Oriental Health Insurance PNB Mediclaim Policy: 2025 Guide for Families and Individuals

Overview: What Is Oriental Health Insurance PNB Mediclaim Policy?

Oriental Health Insurance PNB Mediclaim Policy is a joint health insurance product offered by Oriental Insurance Company Limited in collaboration with Punjab National Bank. It aims to provide comprehensive medical coverage for hospitalisation, surgeries, and related healthcare costs for individuals and families. In 2025, this policy is designed especially for PNB account holders, their families, and anyone seeking cashless treatments at a wide hospital network across India.

Understanding the specifics of Oriental PNB Mediclaim is essential because medical expenses are rising in India. This policy addresses the need for a simple, flexible, and affordable health insurance plan with multiple sum insured options, making it ideal for both first-time buyers and those upgrading their coverage.

What Are the Key Features of Oriental PNB Mediclaim Policy?

Oriental Health Insurance PNB Mediclaim Policy comes with several notable features tailored to meet the requirements of Indian families:

• Multiple Sum Insured Options: Choose sum insured amounts ranging typically from ₹1 lakh to ₹10 lakh to suit your family needs.
• Cashless Treatment: Avail cashless hospitalisation at over 4,000 network hospitals across India.
• No Pre-policy Medical Checkup up to Age Limit: For many age groups (usually up to 55 years if no medical history), pre-policy tests are waived.
• Coverage for All Family Members: Proposes family floater and individual options. Insure spouse, dependent children, and parents under one policy.
• Policy Term Flexibility: Available for 1-year or 2-year tenures, offering discounts on multi-year payments.
• Pre and Post Hospitalisation Expenses: Generally covers 30 days before and 60 days after hospitalisation for expenses directly related to the treatment.
• Daycare Procedures: Includes coverage for various procedures that do not require 24-hour hospital stay.
• Renewal Benefits: Lifelong renewal is allowed, subject to policy terms.

Did you know?

A family floater policy under Oriental Health Insurance PNB Mediclaim can often be expanded to include up to six family members, making it very convenient for larger families.

Who Can Buy the Oriental Health Insurance PNB Mediclaim Policy in 2025?

Individuals between the ages of 18 and 79 are eligible for this plan and can include dependents like children as young as 3 months old. Most PNB account holders are pre-approved for this product, but non-PNB customers are also eligible by fulfilling documentation and premium criteria.

People Also Ask:

Can I include my in-laws or parents-in-law in this plan?
Typically, coverage is extended to self, spouse, dependent children, and parents. Inclusion of parents-in-law depends on the latest policy version. Check with Oriental Insurance for policy-specific eligibility.

What Coverage Does the PNB Mediclaim Policy Provide?

• Hospitalisation Cost: Room, boarding, nursing, ICU charges as per policy schedule.
• Doctor’s Fees, Surgery, and Tests: Surgeon, anaesthetist, consultant fees and diagnostic expenses.
• Ambulance Charges: Often covered within specified limits per hospitalisation.
• Domiciliary Hospitalisation: Expenses incurred for treatment at home (under observation of a doctor) for illnesses where hospitalisation is not possible.
• AYUSH Treatment: Coverage extended to Ayurveda, Yoga, Unani, Siddha, and Homeopathy treatments at government-recognised centres.

Expert Insight: In 2025, AYUSH coverage has become an important point for many, with more people opting for alternate therapies along with conventional treatments.

What Are the Pros and Cons of Oriental Health Insurance PNB Mediclaim Policy?

Understanding strengths and limitations can help you make an informed decision.

Pros

• Wide hospital network with PNB tie-up.
• Competitive premium pricing, often with discounts for PNB customers.
• Flexibility in sum insured and inclusion of various family members.
• Simple claim process with dedicated helpdesk for PNB Mediclaim.
• No-claim bonus, usually offering a bonus on sum insured for claim-free years.
• Tax benefits under Section 80D of the Income Tax Act.

Cons

• Room rent restrictions may apply based on sum insured.
• Sub-limits on certain surgeries, medicines, and treatments.
• Pre-existing illnesses may be covered only after a waiting period, generally 2 to 4 years.
• Maternity benefits are usually not part of the base policy and may need a separate rider.

What Is Not Covered: Exclusions List

Before buying any health insurance, understanding what is not covered is vital. Some general exclusions in 2025 include:

• Pre-existing conditions within the applicable waiting period
• Cosmetic, aesthetic, or plastic surgeries unless due to accident or medically required
• Dental treatments unless arising from an accident
• Injuries from self-harm or substance abuse
• Experimental or unproven treatments
• Non-medical expenses such as personal comfort items

Did you know?

Some online marketplaces now let buyers filter health policies by ‘exclusions’ to easily find plans that match their specific health needs.

People Also Ask:

Are Covid-19 hospitalisations covered in 2025?
Yes, as per IRDAI guidelines, hospitalisation due to Covid-19 is covered under all standard health insurance plans, including Oriental PNB Mediclaim, subject to policy terms.

How Does the Claim Process Work in 2025 for Oriental PNB Mediclaim?

The Oriental PNB Mediclaim Policy offers both cashless and reimbursement options. This means you can either:

• Cashless Claims: Get treatment at a network hospital and the insurance company settles the bill directly with the hospital.
• Reimbursement Claims: If you go to a non-network hospital, pay the bills and claim reimbursement post discharge, by submitting all relevant documents.

Step-by-step process:

1. Show health card at hospital reception for cashless facility.
2. Fill and submit pre-authorization form (hospital will help).
3. Insurer reviews and confirms eligibility.
4. At discharge, finalize smaller non-covered costs, if any.

Case Study: Mr. Arun, a 45-year-old PNB customer from Mumbai, suffered an appendicitis attack in 2024. He was admitted to a network hospital; cashless treatment was approved within an hour, with ₹88,000 covered under his ₹5 lakh sum insured policy. He only paid for a private room upgrade (over policy limits).

How Is the Premium Calculated for Oriental PNB Mediclaim?

Premium depends on multiple factors, usually:

• Sum insured chosen
• Number of individuals/family members covered
• Age of the eldest member (in case of floater)
• Zone or location of primary residence

A 2025 indicative annual premium table is given below for reference:

Note: Actual premiums will vary based on precise member ages and city of residence.

Expert Insight: Buying health insurance early is cost-effective, as premiums rise sharply after age 50.

What Are the Waiting Periods and Other Conditions?

• Initial waiting period for new illnesses: Usually first 30 days after policy start.
• Specific ailments like hernia, cataract, etc: 2 years.
• Pre-existing diseases: 2 to 4 years as per policy.
• Maternity benefits (when available): Waiting period of 2 years or more.

People Also Ask:

Can I reduce waiting period for pre-existing diseases?
Generally, insurers do not allow reduction of waiting periods, but select products might offer a ‘buyback’ rider for an extra premium.

What Documents Are Needed for Buying and Claims?

For buying:

• Identity and address proof (Aadhaar, PAN)
• Proof of relationship for family members (birth/marriage certificate)
• PNB account proof for special rates (optional)

For claims:

• Original bills and discharge summary
• Doctor’s prescription and diagnosis
• Claim form and bank details

Tip: Always keep scanned copies handy for faster online claims.

How Does Oriental PNB Mediclaim Compare to Other Health Insurance Options?

Comparing features of multiple health insurance policies is a smart way to get better value. Here’s a comparison table (as sample, rates will differ in real-time 2025 offerings):

Is There Any No Claim Bonus in 2025 for Oriental PNB Mediclaim?

Yes, Oriental PNB Mediclaim generally provides a no-claim bonus (NCB) that increases the sum insured by a fixed percentage (usually 5 percent each year up to a cap) for every claim-free year. This means, if you stay healthy and do not claim, your policy becomes more rewarding over time.

Did you know?

NCB is cumulative: a 5-years claim-free track on ₹5 lakh sum insured might boost your coverage to ₹6.25 lakh without extra premium.

Why Should You Compare Health Insurance Policies in Online Marketplaces?

In 2025, Indian consumers have multiple options to search, compare, and buy health insurance online. Comparing Oriental PNB Mediclaim with other plans ensures you see:

• Premium differences
• Hospital coverage in your city
• Inclusions, exclusions, and waiting periods
• Unique add-ons and value benefits

These online platforms can save you hours and help you make smarter financial decisions by lining up product options from various leading insurers.

What Extra Benefits or Add-Ons Can Be Bought in 2025?

Many policyholders seek add-ons to enhance their base policy:

• Maternity coverage
• Personal accident protection
• Critical illness rider
• Daily hospital cash allowance
• OPD or outpatient cover

Carefully check the terms, as each add-on has its own premium and waiting period.

People Also Ask:

Does Oriental PNB Mediclaim cover overseas hospitalisation?
No, this plan is designed for treatments in India only. For international coverage, opt for a separate overseas health insurance.

Real-World Use Case: Mrs. Priya’s Experience

Mrs. Priya, a teacher in Delhi with a family floater Oriental PNB Mediclaim, needed gall bladder surgery in 2025. She used the policy’s cashless feature at a partnered hospital. The entire surgical bill of ₹1.45 lakh was settled directly, while her only out-of-pocket cost was medicines above the sub-limit. The experience left her stress-free and financially secure.

How to Buy Oriental PNB Mediclaim Policy in 2025?

• Visit Oriental Insurance official website or nearest PNB branch.
• Fill the online or offline application.
• Submit KYC and relationship documents.
• Pay premium digitally or by cheque.
• Receive e-policy instantly on email (for online purchases).

Tip: Use neutral online health insurance marketplaces to compare this product alongside others for transparent pricing and features before you commit.

Quick Recap / TLDR

• Oriental Health Insurance PNB Mediclaim is a value-packed health insurance option in 2025 for individuals and families, especially PNB clients.
• It provides flexible sum insured, a large hospital network, and both cashless and reimbursement claims.
• Waiting periods apply as per standard Indian health insurance norms.
• No-claim bonus, add-on covers, and AYUSH benefits are notable plus points.
• Always compare with other insurers using online resources to maximize your policy’s value.

People Also Ask: Frequently Asked Questions

What are pre-existing diseases, and are they covered under this plan?
Pre-existing diseases are any health issues you are already aware of at the time of buying the policy. They are usually covered after a waiting period (2-4 years), as per policy terms.

Is there a senior citizen variant or special rates for older customers?
Most adult applicants up to 79 years can enroll, but premiums will be higher for those above 60 due to higher risk.

Does this policy offer lifelong renewability?
Yes, as long as you renew the policy every year without a break, it offers lifelong renewal.

How do I find if my hospital is part of the Oriental PNB Mediclaim network?
Check the Oriental Insurance website or contact customer support. Online policy comparison sites also let you search network hospitals in your locality.

Are online consultations or telemedicine covered?
Depending on the latest policy updates. In 2025, telemedicine has partial coverage under select plans, but always confirm with official documents.

Can I port to another insurer from Oriental PNB Mediclaim?
Yes, as per IRDAI regulations, you can port to or from another insurer at renewal, retaining continuity benefits.

Sources

Data and facts for this article are derived from:

• Oriental Insurance Company Official Brochure and Customer Support [nofollow]
• IRDAI Guidelines for Health Insurance [nofollow]
• Indian Ministry of Health Reports 2025 [nofollow]