{"uin":"OICHLGP26047V012627","name":"GRAMIN HEALTH BIMA POLICY - GROUP","url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627","insurer":{"slug":"oriental-insurance","name":"The Oriental Insurance Company Limited","url":"https://indiainsurances.com/insurer/oriental-insurance"},"line":"health","category":"group-health","category_name":"Group health","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"This is a group health indemnity policy with individual and family floater sum insured options. It covers hospitalisation in India with a 30 days initial waiting period, 12 months PED waiting period and room rent capped at 1% of Sum Insured per day.","analysis":{"state":"machine","analysed_at":"2026-10-19 22:08:07.721746+00","note":"First pass: one AI reading; every stated fact carries a verbatim quote found in the cited clause, but it has not been reviewed. Check the clause before relying on it."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"quote-verified","value":["Individual Option","Floater Option"],"display":"Individual Option and Floater Option","note":null,"quote":"FLOATER OPTION means that a single Sum Insured is available for use by any or all insured family members covered under the policy. ... INDIVIDUAL OPTION under this option, each insured member is covered with a separate Sum","sources":[{"clause":"2.10","heading":"FLOATER OPTION","page":2,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-2-10"},{"clause":"2.20","heading":"INDIVIDUAL OPTION under this option, each insured member is covered with a separate Sum","page":4,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-2-20"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"not-stated","value":null,"display":null,"note":"The wording defines Policy Period by reference to the schedule but does not state a fixed policy term.","quote":null,"sources":[],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"quote-verified","value":"Immediate notice should be given to the Company/TPA while taking treatment, within 48 hours of admission but before discharge, unless waived in writing.","display":"Within 48 hours of admission but before discharge","note":null,"quote":"Immediate notice of claim with particulars relating to Policy Number, ID Card No, Name of Insured Person in respect of whom claim is made, Nature of disease / Injury, and Name and Address of the attending Medical Practitioner / Hospital /Nursing Home, etc. should be given to the Company/ TPA while taking treatment in the Hospital / Nursing Home by fax, e-mail Such notice should be given within 48 hours of admission but before discharge from Hospital / Nursing Home, unless waived in writing.","sources":[{"clause":"5.17","heading":"NOTIFICATION OF CLAIM","page":16,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-5-17"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"quote-verified","value":["Original bills, all receipts, and discharge certificate/card from the Hospital","All documents pertaining to the Illness, starting from the date it was first detected, i.e. Doctor’s consultation reports/history","Medical history of the patient recorded by the Hospital","Original Cash-memo from the Hospital (s) /chemist (s) supported by proper prescription","Original receipt, pathological and other test reports from a pathologist/radiologist including film, etc. supported by the note from the attending Medical Practitioner / Surgeon demanding such tests","Original attending Consultants / Anesthetists / Specialist certificates regarding diagnosis and bills/receipts etc.","Surgeon’s original certificate stating diagnosis and nature of operation performed along with bills/receipts etc.","MLC/FIR/Post Mortem Report, (if applicable)","Disability certificate, Death certificate(if applicable)","Documents in respect of organ donation claim, shall be in accordance with the extant Act, Central/State Rules/regulations, as applicable, in respect of transplantation of human organs","Details of previous policies, if the details are already not with TPA","Any other information required by TPA /Company"],"display":"Original bills, receipts, discharge certificate/card, medical records, prescriptions, reports, certificates, MLC/FIR/Post Mortem where applicable, disability/death certificate where applicable, organ donation documents, previous policy details and any other information required","note":"For reimbursement claims, these must be submitted within 15 days of discharge.","quote":"a) Original bills, all receipts, and discharge certificate/card from the Hospital\nb) All documents pertaining to the Illness, starting from the date it was first detected, i.e. Doctor’s consultation reports/history\nc) Medical history of the patient recorded by the Hospital\nd) Original Cash-memo from the Hospital (s) /chemist (s) supported by proper prescription\ne) Original receipt, pathological and other test reports from a pathologist/radiologist including film, etc. supported by the note from the attending Medical Practitioner / Surgeon demanding such tests\nf) Original attending Consultants / Anesthetists / Specialist certificates regarding diagnosis and bills/receipts etc.\ng) Surgeon’s original certificate stating diagnosis and nature of operation performed along with bills/receipts etc.\nh) MLC/FIR/Post Mortem Report, (if applicable)\ni) Disability certificate, Death certificate(if applicable)\nj) Documents in respect of organ donation claim, shall be in accordance with the extant Act, Central/State Rules/regulations, as applicable, in respect of transplantation of human organs\nk) Details of previous policies, if the details are already not with TPA\nl) Any other information required by TPA /Company","sources":[{"clause":"5.18","heading":"CLAIM DOCUMENTS","page":16,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-5-18"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"quote-verified","value":"The Company shall settle the claim within 15 days from receipt of the last necessary documents; after acceptance of the settlement offer, payment is to be made within 7 days. If investigation is needed, it must be completed within 30 days from receipt of the last necessary document.","display":"Settle within 15 days from last necessary documents; pay within 7 days of acceptance","note":"Another clause in the same wording says non-cashless claims shall be settled within thirty (30) days from submission of the last required claim document.","quote":"The Company shall settle the claim within 15 days from the date of the receipt of last necessary documents in accordance with the provisions of IRDAI (Health Insurance) Regulations, 2024. Upon acceptance of an offer of settlement by the insured Person, the payment of the amount due shall be made within 7 days from the date of acceptance of the offer by the Insured Person. However, where the circumstances of a claim warrant an investigation in the opinion of the Company, it shall initiate and complete such investigation at the earliest, in any case not later than 30 days from the date of receipt of last necessary document","sources":[{"clause":"5.21","heading":"PAYMENT OF CLAIM","page":18,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-5-21"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"quote-verified","value":["Expenses related to the treatment of any disease/ illness within 30 days from the first policy commencement date","Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of the specified waiting period","Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications","Injury / disease directly or indirectly caused by or arising from or attributable to invasion, Act of Foreign enemy, War like operations","Cost of spectacles and contact lenses, hearing aids","Dental treatment or surgery of any kind unless requiring hospitalisation","Convalescence, general debility; run-down condition or rest cure","intentional self-injury and use of intoxication drugs / alcohol","All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus Type III (HTLB - III)","Injury or Disease directly or indirectly caused by or contributed to by nuclear weapon / materials","Any unproven/experimental treatment or alternative treatment","Treatment of Genetic disorders and stem cell implantation / surgery","Treatment of obesity or condition arising there from (including morbid obesity)","No coverage for domiciliary hospitalization, pre and post medical expenses."],"display":"30 days illness waiting, specific disease/procedure waiting, PED waiting, war, spectacles/contact lenses/hearing aids, dental unless hospitalised, convalescence/rest cure, intentional self-injury/intoxication, AIDS-related conditions, nuclear perils, unproven/experimental treatment, genetic disorders and stem cell implantation/surgery, obesity treatment, domiciliary and pre/post medical expenses","note":null,"quote":"Expenses related to the treatment of any disease/ illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered. ... Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of the specified waiting period ... Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 12 months of continuous coverage after the date of inception of the first policy with the insurer. ... Injury / disease directly or indirectly caused by or arising from or attributable to invasion, Act of Foreign enemy, War like operations (whether war be declared or not) ... Cost of spectacles and contact lenses, hearing aids. ... Dental treatment or surgery of any kind unless requiring hospitalisation. ... Convalescence, general debility; run-down condition or rest cure ... intentional self-injury and use of intoxication drugs / alcohol ... All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus Type III (HTLB - III) ... Injury or Disease directly or indirectly caused by or contributed to by nuclear weapon / materials ... Any unproven/experimental treatment or alternative treatment ... Treatment of Genetic disorders and stem cell implantation / surgery. ... Treatment of obesity or condition arising there from (including morbid obesity) ... No coverage for domiciliary hospitalization, pre and post medical expenses.","sources":[{"clause":null,"heading":"1. 30 Days Waiting Period","page":8,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-1-30-days-waiting-period"},{"clause":null,"heading":"2. Specific disease/procedure Waiting Period","page":9,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-2-specific-disease-procedure-waiting-period"},{"clause":null,"heading":"3. Pre-Existing Diseases","page":10,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-3-pre-existing-diseases"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"quote-verified","value":"The insured person may contact the company through its website, toll-free numbers or email, or approach the grievance cell at any branch. If not satisfied, they may contact the Grievance Officer at the Customer Service Department, Corporate Office, before going to the Insurance Ombudsman.","display":"Company website/toll-free/email or branch grievance cell first; then Grievance Officer, Customer Service Department, Corporate Office","note":null,"quote":"In case of any grievance the insured person may contact the company through :Website: www.orientalinsurance.org.in Toll-free:1800118485Or011-33208485 E-mail:csd@orientalinsurance.co.in The insured person may also approach the grievance cell at any of the company’s branches with details of their grievance. If the insured person is not satisfied with the resolution provided through the above methods, they may contact the Grievance Officer at:\nCustomer Service Department, Corporate Office, Block - 4, Plate-A, NBCC Office Complex, Kidwai Nagar East, New Delhi - 110023.","sources":[{"clause":"6.16","heading":"GRIEVANCE REDRESSAL In case of any grievance the insured person may contact the","page":21,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-6-16"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"quote-verified","value":"Individual Sum Insured options are Rs. 50000, Rs. 75000 and Rs. 100000. Family Floater Sum Insured options are Rs. 100000, Rs. 150000 and Rs. 200000.","display":"Individual: Rs. 50000, Rs. 75000, Rs. 100000; Family Floater: Rs. 100000, Rs. 150000, Rs. 200000","note":null,"quote":"Individual\nSum Insured (Rs.) | Per illness Limit (Rs.)\n50000 | 25000\n75000 | 30000\n100000 | 35000 ... Sum Insured (Rs.) | Per illness Limit (Rs.)\n100000 | 25000\n150000 | 30000\n200000 | 35000","sources":[{"clause":null,"heading":"3 – COVERAGE","page":6,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-3-coverage"},{"clause":null,"heading":"Family Floater","page":6,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-family-floater"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":null,"quote":"Expenses related to the treatment of any disease/ illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered.","sources":[{"clause":null,"heading":"1. 30 Days Waiting Period","page":8,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-1-30-days-waiting-period"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"quote-verified","value":{"unit":"months","amount":12},"display":"12 months","note":null,"quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 12 months of continuous coverage after the date of inception of the first policy with the insurer.","sources":[{"clause":null,"heading":"3. Pre-Existing Diseases","page":10,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-3-pre-existing-diseases"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"quote-verified","value":{"unit":"days","amount":90},"display":"90 Days for Hypertension and Diabetes","note":"Most listed specific diseases/procedures have a 12 Months waiting period; Hypertension and Diabetes have 90 Days.","quote":"The waiting Period for all the diseases specified hereunder will be 12 Months, until and unless otherwise specified. ... # Waiting period of 90 Days in case of Hypertension and Diabetes #","sources":[{"clause":null,"heading":"2. Specific disease/procedure Waiting Period","page":9,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-2-specific-disease-procedure-waiting-period"},{"clause":null,"heading":"Ailment / Disease / Surgery","page":9,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-ailment-disease-surgery"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"quote-verified","value":["Benign ENT disorders and surgeries i.e. Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty etc.","Polycystic ovarian diseases.","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.","Joint Replacement due to Degenerative condition.","Age related osteoarthritis and Osteoporosis."],"display":"Benign ENT disorders and surgeries, Polycystic ovarian diseases, hernia, hydrocele, Non infective Arthritis, Undescendent Testes, Cataract, benign prostatic hypertrophy, Hysterectomy/myomectomy/prolapse of uterus, Fissure/Fistula, Piles, Sinusitis, gallbladder and bile duct surgery, genito-urinary surgery, Pilonidal Sinus, Gout and Rheumatism, Hypertension, Diabetes, Calculus diseases, prolapsed inter vertebral disk surgery, varicose veins/ulcers, Joint Replacement due to degenerative condition, Age related osteoarthritis and Osteoporosis","note":null,"quote":"I | Benign ENT disorders and surgeries i.e. Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty etc.\nIi | Polycystic ovarian diseases.\nIii | Surgery of hernia.\nIv | Surgery of hydrocele.\nV | Non infective Arthritis.\nVi | Undescendent Testes.\nVii | Cataract.\nViii | Surgery of benign prostatic hypertrophy.\nIx | Hysterectomy for menorrhagia or fibromyoma or myomectomy or prolapse of uterus\nX | Fissure / Fistula in anus.\nXi | Piles.\nXii | Sinusitis and related disorders.\nXiii | Surgery of gallbladder and bile duct excluding malignancy.\nXiv | Surgery of genito-urinary system excluding malignancy.\nXv | Pilonidal Sinus.\nXvi | Gout and Rheumatism.\nXvii | Hypertension #\nXviii | Diabetes #\nXix | Calculus diseases.\nXx | Surgery for prolapsed inter vertebral disk unless arising from accident.\nXxi | Surgery of varicose veins and varicose ulcers.\nXxii | Joint Replacement due to Degenerative condition.\nXxiii | Age related osteoarthritis and Osteoporosis.","sources":[{"clause":null,"heading":"Ailment / Disease / Surgery","page":9,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-ailment-disease-surgery"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"quote-verified","value":{"unit":"months","amount":60},"display":"sixty continuous months","note":"For enhanced sum insured, the moratorium for the enhanced limits is calculated separately from the date of enhancement.","quote":"After the completion of sixty continuous months under the policy, no look-back provision shall be applied. This period of sixty continuous months is referred to as the Moratorium Period.","sources":[{"clause":"5.11","heading":null,"page":15,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-5-11"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"quote-verified","value":"Policyholders, including all members under family cover, have the option to transfer credits gained from one insurer to another insurer, including Sum Insured, No Claim Bonus, specific waiting periods, PED waiting period and Moratorium period credits.","display":"Available; credits can transfer from one insurer to another insurer","note":null,"quote":"The Policyholders (including all members under family cover), will have the option to transfer the credits gained from one insurer to another insurer. ... By Porting, the policyholder is entitled to transfer the credits gained to the extent of the Sum Insured, No Claim Bonus, specific waiting periods, waiting period for pre-existing disease, Moratorium period etc. from the Existing Insurer to the Acquiring Insurer in the previous policy.","sources":[{"clause":"5.9(a)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-5-9-a"},{"clause":"5.9(b)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-5-9-b"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"not-stated","value":null,"display":null,"note":"The wording states renewal is subject to mutual agreement and continuation of the Group Policy, but does not state lifelong renewal.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"not-stated","value":null,"display":null,"note":"The wording says renewal shall not be denied because claims were made, but does not state whether premium can be loaded because of claims.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"quote-verified","value":["Injury / disease directly or indirectly caused by or arising from or attributable to invasion, Act of Foreign enemy, War like operations","Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident","vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description","Cost of spectacles and contact lenses, hearing aids.","Dental treatment or surgery of any kind unless requiring hospitalisation.","Convalescence, general debility; run-down condition or rest cure","Congenital external disease or defects or anomalies, Sterility, Venereal disease, intentional self-injury and use of intoxication drugs / alcohol","All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus Type III (HTLB - III)","Injury or Disease directly or indirectly caused by or contributed to by nuclear weapon / materials","Any unproven/experimental treatment or alternative treatment","Hospitalisation for investigation or treatment irrelevant to the diseases diagnosed during hospitalisation","Treatment of Genetic disorders and stem cell implantation / surgery.","Treatment of obesity or condition arising there from (including morbid obesity)","Any treatment required because of Insured person’s participation in any hazardous activity","Any treatment received in convalescent home, convalescent hospital, health hydro, nature care clinic or similar establishments.","Hormone replacement therapy, Sex change or treatment which results from or is in any way related to sex change.","No coverage for domiciliary hospitalization, pre and post medical expenses."],"display":"War/invasion, certain circumcision/vaccination/cosmetic/plastic surgery, spectacles/contact lenses/hearing aids, dental unless hospitalised, convalescence/rest cure, congenital external disease/sterility/venereal disease/self-injury/intoxication, AIDS-related conditions, nuclear perils, unproven/experimental or excluded alternative treatments, irrelevant investigation/treatment, genetic disorders and stem cell implantation/surgery, obesity treatment, hazardous activities, convalescent/nature care facilities, domestic hospital stay, hormone replacement/sex change, domiciliary and pre/post medical expenses","note":null,"quote":"Injury / disease directly or indirectly caused by or arising from or attributable to invasion, Act of Foreign enemy, War like operations (whether war be declared or not)\nb) Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness.\nc) Cost of spectacles and contact lenses, hearing aids.\nd) Dental treatment or surgery of any kind unless requiring hospitalisation.\ne) Convalescence, general debility; run-down condition or rest cure, Congenital external disease or defects or anomalies, Sterility, Venereal disease, intentional self-injury and use of intoxication drugs / alcohol ... Any unproven/experimental treatment or alternative treatment (other than Ayurveda, Yoga & Naturopathy Unani, Homeopathy, Siddha,) and related treatment including acupressure, acupuncture, magnetic and such other therapies. ... Treatment of Genetic disorders and stem cell implantation / surgery. ... No coverage for domiciliary hospitalization, pre and post medical expenses.","sources":[{"clause":null,"heading":"3. Pre-Existing Diseases","page":10,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-3-pre-existing-diseases"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"quote-verified","value":"The Group policyholder may cancel by giving 7 days’ written notice. If the policy term is one year and no claim has been made, premium is refunded pro-rata for the unexpired policy period; no refund is made where any claim has been admitted or lodged or any benefit availed.","display":"Pro-rata refund for unexpired Policy Period if one-year policy and no claim; no refund if claim admitted/lodged or benefit availed","note":"Cancellation rights vest with the Group Policyholder; individual insured persons cannot cancel independently.","quote":"The Group policyholder may cancel this Policy at any time during the term, by giving 7 days’ notice in writing, The Company will refund the premium on a pro-rata basis for the unexpired Policy Period if the term of the policy is one year and there is no claim(s) made during the policy period.\nNotwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of Cancellation where any claim has been admitted or has been lodged or any benefit has been availed by the Insured person under the Policy.","sources":[{"clause":"5.5","heading":"CANCELLATION CLAUSE","page":13,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-5-5"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"quote-verified","value":"Medical treatment for this insurance must be taken in India only and claims are payable in Indian currency only.","display":"India only","note":null,"quote":"All medical treatment for the purpose of this insurance will have to be taken in India only and all claims shall be payable in Indian currency only.","sources":[{"clause":"5.21","heading":"PAYMENT OF CLAIM","page":18,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-5-21"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Applies on new health insurance policies and not on renewals or at the time of porting/migrating.","quote":"the Group Policy Holder shall be allowed a free look period of 30 days from the date of receipt of the Policy document to review the terms and conditions of the Policy and to return the same if not acceptable","sources":[{"clause":"5.7","heading":"FREE-LOOK PERIOD","page":14,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-5-7"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"thirty days","note":null,"quote":"The grace period of thirty days is available on the premium due date, to pay the premium.","sources":[{"clause":"6.6","heading":"GRACE PERIOD FOR PAYMENT OF PREMIUM","page":20,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-6-6"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"quote-verified","value":"Minimum entry age is 18 Years and maximum entry age is 65 years. Dependent children can be covered from 91 days under the family-size provisions.","display":"18 Years to 65 years; dependent children from 91 days","note":null,"quote":"Minimum Age is 18 Years & Maximum entry age under the policy is 65 years. ... Dependent Children (i.e. natural or legally adopted) between the ages of 91 days to 18 years.","sources":[{"clause":"6.2","heading":"ENTRY AGE","page":19,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-6-2"},{"clause":"6.1","heading":"FAMILY SIZE: Family consists of the following","page":19,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-6-1"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"not-stated","value":null,"display":null,"note":"The wording says premium is paid in advance, but does not state yearly, half-yearly, quarterly or monthly modes.","quote":null,"sources":[],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"not-stated","value":null,"display":null,"note":"No add-on covers for extra premium are stated in the provided wording or prospectus.","quote":null,"sources":[],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"quote-verified","value":"Coverage is not available during the grace period.","display":"Coverage is not available during the grace period","note":null,"quote":"At the end of the policy period, the policy shall terminate and can be renewed within the Grace Period of 30 days to maintain the continuity of benefits without a break in policy. Coverage is not available during the grace period.","sources":[{"clause":"5.8","heading":"RENEWAL OF POLICY","page":14,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-5-8"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"Daily room limit, if any.","status":"quote-verified","value":"Room and boarding expenses are covered up to 1% of Sum Insured per day.","display":"Not exceeding 1% of Sum Insured per day","note":null,"quote":"Room, Boarding Expenses as provided by the Hospital / nursing home. IC Unit charges | Not exceeding 1% of Sum Insured per day Not exceeding 2% of Sum Insured per day","sources":[{"clause":"Section 1","heading":"HOSPITALISATION","page":7,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-section-1"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Childbirth cover and any waiting period.","status":"quote-verified","value":"In-patient maternity expenses are covered up to Rs.10,000 for normal delivery and Rs.20,000 for caesarean section delivery, after 12 months continuous cover, limited to two deliveries or terminations or either during the insured person's lifetime.","display":"Rs.10,000 normal delivery; Rs.20,000 caesarean section; 12 months waiting; maximum two deliveries/terminations","note":null,"quote":"The Company shall pay the Medical Expenses incurred as an in-patient for a delivery (including caesarean section) or lawful medical termination of pregnancy during the Policy Period. This benefit is limited to two deliveries or terminations or either, during the lifetime of the Insured Person provided that:\ni) The maternity benefit shall be available only if the Insured Person has been continuously covered under this Group Policy, or under any other health insurance policy (group or individual) of the Insurer that includes maternity cover, for a minimum period of twelve (12) months, with no break in coverage from the earlier policy. ... Not exceeding Rs.10000/- in respect of normal delivery Not exceeding Rs.20000/- in respect of caesarean section delivery.","sources":[{"clause":"Section 2","heading":"MATERNITY BENEFIT","page":7,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-section-2"},{"clause":"Section 1","heading":"HOSPITALISATION","page":7,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-section-1"}],"law":[]},{"key":"ped_cover_group","label":"Pre-existing diseases","section":"Waiting periods","meaning":"Whether pre-existing diseases are covered from day one for the group.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"quote-verified","value":"Cashless facility is available where payments of approved treatment costs are made directly to the network provider; cashless claims are through the Company/TPA for admission in a network Hospital/Nursing Home subject to pre-admission authorisation.","display":"Available in network Hospital/Nursing Home through Company/TPA, subject to pre-admission authorization","note":"Pre-authorization is to be provided no later than one hour from receipt of request, and final bill authorization within three hours of discharge authorization.","quote":"CASHLESS FACILITY Cashless facility means a facility extended by the insurer to the insured where the payments, of the costs of treatment undergone by the insured in accordance with the policy terms and conditions, are directly made to the network provider by the insurer to the extent pre-authorization is approved. ... Claim in respect of Cashless Access Services will be through the Company / TPA provided admission is in a network Hospital/ Nursing Home and is subject to pre admission authorization.","sources":[{"clause":"2.4","heading":"CASHLESS FACILITY Cashless facility","page":1,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-2-4"},{"clause":"5.19(a)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-5-19-a"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"quote-verified","value":"Claims and servicing may be handled by the Company and/or its duly appointed Third Party Administrator, wherever applicable.","display":"Company and/or duly appointed Third Party Administrator","note":null,"quote":"the Company agrees to provide insurance cover to the insured members (including their eligible family members, where applicable) named in the Schedule (hereinafter referred to as the “Insured Person(s)”). ... obtaining insurance cover for such insurance from The Oriental Insurance Company Limited (hereinafter referred to as “the Company”) to be serviced by the Company and/or its duly appointed Third Party Administrator, wherever applicable.","sources":[{"clause":"1","heading":"PREAMBLE","page":1,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-1"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"quote-verified","value":true,"display":"Yes, Family Floater Sum Insured options are available","note":null,"quote":"FLOATER OPTION means that a single Sum Insured is available for use by any or all insured family members covered under the policy. ... Family Floater\nSum Insured (Rs.) | Per illness Limit (Rs.)\n100000 | 25000\n150000 | 30000\n200000 | 35000","sources":[{"clause":"2.10","heading":"FLOATER OPTION","page":2,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-2-10"},{"clause":null,"heading":"Family Floater","page":6,"url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843#c-family-floater"}],"law":[]}],"documents":[{"kind":"wording","label":"POLICY WORDING.pdf","pages":13,"fetched_at":"2026-10-17 19:53:29+00","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/POLICY_WORDING_84409e8ebd.pdf","url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13773"},{"kind":"wording","label":"Gramin Health Bima Policy - Group Policy Wordings 04092026.pdf","pages":41,"fetched_at":"2026-10-17 19:55:39+00","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/Gramin_Health_Bima_Policy_Group_Policy_Wordings_04092026_33b6ab9ee1.pdf","url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13843"},{"kind":"prospectus","label":"PROSPECTUS.pdf","pages":8,"fetched_at":"2026-10-17 19:52:50+00","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/PROSPECTUS_15401ac6c4.pdf","url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13752"},{"kind":"prospectus","label":"Gramin_Health_Bima_Group_Prospectus_04092026.pdf","pages":6,"fetched_at":"2026-10-17 19:54:35+00","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/Gramin_Health_Bima_Group_Prospectus_04092026_4a9ec6db56.pdf","url":"https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627/document/13803"}],"versions":[{"uin":"OICHLGP250050V012425","version":null,"approved_on":null},{"uin":"OICHLGP26047V012627","version":null,"approved_on":null}],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"Oriental Insurance official website","url":"https://www.orientalinsurance.org.in/","note":"Buy directly from the insurer."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"insurer","name":"Claim forms","url":"https://www.orientalinsurance.org.in/claim-form","note":null},{"purpose":"claim","kind":"insurer","name":"Health claim status","url":"https://www.orientalinsurance.org.in/health-claim-status","note":null},{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"insurer","name":"Grievance redressal","url":"https://www.orientalinsurance.org.in/grievance-redressal","note":null},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"GRAMIN HEALTH BIMA POLICY - GROUP (UIN OICHLGP26047V012627), IndiaInsurances, https://indiainsurances.com/policy/oriental-insurance/gramin-health-bima-policy-group-oichlgp26047v012627"}