Q1. What if my Oriental health insurance cashless claim is partially approved?

Ans: If a cashless claim is partially approved, you will need to pay the difference between the hospital bill and the approved claim amount. Afterwards, you can submit a reimbursement claim for any additional eligible expenses.

Q2. How do I know if a hospital is part of Oriental Health Insurance's network for cashless claims?

Ans: To check if a hospital is in Oriental Insurance Company's network, you can refer to the list on their website or reach out to their customer service. Policybazaar customers can also contact Policybazaar's customer support for assistance in confirming the network status of hospitals.

Q3. What should I do if I receive partial reimbursement for my claim?

Ans: If you receive partial reimbursement, review the settlement letter for the reason behind the partial payment. If you believe there has been an oversight or error, contact Oriental Insurance for clarification and potential resolution.

Q4. How can I escalate a claim dispute with Oriental Insurance?

Ans: In case of a claim dispute, you can use Oriental Insurance's grievance redressal process. Reach out to their customer service for the necessary steps. Policybazaar customers are also advised to contact Policybazaar's customer support for additional guidance on the escalation process.

Q5. Is there a limit to the number of claims I can make in a year with Oriental Health Insurance?

Ans: Generally, there is no limit to the number of claims you can make in a year, but the total claim amount should not exceed your policy's sum insured. Check your policy details for any specific conditions or limits.

How to File a Claim with Oriental Health Insurance?

Oriental Health Insurance Company Ltd. is recognised for its commitment to a customer-centric and efficient claim process, tailored to meet the needs of its policyholders. Oriental Health Insurance goes beyond standard procedures by offering a range of support options, including online resources and accessible customer service channels, ensuring policyholders have all the necessary. This guide is designed to meticulously explain Oriental's cashless and reimbursement claim filing process, from the first step of notification to the final stages of claim settlement, providing clear and concise instructions to make the process as smooth and manageable as possible for Oriental health insurance policyholders.

Ways to File an Oriental Health Insurance Claim

The Oriental Insurance Company Ltd. allows policyholders two distinct pathways for filing claims, designed to suit various medical circumstances: cashless claims and reimbursement claims.

Oriental Cashless Claims:

The Oriental Insurance Company Ltd. offers a streamlined cashless claim process within its comprehensive network of associated hospitals. This facility enables insured members to access medical treatments without the burden of immediate payments, making it an ideal choice during emergencies. The steps involved are structured to ensure prompt and effective handling of claims.
Oriental Reimbursement Claims

For treatments availed at hospitals outside of Oriental Insurance Company’s network, the company provides a clear-cut reimbursement claim approach. Insured individuals settle their medical bills first and then proceed to claim the amount from the insurer. This option allows a wider selection of hospitals, accommodating various medical preferences. The reimbursement procedure is meticulously planned for a smooth claim experience.

How to File an Oriental Health Insurance Claim Online with Policybazaar?

To file an online claim for Oriental health insurance via Policybazaar, follow these simple steps:

Step 1: Immediately contact Policybazaar's claim support team to report your hospitalization. Call them at 1800-258-5881 or email care@policybazaar.com.

Step 2: Visit Policybazaar.com and click on ‘File a New Claim’ under the ‘Claims’ tab.

Step 3: Select the ‘Health Insurance’ option, and log in with your mobile number and the received OTP/password.

Step 4: Follow the provided instructions and click on ‘File a new claim’.

Policybazaar will facilitate the processing of your claim and coordinate on your behalf with The Oriental Insurance Company Ltd.

How to File a Claim with Oriental Health Insurance

Explore the steps for filing cashless and reimbursement claims with The Oriental Insurance Company:

Oriental Health Insurance Cashless Claim Process:

For policyholders looking to avail of the cashless treatment facility, the following steps outline the specific procedure to follow with Oriental Health Insurance:

Reporting Hospitalisation

When seeking cashless treatment, immediately inform Oriental Insurance about the hospitalisation within 24 hours. This can be done through a phone call or email, providing details like the hospital's name, date of admission, and nature of the illness or injury.

Document Presentation at Hospital

At the network hospital, present your Oriental Health Insurance details for verification. This includes showing your medical insurance ID card and any other required policy documents to confirm your eligibility for cashless services.

Completion and Submission of Pre-Authorization Form

Fill out the hospital's pre-authorisation form, attaching the treating doctor's consultation papers. This form, once completed, is sent by the hospital to Oriental Insurance for pre-authorisation of cashless treatment, detailing the medical necessity and estimated costs.

Claim Verification

After receiving the pre-authorization request, Oriental Insurance will verify the details for authenticity and policy coverage. This process ensures that the treatment falls within the scope of the policy's benefits.

Finalising the Cashless Claim Settlement

Once the treatment is completed, the hospital will forward all bills directly to Oriental Insurance. The insurer then assesses these bills and settles the payment with the hospital, covering the expenses as per the policy terms.
Oriental Health Insurance Reimbursement Claim Process:

If you need to opt for a reimbursement claim after paying your medical bills, here's the detailed process to follow with Oriental Health Insurance:

Immediate Notification to the Insurer

It's crucial to inform Oriental Insurance about hospital admission within 24 hours. This initial notification should include details about the hospitalisation and the nature of the emergency or treatment.

Handling of Medical Expenses

Upon discharge, you are required to pay all hospital bills, which can later be claimed for reimbursement. Keeping a detailed record and receipts of all expenses is vital for the claim process.

Accumulation of Required Documents

Collect all necessary documents including medical bills, discharge summaries, and prescriptions. These documents provide evidence of the treatment received and the expenses incurred.

Claim Form Filling and Submission

Download the claim form from Oriental Insurance Company's website, fill it accurately with details of the treatment and expenses, and submit it along with the required documents. The accuracy and completeness of this form are critical for claim approval.

Sending Documents to Oriental Insurance

Submit the filled claim form along with all other required documents to Oriental Insurance within 15 days of discharge. Timely submission is crucial for the prompt processing of your claim.

Completion of the Reimbursement Process

Once Oriental Insurance receives the documents, they review them for details and policy adherence. After approval, the insurer processes the reimbursement, crediting the claim amount to the policyholder's account as per the policy's terms.

Documents Required to File an Oriental Health Insurance Claim

To file a health insurance claim with Oriental Health Insurance, policyholders need to submit the following documents:

Duly filled claim form
Original hospital bills and payment receipts
Hospital discharge report/medical treatment report
Medical recovery report
Original test reports (X-rays, sonography, ECG, etc.)
Detailed medical expenses with original bills/cash memos receipts and prescriptions
Leave certificate from the employer, if applicable
Hospital/Nursing Home registration number. If not registered, a certificate from the treating doctor about the hospital's facilities
Police Panchnama/first information report in case of an accident
Copy of claim intimation given to the company, along with a photocopy of the policy and premium receipt

FAQs

Q1. What if my Oriental health insurance cashless claim is partially approved?

Ans: If a cashless claim is partially approved, you will need to pay the difference between the hospital bill and the approved claim amount. Afterwards, you can submit a reimbursement claim for any additional eligible expenses.
Q2. How do I know if a hospital is part of Oriental Health Insurance's network for cashless claims?

Ans: To check if a hospital is in Oriental Insurance Company's network, you can refer to the list on their website or reach out to their customer service. Policybazaar customers can also contact Policybazaar's customer support for assistance in confirming the network status of hospitals.
Q3. What should I do if I receive partial reimbursement for my claim?

Ans: If you receive partial reimbursement, review the settlement letter for the reason behind the partial payment. If you believe there has been an oversight or error, contact Oriental Insurance for clarification and potential resolution.
Q4. How can I escalate a claim dispute with Oriental Insurance?

Ans: In case of a claim dispute, you can use Oriental Insurance's grievance redressal process. Reach out to their customer service for the necessary steps. Policybazaar customers are also advised to contact Policybazaar's customer support for additional guidance on the escalation process.
Q5. Is there a limit to the number of claims I can make in a year with Oriental Health Insurance?

Ans: Generally, there is no limit to the number of claims you can make in a year, but the total claim amount should not exceed your policy's sum insured. Check your policy details for any specific conditions or limits.

Policybazaar exclusive benefits

30 minutes claim support*(In 120+ cities)
Relationship manager For every customer
24*7 claims assistance In 30 mins. guaranteed*
Instant policy issuance No medical tests*

Health insurance companies

View more insurers

Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

Oriental Health Insurance Plans

Individual Mediclaim Policy

Family Floater Health Insurance

Happy Family Floater

Group Mediclaim Policy

OBC Oriental Royal Mediclaim Policy