Pre-insurance Health Check Up through Company’s

authorized diagnostic centre and cost of such expenses to be borne by him.

01) PLAN OPTED (Please Put √ Mark, which ever is applicable)

Silver Plan Gold Plan Hardship – A Hardship – B

02) NAME OF THE INSURED PERSON AND RELATIONSHIP WITH THE PROPOSER

Sl Name of the Insured Relation SexWhether

DependentDate of Birth Age Occupation

Sum Insured

MEDICLAIM PA

01

02

03

04

05

06

03) ADDRESS OF PROPOSER

(Including TelephoneNumbers and E-mail ID)

:

Land Line : Mobile:

E-Maid ID :

04) PAN NUMBER (Issued by IT Dept)

:

05) FAMILY PHYSICIAN (Name, Address andTelephone Number)

:

Land Line : Mobile:

06) PLEASE FURNISH DETAILS OF ANY HOSPITALISATION / ILLNESS / DISEASE AT PRESENT OR IN THE PAST:

Sl Name of the Insured Name of InsurerType of Policy (Please specify) PA, Cancer, Mediclaim, Others

Policy NumberPolicy Period

From To

Contd ………….

:: 02 ::

07) PLEASE GIVE THE DETAILS OF ANY HOSPITALISATION / ILLNESS / DISEASE IN THE PAST 4 YEARS:Sl Name of the Insured Name of the Insurer Policy Number Sum Insured Period Remarks

08) HAS THE PROPOSER / ANY FAMILY MEMBERS BEEN REFUSED COVER FOR SIMILAR PROPOSER:Sl Name of Insured Refusal by Insurer Cancellation of Policy by Insurer

09) NAME OF THE NOMINEE IN THE EVENT OF DEATH OF INSURED DURING THE COURSE OF TREATMENT:Sl Name of Insured Name of the Nominee Relationship with Insured

10) PERIOD OF INSURANCE (Proposed Period)

:From : To :

I/we declare that the statements made by me/us in this proposal form are true and to best of my/our knowledge and beliefand I/We hereby agree that this declaration shall form the basis of the contract between me / us and The Oriental InsuranceCompany Limited.

I/We also declare that if nay additions of alterations are carried out after the submission of this proposal form and/orissuance of policy documents, the same would be conveyed to The Oriental Insurance Company Ltd.

I/We hereby agree to and authorize the disclosure to the insurer or the TPA or any other person nominated by the insurerany all Medical records and information held by any institution/Hospital or person from whom the insured person hasobtained any medical or other treatment to the extent reasonably required by either than insurer or the TPA in connectionwith any claim made under this policy or the insurer’s liability there under.

I/We further declare that/we have read the prospectus and have understood the same. I accept the policy, subject toterms, exceptions and conditions prescribed therein disclose that on the event of finding any thing contrary to what hasbeen declared by me. I/We shall be held responsible for all consequences thereof and Insurance Company shall incur noliability under this insurance.

I/We further declare that the Insurance Company shall not be liable to make any payment under this policy in respect of anyclaim if such claim be in any manner intentionally or recklessly or otherwise misrepresented or concealed or non disclosureof material facts or making false statements or submitting false bills whether by the Insured Person orInstitution/Organization on his behalf. Such action shall render this policy null and void and all benefits hereunder shall beforfeited. Company may take suitable legal action against the Insured Person/ Institution/Organization as per law.

Place : Signature of proposer :

Date : Name of the Proposer :

PROHIBITION OF REBATES (Section 41 of the Insurance Act 1938 Provides)

No person shall allow, or offer to allow, either directly or indirectly as an inducement to any person to take out or renew or continue aInsurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable ofany rebate of the premium shown on the policy nor shall any person taking out or renewing or continuing a policy accept any rebate exceptsuch rebate as may be allowed in accordance with the published prospectus or tables of the insurer. Any person making default incomplying with provision of this section shall be punishable with fine, which may extend Rs.500/-


Head Office: Oriental House, PB No: 7037, Asaf Ali Road, New Delhi – 110 002HAPPY FAMILY FLOATER – SELF DECLARATION FORM

01) PERSONAL DETAILS (Details of person, whowishes to propose HealthInsurance)

: Name of Insured Person :

Date of Birth and Age :

Address of Insured person :

Phone Nos and E-mail ID :

Photo ID with Age/DOB :02) PERSONAL DETAILS:

Particulars of any Illness/Disease/Disability Yes/No Details, if applicable

A Are you in good health and free from physical and mental diseases or infirmity or major complaints?

B Have you ever suffered from any of the following diseases/illness

01) Any Neurological/Mental or related diseases?

02) Slipped disc or other spinal disorder or paralysis of any kind or fainting episode, blackout, fit?

03) High Blood Pressure, Palpitation, Heart disease? (Including ischemic heart diseases, other circulatory disorders including rheumatic fever etc)

04) Diseases of uterus, ovaries, breast or any other gynecological disorder?

05) Fistula, Piles, Hernia, Varicose Veins etc?

06) Any disease of bones, joints, Arthritis including rheumatic disorders etc?

07) Any respiratory diseases?

08) Any allergic diseases?

09) Any dimness of vision or Cataract etc?

10) Any disease of ears or difficulty or interference with hearing etc?

11) Any disorder of the stomach, ulcer, bowel or gall bladder, kidney etc?

12) Cancer, Malignant Grown, Boil, Cyst or Wound etc?

13) Diabetes or any urinary diseases?

14) Genital Disorders?

15) Any cerebral or Vascular stores or sudden loss of consciousness or similar diseases?

16) Tuberculosis (TB)?

17) AIDS/HIV/Related disorders etc?

18) Congenital diseases (Since Birth)

19) a) Have you ever suffered from Dental problem? Yes/No

b) If yes, Please specify the same?

c) When were you treated last, for the same?

20) Any other complaint requiring specialist’s consultation / surgical / hospital treatment / investigations?

21) Any other complaint or tendency that may necessitate such consultation or treatment in the future?

C Have you noticed any sudden decrease or increase in your weight in past six months?

D Have you visited any Doctor / Hospital / Health care unit for evaluation of treatment in the recent past?

E If so, please give Hospitalization Details? (Attach copy of discharge summary & other relevant documents)

F Past surgical Details

a) Name of surgery or part operated?

b) Date of Operation?

c) Whether completely cured? If No, please furnish the details?

I/We, the undersigned hereby declare that all the information given by me/us in this form is true and I understand that anyof these details if found untrue on correlation with my medical test or medical examination before or after issuance ofpolicy will affect the coverage and payments of my health insurance benefit under this Mediclaim Policy.



















































































































































































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Floater Policy