Oriental Happy Family Floater 2015 Plan
Product Overview
Oriental Happy Family Floater 2015 Plan is an inpatient hospitalization policy which covers medical expenses following hospitalization/ domiciliary treatment due to Illness/ Diseases/ Accident.
Unique Features of Oriental Happy Family Floater 2015 Plan
- No pre-medical check-up for applicant up to Age 60 Years (Silver and Gold Plan) and 55 years in (Diamond plan).
- No Co-pay in Gold and Diamond Plan.
- Restoration of the Sum Insured - 2 Options available - 50% and 100% of the Sum Insured (Silver and Gold Plan with extra premium).
- Under the diamond plan there is a coverage for Maternity Benefit.
- Some Organ Specific Ailments/ Treatments are covered after 1 year like ENT disorder, etc.
- Geographical Extention to SAARC Countries.
OneInsure App Benefits
Store Digitally | Get Premium Reminders | Service and Claim assistances | Empower Nominee
Critical features of Oriental Happy Family Floater 2015 Plan
- Room rent:
Limits imposed towards room and ICU rent expenses
This Plan has 3 Variants Silver, Gold and Diamond Plan.
- Silver and Gold Plan - Room Rent - 1 % of the sum insured and Diamond plan - Rs 10,000 + 0.5% of the Sum insured per day.
- Silver and Gold Plan - ICU - 2% of the sum Insured and Diamond plan - Rs 20,000 + 1% of the Sum insured per day.
- Co-Pay:
Specific % of admissible claim amount to be borne by Insured
- 10% Co-payment in Silver Plan
- 20 % Co-payment on Extension Entry age between 66 and 70 years of age.
- No Claim Bonus:
Health Insurance policies may offer Cumulative Bonus wherein for every claim free year, the Sum Insured is increased by a certain percentage at the time of renewal
This plan does not have no claim bonus benefit. - Pre-Existing Diseases:
Means any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to the first policy issued by the insurer
This plans has a waiting period of 4 years is case of a pre-existing diseases.
Eligibility Criteria
- Minimum Age of Entry:- Children- 3 months to 25 years / Adult-18 years
- Maximum age of Entry:- 65 Years / Extension of Maximum Entry Age up to 70 Years with 20% Co-payment (Silver and Gold Plan)
- Renewal Age:- Life Long Renewal
- Sum Insured:-
Silver Plan - 1/2/3/4/5 Lakhs
Gold Plan - 6/7/8/9/10 Lakhs
Diamond - 12/15/18/20 Lakhs - Policy Tenure:- 1 year
- Family Definition:- Family floater - Self, Spouse, Children, Parent, Parent in law
- Premium Calculated on Basis of:- Age, (i.e. sum Insured Choosen)
Add-ons
- Geographical Extension to SAARC Countries:
The Policy can be extended to cover Insured Persons visiting other SAARC (South Asian Association for Regional Co-operation) countries -Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, Pakistan, Sri Lanka. No additional premium will be charged for this extension. - Restoration of Sum insured:
If during the Policy Period the Sum Insured gets reduced or exhausted on account of a claim under the Policy, the Sum Insured is automatically restored to the extent of the claim amount but not exceeding the Restoration limit opted (50% / 100% of Sum Insured) at the inception of the Policy. - Personal Accident Cover:
If at any time during the currency of the Policy, the Insured Person sustains any bodily Injury will be covered as below:
- Death - 100% of CSI
- Loss of two entire limbs, or sight of two eyes or one entire limb and sight of one eye: 100% of CSI
- Loss of one entire limb or Sight of one eye: 50% of CSI
- Permanent Total Disablement: 100% of CSI
- Life Hardship Benefits:
If during the Policy Period, any Insured Person is diagnosed with any of the 11 critical Illnesses, then a survival benefit shall be paid as give below.
Cancer, First Heart Attack, Open Chest CABG, Open Heart Replacement or Repair of Heart Valves, Coma of Specified severity, Kidney Failure, Stroke MajorOrgan/ Bone Marrow Transplant, Permanent Paralysis of Limbs, Motor Neuron disease with permanent symtpoms, Multiple Sclerosis with persistent symptoms.
| Plan | Total Amount Payable | Amount payable on survival for 180 days and above from the date of discharge from the Hospital (the first discharge date when more than one Hospitalisation is involved) | Amount payable on survival for 270 days and above from the date of discharge from the Hospital (the first discharge date when more than one Hospitalisation is involved) |
| A | 15% of the Sum Insured under the policy | 5% of the Sum Insured | 10% of the Sum Insured |
| B | 25% of the Sum Insured under the policy | 10% of the Sum Insured | 15% of the Sum Insured |
Additional Discounts
- No Claim Discount/ Loading:
This is a one-time benefit for those Insured Persons covered under Happy Family Floater Policy. Happy Family Floater Policy had the provision of No Claim Discount / Loading, which has been discontinued under Happy Family Floater Policy-2015.
Waiting Period
- Covered from Day 1:
Accidental Injuries. - Covered after 30 Days:
All incidences apart from specified surgeries, Permanent exclusion & Pre-existing diseases (if any) - Covered after 1 Year:
Benign ENT disorders and surgeries i.e. Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty etc,Polycystic ovarian diseases - Covered after 2 Years:
Surgery of hernia, Surgery of hydrocele, Non infective Arthritis, Undescendent Testes, Cataract,Surgery of benign prostatic hypertrophy, Hysterectomy for menorrhagia or fibromyoma or myomectomy or prolapse of uterus, Fissure / Fistula in anus, Piles, Sinusitis and related disorders, Surgery of gallbladder and bile duct excluding malignancy, Surgery of genito urinary system excluding malignancy, Pilonidal Sinus, Gout and Rheumatism, Hypertension, Diabetes, Calculus diseases, Surgery for prolapsed inter vertebral disk unless arising from accident, Surgery of varicose veins and varicose ulcers, Congenital internal diseases. - Covered after 4 Years:
Joint Replacement due to Degenerative condition,Age related osteoarthritis and Osteoporosis.
Exclusions
- Expenses attributable to self-inflicted injury (resulting from suicide, attempted suicide)
- Expenses arising out of or attributable to alcohol or drug use/misuse/abuse
- Medical expenses incurred for treatment of AIDS
- Treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion and its consequences
- Tests and treatment relating to infertility and in vitro fertilization.
- War, riot, strike, nuclear weapons induced hospitalization.
- Vaccination, inoculation, cosmetic or aesthetic treatment of any description, plastic surgery
- Surgery for correction of eye sight, cost of spectacles, contact lenses, hearing aids etc
- Genetic disorders and stem cell implantation / surgery
- Treatment of obesity/participation in any hazardous activity
- Out patient Diagnostic, Medical or Surgical procedures or treatments, non-prescribed drugs and medical supplies
- Medical Expenses relating to any hospitalisation primarily and specifically for diagnostic, X-ray or laboratory examinations and investigations
Note: Any claims arising out of or attributable to any of the following is not covered, Please refer policy T & C for detailed list of exclusions.
Tax Benefits
When you pay the premium for your health insurance policy, you are liable to get a tax rebate under section 80D of the Income Tax Act, 1961.
Claim Process
In case you would like to know about the Claim Process or would like to register a Claim please click the link below
