Oriental Health Insurance OBC Mediclaim Policy: Detailed Guide 2025

The cost of treatment in hospitals and unforeseen diseases may cause a lot of financial pressure to families. As hospitalization expenses are increasing, it might not be sufficient to use savings alone. The OBC Mediclaim Policy offered by Oriental Health Insurance provides financial stability and the comfort of group policies and wider coverage than most individual policies. The policy is customer-specific to the Oriental Bank customers and provides flexible benefits, cashless hospitalisation through a strong network of hospitals, and value-added services.

You know, did you know? According to IRDAI, the average claim size of group mediclaim policies has grown by more than 25 percent between 2022 and 2024, further making group health covers with a wide range of features more pertinent to Indian families.

What are the Major Points or Highlights of the Oriental OBC Mediclaim Policy?

• Wide eligibility: Available for all Oriental Bank of Commerce (now PNB) account holders and eligible family members.
• Sum insured options: The usual amount is between 1 lakh and 5 lakhs per family, and more can be offered to the senior citizens and premium customers.
• Coverage: Includes hospitalization, pre- and post-hospitalization expenses (up to 30 and 60 days, respectively), day care procedures, AYUSH treatments, maternity and newborn benefits (in selected variants), and domiciliary hospitalization.
• Cashless treatment: More than 7500 network hospitals in India to avail cashless medical care.
• Family floater: An option to cover self, spouse, dependent children and dependent parents under a single sum insured.
• Low premium: Tends to be cheaper than retail mediclaim since it is negotiated on a group basis; premium is calculated on annual basis on the basis of sum insured and age category.
• Pre-existing diseases: Covered after a specified waiting period (generally 2 to 4 years, depending on the plan).
• No medical tests: Not normally necessary until a particular age limit unless there is an unfavorable health history.
• Tax Benefit: The premium paid is deductible as per section 80D of Income Tax Act.

Table of Important Information OBC Mediclaim Policy

What are the Advantages and Disadvantages of OBC Mediclaim Policy?

Pros:

• Broad Coverage: Covers pre and post hospitalisation, major surgeries, daycare and at times even maternity benefits.
• Reduced Premiums: Group covers are cheaper as compared to individual covers of similar features.
• Cashless Facility: Claims are processed without any hassle and cashless transactions at network hospitals.
• Simple Enrollment: It is offered to the bank customers directly with minimum paperwork.
• Options of Family Floater: The family may be taken under one policy.
• Long Age Limit: The senior citizens can also be covered, typically up to age 79 years.
• Renewable till Life: According to the IRDAI guidelines, these policies are renewable throughout the life.
• No prior health checkup (up to certain limits): Useful for people with limited medical documentation.

Cons:

• Coverage Restrictions: There are restrictions to pre-existing diseases and certain capping of treatments in some variants.
• Little Customization: Cannot be customized as individual policies.
• Network Hospitals: Treatment at non-network hospitals may be on reimbursement basis.
• Co-payment provisions: Co-payment can be applied on the elderly groups.
• Waiting Periods: It has a waiting period on pre-existing diseases, maternity and certain illnesses.
• Bank Dependent Policy: Policy can be lost when the bank account is closed.

Professional advice: As per the top insurance consultants, group mediclaim plans such as the one provided by Oriental OBC are of high value to a family, however, it is always advisable to read policy exclusions, sub-limits, and co-pay provisions before buying the policy.

What is the Real-life of the OBC Mediclaim Policy? (Case Study)

Priya, 36, OBC account holder
Priya chose a 3 lakh family floater OBC mediclaim cover with an annual premium of about 7800. In 2024, her mother underwent gall bladder surgery that cost 1.8 lakhs in the hospital. The hospital belonged to the cashless network of Oriental. Priya did some formalities and the insurer paid the bill to the hospital. The non-payable items were deducted according to the policy and the whole process of the claim took a week. Her family cover would then run out till the end of the year at a lower sum insured.

Main Takeaway:

• Stress-free, paperless claim
• Insurance of several family members
• Coverage of major health event without affecting savings

What Is the Coverage of the Oriental OBC Mediclaim Policy?

Inclusions:

• Inpatient hospitalization: Includes renting a room, nursing, doctors, ICU, surgery, anesthesia, diagnostics, medicines.
• Pre & post-hospitalization: Health care costs within a pre-determined time before and after the hospitalization.
• Day Care Procedures: Cover for medical treatments needing less than 24 hr admission (eg. cataract, dialysis).
• Domiciliary treatment: In case of a situation when hospitalization is impossible but active treatment is needed at home.
• AYUSH Coverage: Ayurveda, Yoga, Unani, Siddha, and Homeopathy treatments included (as per limits).
• Maternity and newborn: Can be availed upon a waiting period in designated plans.
• Ambulance charges: There is limited cover of ambulance transportation.
• Health check up benefit: 3–4 years according to the policy schedule.

Exclusions:

• Pre-existing illnesses (before the waiting period)
• Passive treatment by investigation and diagnosis
• Cosmetic or dental surgery
• HIV, AIDS or sexually transmitted diseases
• Self-inflicted wounds, war or nuclear events
• Non-approved or experimental treatment

Other questions people ask are:

Q: Does outpatient treatment cover?
A: OPD costs are usually not covered unless in special variants except in specified day care procedures or post hospitalisation.

Q: Does consultation fee include online consultation?
A: By 2025, telemedicine consultations carried out online can be partially reimbursed in some variants, depending on the wording of the policy.

Where to Purchase Oriental Health Insurance OBC Mediclaim Policy in 2025?

• Eligibility check: Should be an OBC/PNB account holder or should be eligible under group policy.
• Form of proposal: Fill a simple group mediclaim form either through the bank or online.
• Nominee information: Give proper information to facilitate easy processing of claims.
• Document submission: Bank passbook copy, ID proof, prior health records (if required).
• Pay premium: Depending on age, sum insured and the number of family members enrolled.
• Order your e-policy: Digital policy document is provided right after payment.

Compare Online Plans:

There are numerous reputable online insurance portals today that allow one to compare the group mediclaim of Oriental with that of other insurance companies. You may compare premium rates, hospitals networks, special features, and choose the plan that suits you the most, all using one portal.

Did you know? A consumer survey conducted by the National Insurance Academy Pune has found that more than 70 percent of urban customers now use online insurance marketplaces in India to compare and buy their health policy.

How to Renew Your OBC Mediclaim Health Insurance: Steps & Tips

• Time renewal: Renewal must be in time to avoid lapse in cover.
• No Claim Bonus: A few policies pay a larger sum insured on claim-free renewals.
• Change of information: Inform insurer of change of health or dependents.
• Renew online: Most banks and the insurer have the online facility of paying premiums and renewing it.
• Upgrade: As your family needs increase you can upgrade the sum insured during renewal.

Q: What will happen in case I do not renew my policy?
A: Insurers allow a grace period (usually 30 days) for late renewal, but no claim can be made during the lapsed period. After that, new medical examinations can be necessary.

Oriental OBC Mediclaim Policy vs Individual Health Insurance: Comparison Table

Claiming Oriental OBC Health Insurance

Cashless process:

• Get admitted in the network with your cashless card or policy details
• Seek the pre-authorization of the insurance desk of the hospital
• The claim is examined and accepted by the Oriental Insurance
• Settle hospital bill (barring certain non-covered expenses)

Reimbursement process:

• Gather all the original bills, reports, discharge summary
• Fill claim form and submit with documents to Oriental Insurance or TPA
• The processing of claim takes 2–4 weeks

Standard Claim Forms

• Filled claim form
• Policy copy and ID proof
• Original bills of hospitals, pharmacy bills, investigation reports
• Medical certificate or hospital discharge summary

Did you know? According to the statistics of 2025, 93 percent of the cashless claims in the partner hospitals of Oriental Insurance were paid within 15 days.

Important Terms to Learn

• Sum Insured: The most that your policy will cover in a year.
• Co-payment: A portion of claim which you pay, usually senior citizens.
• Pre Existing Disease: Diseases that are already in existence prior to policy date, are covered after waiting period.
• Network Hospital: Hospitals in which you avail cashless claim facility according to the terms of the policy.
• Family Floater: A single health policy that covers the whole family upto the sum insured.

Q: Is it possible to add new members of the family after buying the policy?
A: Yes, new dependents can be added mid-term or at renewal in some cases of marriage or birth.

Tips and Advice

• Be truthful about all the diseases that one has when completing the proposal form.
• To cover future healthcare inflation, choose as much sum insured as you can afford.
• Before purchasing, read policy schedule, sub-limits, and disease-specific caps.
• Photos can be clicked or important policy documents and hospitalization proofs can be scanned to access easily during claims.
• Check hospital network on a regular basis because insurers continue to update their partner list.

Expert Tip: You can use online marketplaces to compare group and individual mediclaim policies with the help of an insurance advisor or trusted online marketplaces to find the best coverage in 2025.

The Most Common Mistakes

• Failure to renew policy in time, which may cause loss of continuity benefits.
• Assuming all medical expenses (like OPD or alternative therapies) are covered without reading policy details.
• Neglecting sum insured increases that can cause you to be underinsured because of medical inflation.
• Not updating family dependent details in the policy.

Quick Recap (TL;DR)

• Oriental OBC Mediclaim is a group health policy for OBC (PNB) account holders, offering extensive family and individual cover.
• It is characterised by affordable premiums, cashless hospitalisation, AYUSH, and maternity cover.
• There are pre-existing disease and select benefit waiting periods.
• Compare plans online to get the most suitable ones and renew in time to have no gaps in health security.
• Learn what is included, what is not included and have all the documents readily available to make claims.

People Ask: FAQ

Q1: Who is eligible to purchase Oriental OBC Mediclaim Policy?
A: It is open to all Oriental Bank of Commerce (now PNB) account holders and their eligible family members.

Q2: Which diseases or treatment are excluded?
A: Pre-existing conditions prior to the waiting period, cosmetic surgery, dental, HIV and self-inflicted injuries are usually not covered.

Q3: What is the procedure of making a cashless claim?
A: Your cashless card or policy number can be used at a network hospital to be billed directly to the insurer, after pre-authorization procedure.

Q4: Am I able to transfer this group mediclaim to an individual policy?
A: Yes, according to the portability rules of IRDAI, it can be migrated upon request, on terms.

Q5: What is the comparison of OBC Mediclaim to other health insurance?
A: Trusted online insurance marketplaces where you can compare features, premiums and hospital networks across insurers in a single place.

Sources:

• National Insurance Academy Pune, Indian Health Insurance 2024–25 Report
• Oriental Insurance Official Website