This Document is Digitally Signed

The Oriental Insurance Company Limited

Signer: MEERA PARTHASARTHY
Date: Mon, Apr 28, 2025 15:17:35 IST
Reason: Signing Policy for OICL

ORIENTAL MEDICLAIM INSURANCE POLICY(INDIVIDUAL) - 2024 POLICY

SCHEDULE
IRDA UIN NO.:OICHLIP25048V052425

Policy No. : 411200/48/2026/257 Prev. Policy No. : 411200/48/2025/353

Cover Note No. : - Cover Note Date : -
Insured's Code : 4550343 Issue Office Code : 411200
Insured Name : MRS LAKSHMI VISWANATHAN Issue Office Name : BO ESPLANADE CHENNAI (GSTIN:
(GSTIN: 0) 33AAACT0627R3Z4)
Address : OLD NO : 41, NEW NO : 34, III Address : Immediate Claim intimation(excluding
STREET, ABIRAMAPURAM, Marine Hull and Health claim) be sent
CHENNAI - 600 018 to [email protected]
- -
UIL BUILDING, 4TH FLOOR
- CHENNAI TAMIL NADU 600108
CHENNAI TAMIL NADU 600018
Tel./Fax/Email : / / 9884714030 / [email protected] Tel./Fax/Email : 044-23458234, 23458236 / 044-
23458235 /
[email protected]
Agent/Broker Details
Dev.Off.Code : NY0000000744 M. Vasanthi - SBDM
Agent/Broker : BB0000000200 S.L. GURUMURTHI
Address : B2/7, II Floor,,Bhagat Singh Road,Thiruvalluvar Nagar, Thiruvanmiyur, Chennai 600
041.,CHENNAI,TAMIL NADU,600041
Tel/Fax/Email : 7550063147/7550063147//[email protected]

Period of Insurance : FROM 00:00 ON 15/05/2025 TO MIDNIGHT OF 14/05/2026

Collection No. & Dt. : CHQ 5005000317 - 28/04/2025 GST INVOICE NO :332463553 UIN :0
Gross Premium : 25,098 Service Tax : 4,518 Stamp Duty : .5 Total : 29,616

Co-insurance Details : Nil

Channel of Sale Yes/No

1.Online NO

2.Fresh NO

3.Renewal YES

TPA Details :
TPA ID : YA0000000342
TPA Name : M/S GOOD HEALTH INSURANCE TPA LTD
Address : SUITE 403-406A, 4TH FLOOR, ASHOKA MY HOME CHAMBERS, BEHIND ASHOK
BHOOPAL CHAMBERS, SARDAR PATEL ROAD, SECUNDERABAD, TELANGANA-
500003,[email protected]
Telephone No :
Toll Free No. : 1800-425-3232, 1860-425-3232

Place : CHENNAI
Page 1 of 9
Date : 28/04/2025
 This Document is Digitally Signed
The Oriental Insurance Company Limited
Signer: MEERA PARTHASARTHY
Date: Mon, Apr 28, 2025 15:17:35 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 411200/48/2026/257

TPA ID : YA0000000342
Toll Free No. :
Address : FAX No. :

Particulars of the Persons covered : Number of persons covered : 1

Sr. Relationship Pre-Existing Sum Insured
Name of The Gender Date of Age Co-Pay PA Capital
No. With Diseases (INR)
Persons Birth (%) Sum Insured (INR)
Proposer

1 LAKSHMI F 15/12/1946 78 Self 2,50,000

VISWANATHAN
Nominee Details
Name Of the Nominee Relationship With the Insured Age Of the Nominee M/F/TG*
DR. CHALAM Son 52 M
VISWANATHAN

Total Premium in words : Indian Rupees Twenty-Nine Thousand Six Hundred Sixteen Only

The insurance under this policy is extended to cover risks of :

Domiciliary Hospitalisation Cover, Daily cash allowance.

Deductible : Nil
The insurance under this policy is subject to conditions, clauses, warranties,exclusion which are available on Company
website:www.orientalinsurance.org.in or on demand from policy issuing office.

The policy shall pay for hospitalisation expenses for medical/surgical treatment taken as an in-patient at any Nursing
Home/Hospital in INDIA as defined in the policy.

LOCKDOWN PERIOD. THE INSURED HAS PAID THE PREMIUM ON 11.05.2020. THE SAID POLICY HAS
CONTINUOUS COVERAGE FROM 15.05.2020 TO 14.05.2021.
In the event of a claim under the policy exceeding Rs. 1 lac or a claim for refund of premium exceeding Rs. 1 lac,the
insured will comply with the provisions of the AML policy of the Company.The AML policy is available in all our operaing
offices as well as Company's website.

Warranted that in case the person covered under the policy has lodged any claim under the previous policy and the sum
insured is enhanced under the current policy, for a further claim for the same disease during the current policy, the earlier
limit of Sum Insured shall be applicable and not the enhanced sum insured.

Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy
shall be void abinitio (from inception).

"We at Oriental continuously strive to ensure that you get the best possible treatment from our network hospitals.
Please contact your TPA or any of the Oriental offices for our preferred hospitals in your area before going for a
treatment. This will help us serve you in the best possible manner"

Place : CHENNAI
Page 2 of 9
Date : 28/04/2025
 This Document is Digitally Signed
The Oriental Insurance Company Limited
Signer: MEERA PARTHASARTHY
Date: Mon, Apr 28, 2025 15:17:35 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 411200/48/2026/257

In witness whereof the undersigned being authorised by and on behalf of the Company has/have herein to set his/their hands
at BO ESPLANADE CHENNAI (GSTIN: 33AAACT0627R3Z4) on 28-APR-25.

1.Claim to be reported within 48 hrs of admission but before discharge.

2.Claim documents to be submitted within 15 days of discharge.

For complete details please refer to policy condition.

3.The insured is advised to visit:

i. https://orientalinsurance.org.in/policies-related-document
for policy terms & conditions and customer Information Sheet.
ii. https://orientalinsurance.org.in/network-hospitals
for List of Network Hospitals.
Policy History Data

Policy No. Period From Period To Insurer Name Sum Insured

411200/48/2009/408 15-MAY-08 14-MAY-09 The Oriental Insurance Company Ltd. 2,50,000

411200/48/2010/337 15-MAY-09 14-MAY-10 The Oriental Insurance Company Ltd. 2,50,000
411200/48/2011/488 15-MAY-10 14-MAY-11 The Oriental Insurance Company Ltd. 2,50,000
411200/48/2012/812 15-MAY-11 14-MAY-12 The Oriental Insurance Company Ltd. 2,50,000
411200/48/2013/525 15-MAY-12 14-MAY-13 The Oriental Insurance Company Ltd. 2,50,000
411200/48/2014/822 15-MAY-13 14-MAY-14 The Oriental Insurance Company Ltd. 2,50,000
411200/48/2015/616 15-MAY-14 14-MAY-15 The Oriental Insurance Company Ltd. 2,50,000
411200/48/2017/613 15-MAY-16 14-MAY-17 The Oriental Insurance Company Ltd. 2,50,000
411200/48/2016/801 15-MAY-15 14-MAY-16 OICL
411200/48/2018/536 15-MAY-17 14-MAY-18 The Oriental Insurance Company Ltd. 2,50,000
411200/48/2019/316 15-MAY-18 14-MAY-19 The Oriental Insurance Company Ltd. 2,50,000
411200/48/2020/377 15-MAY-19 14-MAY-20 The Oriental Insurance Company Ltd. 2,50,000
411200/48/2021/491 18-MAY-20 14-MAY-21 The Oriental Insurance Company Ltd. 2,50,000
411200/48/2022/202 15-MAY-21 14-MAY-22 The Oriental Insurance Company Ltd. 2,50,000
411200/48/2023/323 15-MAY-22 14-MAY-23 The Oriental Insurance Company Ltd. 2,50,000

Place : CHENNAI
Page 3 of 9
Date : 28/04/2025
 This Document is Digitally Signed
The Oriental Insurance Company Limited
Signer: MEERA PARTHASARTHY
Date: Mon, Apr 28, 2025 15:17:35 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 411200/48/2026/257

411200/48/2024/158 15-MAY-23 14-MAY-24 The Oriental Insurance Company Ltd. 2,50,000

411200/48/2025/353 15-MAY-24 14-MAY-25 The Oriental Insurance Company Ltd. 2,50,000

Claim History Data

Policy no. Claimant Name Claim No. Claim OS Claim Paid

"In case of grievance related to any issue related to this policy the same may be addressed to the office In-Charge or the
Grievance Officer at above policy address. If the grievance remains pending, it may be escalated to Grievance Officer of the
concerned Regional Office P.B.NO.1877 U.I.L BUILDING III FLOOR,NO.4, ESPLANADE OPP.ESPLANADE POLICE STN.,,. The next
escalation in case grievance remains unresolved is CSD, Head Office, situated at Oriental House, A-25/27, Asaf Ali Road, New
Delhi-110002.
If the insured is not satisfied with the resolution/reply provided by the company, he/she may approach the Office of Insurance
Ombudsman, within his/her jurisdiction. The list of offices of Ombudsman is available on Company's portal."

Entered By : VASANTHI
Examined By : VASANTHI
Digitally Signed
By
Authorised Signatory

This is an electronically generated document (Policy Schedule)..The Policy document duly stamped will be sent by post.

In case of any query regarding the Policy please call Toll Free No. 1800 11 8485 and 011 33208485.
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in and through other

digital platforms including Whatsapp(Send "Hi" to 9560711200).

Place : CHENNAI
Page 4 of 9
Date : 28/04/2025
 This Document is Digitally Signed
The Oriental Insurance Company Limited
Signer: MEERA PARTHASARTHY
Date: Mon, Apr 28, 2025 15:17:35 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 411200/48/2026/257

Customer Information Sheet

Description is illustrative and not exhaustive

SI.No Title Description Refer to policy

clause No.

Product Name Oriental Mediclaim Insurance Policy

1.
(Individual)

2. Policy No 411200/48/2026/257

3. Type of insurance product/ Indemnity (Where Insured Losses are covered up to

policy Sum Insured under the policy)

Individual Basis (i.e., Sum Insured and Cumulative Bonus shall

4. Sum Insured (Basis ) Along
with Amount apply separately on each Insured Person)
Sum Insured option from Rs. 1 lac
to Rs. 50lacs.

Policy Coverage Hospital admission of minimum24 hours 3.1

5.
(what the Policy covers * Related medical expenses incurred 30 days prior
tohospitalization & 60 days from date of discharge.
* Specified / Listed procedures requiring less than 24hours
hospitalization (day care)
* Cover for 22 critical illnesses.
* Ambulance Charges
* Donor Expenses
* Ayurveda, Yoga, Siddha, Unani and Homeopathic
treatment.
* Air ambulance
* OPD benefit for dental and ophthalmic cover,
* Medical Second Opinion
* Daily hospital cash
* PAas optional cover
Voluntary co-pay option
* Family discount
* Portal Discount
* HIV/AIDS
* Mental Illness
* Telemedicine
* Pre and Post hospitalization expenses
covered upto 30 and60 days

Place : CHENNAI
Page 5 of 9
Date : 28/04/2025
 This Document is Digitally Signed
The Oriental Insurance Company Limited
Signer: MEERA PARTHASARTHY
Date: Mon, Apr 28, 2025 15:17:35 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 411200/48/2026/257

6. Exclusions * Any hospital admission primarily for investigation/ diagnostic

4
(what the purpose
policy does * Sex change surgery ,cosmetic surgery& plasticsurgery,
not cover ) * Pregnancy( except ectopic), infertility
* Hazardous or AdventureSport
* Refractive error, cosmetic dental surgeries
* UnprovenTreatments
* Substance abuse, self-inflicted injuries,
* Breach of law
* Any kind of admission fees,registration fees levied by the
hospital
* Treatment outside India
* External congenital diseases.
(Note: the above is a partial listing of the policy exclusions.
Please refer to the policy clauses for the fulllisting).

Waiting period * Pre-existing diseases: Covered after 36months 4.1

7. -Time period during * Initial waiting period: 30 days for all illnesses 4.2
which specified (notapplicable on renewal or for accidents) 4.3
diseases/treatments * Specific waiting periods:
are not covered 1. 90 days for named diseases.
-It is counted from 2. 12 months for named diseases(clause 4.3( i & ii)
the beginning of the 3. 24 months for disease at (clause 4.3 (iii to xxii)
policy coverage 4. 36 months for diseases (clause 4.3 (xxiii to xxiv)

* Upto sum insured.

Financial Limit of A. HOSPITALISATION BENEFITS 3.1
8.
Coverage .I Sub-Limit i. Room, Boarding and Nursing Expenses as provided
(it is pre defined limit by the Hospital /Nursing Home:Not exceeding 1 % of the
and Sum Insured per day
the insurance company ii. Intensive Care Unit (ICU) Expenses as provided by
will not pay any amount the Hospital /Nursing Home.: Not exceeding 2% of the
in excess of this limit ) Sum Insured per day.
iii. Ambulance service charges as herein after defined.:
Rs.2,000 OR 1% of the sum insured whichever is less per
hospitalization subject to aggregate expenses not
exceeding Rs. 4,000 under the policy.
iv. Daily Hospital Cash Allowance 0.1% of the sum
insured per day subject to maximum of 6 days per insured
person during the entire policy period. Deductible of 2 days
shall apply for each hospitalization.

Place : CHENNAI
Page 6 of 9
Date : 28/04/2025
 This Document is Digitally Signed
The Oriental Insurance Company Limited
Signer: MEERA PARTHASARTHY
Date: Mon, Apr 28, 2025 15:17:35 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 411200/48/2026/257

ii) Co-payment (it is a B. DOMICILIARY HOSPITALISATION

3.1.
specified amount BENEFITS
i. Surgeon, Medical Practitioner, Consultants, Specialists Fees, 3
/percentage of the
admissible claim Blood, Oxygen, Surgical Appliances, Medicines &Drugs,
amount to be paid Diagnostic
by policy Material and Dialysis, Chemotherapy, Nursing expenses.: 20%
holder/insured of the Sum Insured subject to maximum Rs.50,000 per Insured
iii) Deductible (it is Person, during the entire policy period.
a specified amount ii. Treatment for Dog bite (or bite of any other rabid animal like
:Upto which an monkey, cat etc.): Maximum Rs.5,000/- actually incurred on
insurance company will immunization injections inany one Policy Period. This will be part of
not pay any claim and Domiciliary Hospitalization limits as specified. For the purpose of
Which will be deducted this clause the conditions for Domiciliary Hospitalization benefit shall
from total claim amount not apply.
(if claim amount is more * Option of voluntary co-payment of 10% and 20% with
than the specified corresponding premiumdiscount of 10% and 20% respectively on SI o
amount)
For Cashless Service: Hospital Network Details are available at
Claims/ claim www.orientalinsirance.org.in 5.2
9.
Procedure For reimbursement of Claim:Policy issuing Office /TPA 2
* Cashless services for coveredexpenses in Network hospitals
* Reimbursement of admissible expenses
Web link for following :
1. Network Hospital Details:
https://orientalinsurance.org.in/network-hospitals
2. Help Line Number:
Toll free : 1800118485/011-33208485
3. Hospitals which are blacklisted or from where no claims will be
accepted by insurer. https://orientalinsurance.org.in/network-hospitals
4. Download/getting claim form
https://orientalinsurance.org.in/policies-related-document

1.Company officials :
10. Policy Website: www.orientalinsurance.org.in
servicing 2. . Toll free: 1800118485 Or 011-33208485
3.Policy issuing office

Place : CHENNAI
Page 7 of 9
Date : 28/04/2025
 This Document is Digitally Signed
The Oriental Insurance Company Limited
Signer: MEERA PARTHASARTHY
Date: Mon, Apr 28, 2025 15:17:35 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 411200/48/2026/257

11. Grievances/ * www.orientalinsurance.org.in

Complaints E-mail: [email protected]
* IRDAI Integrated Grievance Management System https://igms.irda.gov.in
* Insurance Ombudsman - Contact details of the Insurance Ombudsman
have been provided in Annexure 1 of the policy document.
Ombudsman website:
http://ecoi.co.in/ombudsman.html

a. Free Look period of 30 days from the date of receiptof the policy shall be
12. Things to remember applicable at the inception
B. Renwable Conditions
* Grace period of 30 days
* Policyis ordinarily renewable Adjustment of premium on renewal in lieu of
OMP policy.
c. Right to migrate from one product to another product of the company.
www.orientalinsurance.org.in
d. Right to port the policy from one company toanother company -
www.orientalinsurance.co.in
e. Change in SI during the policy term or at the time ofrenewal (please contact
the policy issuing office)
f. Insurer to specify the norms on TAT - Please refer to clause 9 of the CIS of
policy document.
Moratorium Period: After Completion of five continuous years under the policy
no look back to be applied. This period of five year is called as moratorium
period. The moratorium would be applicable for the sums insured of the first
policy and subsequently completion of five continuous years would be
applicable from date of enhancement of sums insured only on the enhanced
limits. After the expiry of Moratorium period no health policy shall be contestable
except for proven fraud and permanent exclusion specified in the policy contract
.
Renewal Benefits : Health check up benefit for everyblock of 3 claim free
policy years for the insured persons up to 1% of average sum insured subject to
maximum Rs. 5000/-per insured person

Insured's Please disclose all pre-existing disease/s or condition/s before buying

13 Obligations a policy. Non-disclosure may result in claim not being paid.
Disclosure of Material Information during the policy period such as
change in occupation.

Place : CHENNAI
Page 8 of 9
Date : 28/04/2025
 This Document is Digitally Signed
The Oriental Insurance Company Limited
Signer: MEERA PARTHASARTHY
Date: Mon, Apr 28, 2025 15:17:35 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 411200/48/2026/257

Declaration by the Policy Holder,

I have read the above and confirm having noted the details
Place

Date (Signature of the Policyholder)

Note
i.Web-link where the product related documents including the Customer Information sheet are available:
https://orientalinsurance.org.in/policies-related-document
i.In case of any conflict, the terms and conditions mentioned in the policy document shall prevail.

ii.Insurer to take confirmation of the policyholder regarding receiving of the Customer Information Sheet.

Place : CHENNAI
Page 9 of 9
Date : 28/04/2025