{"uin":"OICHLIP25039V042425","name":"HEALTH OF PRIVILEGED ELDERS (HOPE) 2024","url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425","insurer":{"slug":"oriental-insurance","name":"The Oriental Insurance Company Limited","url":"https://indiainsurances.com/insurer/oriental-insurance"},"line":"health","category":"health-senior","category_name":"Senior citizen health","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Health of Privileged Elders 2024 is a senior citizen specified diseases indemnity policy for Indian citizens aged 60 years and above with a one year policy period. It offers sum insured from Rs 100,000 to Rs. 5,00,000 and has 20% compulsory co-payment, a 30 day initial waiting period, a 24 month pre-existing disease waiting period, and a five year moratorium.","analysis":{"state":"machine","analysed_at":"2026-10-19 22:01:07.760553+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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"quote-verified","value":"This insurance policy is issued for a period of one year.","display":"one year","note":null,"quote":"PERIOD OF POLICY: This insurance policy is issued for a period of one year as shown in the schedule.","sources":[{"clause":"9(b)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-9-b-2"}],"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 of claim must be given to the Company or TPA while taking treatment, within 48 hours of admission or before discharge, whichever is earlier, unless waived in writing.","display":"Within 48 hours of admission or before discharge, whichever is earlier","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 / illness / 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, Email. Such notice should be given within 48 hours of admission or before discharge from Hospital / Nursing Home, whichever is earlier, unless waived in writing by the Company.","sources":[{"clause":null,"heading":"5 CONDITIONS","page":13,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-5-conditions"}],"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, receipts and discharge certificate / card from the hospital","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 attending medical practitioner / surgeon demanding such tests","Attending Consultants / Anaesthetists / Specialist certificates regarding diagnosis and bill / receipts etc.","Surgeon’s original certificate stating diagnosis and nature of operation performed along with bills / receipts etc.","Any other information required by TPA / Insurance Company"],"display":"Original bills, discharge card, medical history, cash memos with prescriptions, test reports, consultant certificates, surgeon certificate, and any other information required","note":"Final claim documents are to be submitted within 7 days of discharge; post-hospitalisation documents within 7 days after completion of such treatment.","quote":"a) Original bills, receipts and discharge certificate / card from the hospital. ... b) Medical history of the patient recorded by the Hospital. ... c) Original Cash-memo from the hospital (s) / chemist (s) supported by proper prescription. ... d) Original receipt, pathological and other test reports from a pathologist / radiologist including film etc. supported by the note from attending medical practitioner / surgeon demanding such tests. ... e) Attending Consultants / Anaesthetists / Specialist certificates regarding diagnosis and bill / receipts etc. ... f) Surgeon’s original certificate stating diagnosis and nature of operation performed along with bills / receipts etc. ... g) Any other information required by TPA / Insurance Company.","sources":[{"clause":null,"heading":"5 CONDITIONS","page":13,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-5-conditions"}],"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 or reject a claim within 15 days from submission of claim. If investigation is warranted, it must complete investigation within 30 days from receipt of the last necessary document and settle or reject within 45 days from receipt of the last necessary document.","display":"15 days from submission of claim; investigated claims within 45 days from last necessary document","note":"Delay attracts interest at a rate 2% above the bank rate as stated in the claim settlement clause.","quote":"The Company shall settle or reject a claim, as the case may be, within 15 days from the date of submission of claim. ... where the circumstance 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. In such cases, the Company shall settle or reject the claim within 45 days from the date of receipt of last necessary document.","sources":[{"clause":null,"heading":"DISCLOSURE TO INFORMATION NORM","page":16,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-disclosure-to-information-norm"}],"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":["Any disease / health condition / illness / ailment or any condition arising there from other thanthose specified in the policy as covered","Pre-existing Disease (PED) and its direct complications until 24 months","Listed conditions, surgeries/treatments during the specified waiting period","Any illness within 30 days from the first policy commencement date except covered accident claims","Investigation & Evaluation","Rest Cure, rehabilitation and respite care","Obesity/Weight Control","Change of Gender Treatments","Cosmetic or Plastic Surgery","Hazardous or Adventure sports","Breach of law","Any expenses incurred on OPD treatment","Treatment taken outside the geographical limits of India"],"display":"Specified diseases only; PED for 24 months; listed conditions for first two policy years; 30 day illness waiting period; diagnostics/evaluation, rest cure, obesity, gender change, cosmetic surgery, hazardous sports, breach of law, OPD and treatment outside India excluded","note":null,"quote":"Any disease / health condition / illness / ailment or any condition arising there from other thanthose specified in the policy as covered. ... Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first policy with the insurer. ... Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of the specified waiting period of the continuous coverage after the date of inception of the first policy with us. ... Expenses related to the treatment of any 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. ... Investigation & Evaluation – Code – ExcI04 ... Rest Cure, rehabilitation and respite care – Code -ExcI05 ... Obesity/Weight Control: Code- EscI06 ... Change of Gender Treatments: Code – ExcI07 ... Cosmetic or Plastic Surgery- Code- ExcI08 ... Hazardous or Adventure sports- Code- ExcI09 ... Breach of law – Code –ExcI10 ... Any expenses incurred on OPD treatment Treatment taken outside the geographical limits of India.","sources":[{"clause":null,"heading":"Withdrawal: WITHDRAWAL OF POLICY","page":7,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-withdrawal-withdrawal-of-policy"},{"clause":null,"heading":"Pre-existing Diseases - code -ExcI0 1","page":8,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-pre-existing-diseases-code-exci0-1"},{"clause":null,"heading":"Specified disease/ procedure waiting period- code- ExcI02","page":9,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-specified-disease-procedure-waiting-period-code"},{"clause":"9(a)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-9-a-3"},{"clause":null,"heading":"Investigation & Evaluation – Code – ExcI04","page":9,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-investigation-evaluation-code-exci04"},{"clause":null,"heading":"Rest Cure, rehabilitation and respite care – Code -ExcI05","page":9,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-rest-cure-rehabilitation-and-respite-care-code-e"},{"clause":null,"heading":"Obesity/Weight Control: Code- EscI06","page":10,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-obesity-weight-control-code-esci06"},{"clause":null,"heading":"Change of Gender Treatments: Code – ExcI07","page":10,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-change-of-gender-treatments-code-exci07"},{"clause":null,"heading":"Cosmetic or Plastic Surgery- Code- ExcI08","page":10,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-cosmetic-or-plastic-surgery-code-exci08"},{"clause":null,"heading":"Hazardous or Adventure sports- Code- ExcI09","page":10,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-hazardous-or-adventure-sports-code-exci09"},{"clause":null,"heading":"Breach of law – Code –ExcI10","page":10,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-breach-of-law-code-exci10"},{"clause":"9(c)","heading":"Biological attack or weapons","page":11,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-9-c-4"}],"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 may contact the company through its website, toll free numbers or email, or approach the grievance cell at any branch. If not satisfied, the insured may contact the grievance officer at the Customer Service Department, Corporate Office, New Delhi, before approaching the Insurance Ombudsman.","display":"Contact Oriental Insurance through website, toll free or email, or branch grievance cell; then Customer Service Department grievance officer","note":null,"quote":"In case of any grievance the insured person may contact the company through\nWebsite: www.orientalinsurance.org.in Toll free: 1800118485 Or 011- 33208485 E-mail: csd@orientalinsurance.co.in Insured person may also approach the grievance cell at any of the company’s branches with the d details of grievance. If Insured person is not satisfied with the redressal of grievance through one of the above methods, insured person 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":null,"heading":"19 Complete Discharge","page":22,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-19-complete-discharge"}],"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":"Minimum sum insured is Rs 100,000/-; higher sum insured can be selected in multiples of Rs 100,000/- up to Rs. 5,00,000/-.","display":"Rs 100,000 to Rs. 5,00,000 in multiples of Rs 100,000","note":null,"quote":"Minimum sum insured that can be selected is Rs 100,000/- and higher sum insured can be selected in multiples of Rs 100,000/- up to a maximum sum insured of Rs. 5,00,000/- .","sources":[{"clause":"Row 2(X)(b)(v)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-row-2-x-b-v"}],"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":"Does not apply if the insured person has continuous coverage for more than twelve months.","quote":"Expenses related to the treatment of any 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":"9(a)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-9-a-3"}],"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":24},"display":"24 months","note":"On sum insured enhancement, the exclusion applies afresh to the increased sum insured; coverage after 24 months is subject to the PED being declared and accepted.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first policy with the insurer.","sources":[{"clause":null,"heading":"Pre-existing Diseases - code -ExcI0 1","page":8,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-pre-existing-diseases-code-exci0-1"}],"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":"years","amount":2},"display":"first two policy years","note":"This exclusion is not applicable for claims arising due to an accident.","quote":"The expenses on treatment of following ailments / diseases / surgeries, if contracted and / or manifested after inception of first Policy (subject to continuity being maintained), are not payable for first two policy years.","sources":[{"clause":"9(f)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-9-f"}],"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":["Non-infective Arthritis","Cataract","Surgery of benign prostatic hypertrophy","Surgery of gallbladder and bile duct excluding malignancy","Surgery of genitor urinary system excluding malignancy","Gout and Rheumatism","Calculus diseases","Joint Replacement due to Degenerative condition","Age related osteoarthritis and Osteoporosis"],"display":"Non-infective arthritis, cataract, benign prostatic hypertrophy surgery, gallbladder and bile duct surgery, genito-urinary surgery, gout and rheumatism, calculus diseases, degenerative joint replacement, age related osteoarthritis and osteoporosis","note":null,"quote":"i Non-infective Arthritis. ii Cataract. iii Surgery of benign prostatic hypertrophy. iv Surgery of gallbladder and bile duct excluding malignancy. v Surgery of genitor urinary system excluding malignancy. vii Gout and Rheumatism. viii Calculus diseases. ix Joint Replacement due to Degenerative condition. x Age related osteoarthritis and Osteoporosis.","sources":[{"clause":"9(f)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-9-f"}],"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":"years","amount":5},"display":"five continuous years","note":"For enhanced sums insured, five continuous years applies from the date of enhancement only on the enhanced limits.","quote":"After completion of five continuous years under this policy no look back to be applied. This period of five years is called as moratorium period. ... After the expiry of Moratorium Period no health insurance claim shall be contestable except for proven fraud and permanent exclusions specified in the policy contract.","sources":[{"clause":null,"heading":"18 MORATORIUM PERIOD","page":21,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-18-moratorium-period"}],"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":"The insured person can port the policy to other insurers by applying at least 30 days before, but not earlier than 60 days from, the policy renewal date. If continuously covered without lapses under any Indian general or health insurer policy, the proposed insured person gets accrued continuity benefits in waiting periods as per IRDAI portability guidelines.","display":"Can port to other insurers with waiting-period continuity credit","note":null,"quote":"The Insured Person will have the option to port the Policy to other insurers by applying to such insurer to port the entire policy along with all the members of the family, if any, at least 30 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance policy with an Indian General/Health insurer, the proposed insured person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.","sources":[{"clause":null,"heading":"8 Portability","page":18,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-8-portability"}],"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":null,"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":"quote-verified","value":"No loading shall apply on renewals based on individual claims experience.","display":"No loading on renewals based on individual claims experience","note":null,"quote":"No loading shall apply on renewals based on individual claims experience.","sources":[{"clause":"Row 2(X)(b)(v)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-row-2-x-b-v"}],"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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"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 insured may cancel any time during the term by giving 7 days' written notice. For annual policies, the insurer refunds proportionate premium for the unexpired policy period if no claim has been made; no refund is made where a claim has been admitted or lodged or any benefit has been availed.","display":"7 days' notice; proportionate refund for unexpired annual policy period if no claim","note":null,"quote":"Cancellation by insured - Any time during the term, by giving 7 days’ notice in writing. Refund by Insurer : ... Proportionate premium for unexpired policy period, in case of Annual policies, subject to no claim (s)having been made during the policy period. ... Notwithstanding 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":null,"heading":"DISCLOSURE TO INFORMATION NORM","page":16,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-disclosure-to-information-norm"},{"clause":"Row 2(X)(a)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-row-2-x-a"},{"clause":"Row 2(X)(b)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-row-2-x-b"}],"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":"The policy covers illness, disease or accidental bodily injury sustained during the policy period anywhere in India, and all medical or surgical treatment has to be taken in India.","display":"India only","note":null,"quote":"The policy covers illness, disease or accidental bodily injury sustained by the insured person during the policy period anywhere in India and all medical / surgical treatment under this policy shall have to be taken in India","sources":[{"clause":"Row 2(X)(b)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-row-2-x-b"}],"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":"thirty days","note":"Applicable on new individual health insurance policies, not on renewals or at the time of porting or migrating the policy.","quote":"The insured shall be allowed free look period of thirty 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":null,"heading":"5 CONDITIONS","page":13,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-5-conditions"}],"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 in all other cases; fifteen days where premium payment mode is monthly","note":"The displayed default is 30 days; the grace period is 15 days where the premium payment mode is monthly.","quote":"The grace period for payment of the premium for all types of insurance policies shall be: fifteen days where premium payment mode is monthly and thirty days in all other cases.","sources":[{"clause":"9(b)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-9-b-2"}],"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":"The policy is available to Indian citizens aged 60 years and above.","display":"60 years and above","note":null,"quote":"This policy is available to any Indian citizen who is aged 60 years and above","sources":[{"clause":null,"heading":"PROSPECTUS HEALTH OF PRIVILEGED ELDERS 2024","page":1,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13715#c-prospectus-health-of-privileged-elders-2024"}],"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":null,"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":null,"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 for the period no premium is received. The insurer shall offer coverage during the grace period if the premium is paid in instalments during the policy period.","display":"Coverage is not available for the period no premium is received; offered during grace period if premium is paid in instalments during the policy period","note":null,"quote":"Coverage is not avail- able for the period no premium is received. ... Provided the insurers shall offer coverage during the grace period, if the premium is paid in instalments during the policy period","sources":[{"clause":"9(b)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-9-b-2"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed.","status":"quote-verified","value":"Room, boarding and nursing expenses are covered up to 1% of the Sum Insured per day. I.C. Unit expenses are covered up to 2% of the Sum Insured per day.","display":"Room up to 1% of Sum Insured per day; I.C. Unit up to 2% of Sum Insured per day","note":"If admitted in a room where room category or room rent is higher than eligibility, the insured bears a rateable proportion of associated medical expenses.","quote":"Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing Home not exceeding 1% of the Sum Insured per day. ... I.C. Unit expenses not exceeding 2% of the Sum Insured per day.","sources":[{"clause":"Row 11(a)","heading":null,"page":2,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-row-11-a"},{"clause":"Row 11(b)","heading":null,"page":2,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-row-11-b"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself.","status":"quote-verified","value":"The insured has to bear 20% of the admissible claim amount in each and every claim. The insured may also opt for voluntary co-payment after application of compulsory co-payment.","display":"20% compulsory co-payment on every admissible claim","note":"Voluntary co-payment options shown are 10%, 20%, 30%, 40%, and 50% & above, with corresponding premium discounts.","quote":"COMPULSORY CO-PAYMENT: Insured has to bear 20% of admissible claim amount in each and every claim. ... VOLUNTARY CO-PAYMENT: The insured may opt to bear a part of the claim amount (after application of compulsory co-payment) for which following discounts are applicable, subject to a maximum of 50%.","sources":[{"clause":"9(b)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-9-b-2"},{"clause":null,"heading":"Withdrawal: WITHDRAWAL OF POLICY","page":7,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-withdrawal-withdrawal-of-policy"}],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments even if the sum insured is higher.","status":"quote-verified","value":["Accidental Injury | 100% of Sum Insured","Knee Replacement | 70% of Sum Insured","Cardio Vascular Diseases | 50% of Sum Insured","Chronic Renal Failure | 50% of Sum Insured","Cancer | 50% of Sum Insured","Hepato-Biliary Disorders | 50% of Sum Insured","Chronic Obstructive Lung Diseases | 20% of Sum Insured","Stroke | 20% of Sum Insured","Benign Prostrate | 15% of Sum Insured","Orthopaedic Diseases | 15% of Sum Insured","Ophthalmic Diseases | 10% of Sum Insured","Oral chemotherapy | Per policy period 25% of SI, subject to maximum INR 50,000","Immunotherapy- Monoclonal Antibody to be given as injection | Per policy period 10% of SI, subject to maximum INR 50,000","Intra vitreal injections | Per policy period 10% of SI, subject to maximum INR 50,000","Robotic surgeries | Per policy period 10% of SI, subject to maximum INR 1,00,000","Stereotactic radio surgeries | Per policy period 10% of SI, subject to maximum INR 1,00,000","Vaporization of the prostrate (Green laser treatment or holmium laser treatment) | Per policy period 10% of SI, subject to maximum INR 50,000","IONM - (Intra Operative Neuro Monitoring) | Per policy period 10% of SI, subject to maximum INR 50,000"],"display":"Specified disease limits from 10% to 100% of sum insured, plus listed procedure sub-limits up to INR 50,000 or INR 1,00,000","note":"The policy states liability is restricted to the specified diseases, illness or injury only.","quote":"1. | Accidental Injury | 100% of Sum Insured\n2. | Knee Replacement | 70% of Sum Insured\n3. | Cardio Vascular Diseases | 50% of Sum Insured\n4. | Chronic Renal Failure | 50% of Sum Insured\n5. | Cancer | 50% of Sum Insured\n6. | Hepato-Biliary Disorders | 50% of Sum Insured\n7. | Chronic Obstructive Lung Diseases | 20% of Sum Insured\n8. | Stroke | 20% of Sum Insured\n9. | Benign Prostrate | 15% of Sum Insured\n10. | Orthopaedic Diseases | 15% of Sum Insured\n11. | Ophthalmic Diseases | 10% of Sum Insured ... Oral chemotherapy | Per policy period 25% of SI, subject to maximum INR 50,000.\nImmunotherapy- Monoclonal Antibody to be given as injection | Per policy period 10% of SI, subject to maximum INR 50,000.\nIntra vitreal injections | Per policy period 10% of SI, subject to maximum INR 50,000.\nRobotic surgeries | Per policy period 10% of SI, subject to maximum INR 1,00,000.\nStereotactic radio surgeries | Per policy period 10% of SI, subject to maximum INR 1,00,000.\nVaporization of the prostrate (Green laser treatment or holmium laser treatment) | Per policy period 10% of SI, subject to maximum INR 50,000.\nIONM - (Intra Operative Neuro Monitoring) | Per policy period 10% of SI, subject to maximum INR 50,000.","sources":[{"clause":null,"heading":"HEALTH OF PRIVILEGED ELDERS 2024","page":1,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-health-of-privileged-elders-2024"},{"clause":"Row 11(a)(iv)","heading":null,"page":2,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-row-11-a-iv"}],"law":[]},{"key":"pre_policy_checkup","label":"Medical tests before buying","section":"Eligibility","meaning":"Whether you need medical tests before the policy is issued.","status":"quote-verified","value":"A person taking fresh insurance cover must submit the listed medical reports and any other reports required by the company from an authorised network diagnostic centre. The insured bears the cost, but for fresh proposals the company reimburses 50% per person.","display":"Required for fresh cover; company reimburses 50% cost per person for fresh proposals","note":"Listed tests include urine microalbumin urea, glycocylated haemoglobin, ultrasonography, X-ray both knees, complete eye test including fundus, and stress test (TMT).","quote":"Any person desiring to take fresh insurance cover has to submit following medical reports (and any other medical reports) required by the company from authorized network Diagnostic Centre. ... The cost of such checkup shall be borne by the insured. However in case of fresh proposals, the Company shall reimburse per person 50% cost of Medical Checkup.","sources":[{"clause":"Row 2(X)(b)(v)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-row-2-x-b-v"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs before admission that are paid.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"up to 30 days prior to the date of admission","note":"Expenses must be for the same condition for which hospitalisation was required and the in-patient hospitalisation claim must be admissible.","quote":"PRE-HOSPITALISATION EXPENSES: Medical Expenses incurred during the period up to 30 days prior to the date of admission","sources":[{"clause":"9(c)(xv)","heading":null,"page":4,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-9-c-xv"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs after discharge that are paid.","status":"quote-verified","value":{"unit":"days","amount":60},"display":"up to 60 days from the date of discharge","note":"Expenses must be for the same condition for which hospitalisation was required and the in-patient hospitalisation claim must be admissible.","quote":"POST-HOSPITALISATION EXPENSES: Medical Expenses incurred for a period up to 60 days from the date of discharge from the hospital","sources":[{"clause":"9(c)(xv)","heading":null,"page":4,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-9-c-xv"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital.","status":"quote-verified","value":"The 24 hour minimum hospitalisation limit does not apply to listed specific treatments taken in a networked hospital or nursing home where the insured is discharged on the same day, and to qualifying procedures in a hospital or day care centre in less than 24 hours because of technological advancement.","display":"Specified day-care treatments covered even when admission is less than 24 hours","note":"Procedures or treatments usually done in out-patient department are not payable even if converted to day care surgery or in-patient treatment for more than 24 hours.","quote":"Expenses on Hospitalisation are admissible only if hospitalisation is for a minimum period of 24 (Twenty Four) hours. However,\n(A) This time limit shall not apply to following specific treatments taken in the Networked Hospital / Nursing Home where the Insured is discharged on the same day. ... undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24 hrs because of technological advancement, and ... which would have otherwise required a hospitalization of more than 24 hours.","sources":[{"clause":"9(c)(iv)","heading":null,"page":4,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-9-c-iv"},{"clause":"9(c)(xv)","heading":null,"page":4,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-9-c-xv"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"quote-verified","value":"The policy gives a no claim discount of 5% of renewal premium after every claim-free policy year, up to 20%, if renewed without break. The discount becomes nil once a claim is paid or becomes payable.","display":"5% renewal premium discount after each claim-free year, up to 20%; nil after a paid or payable claim","note":"This is a premium discount, not an increase in sum insured.","quote":"The insured shall be entitled for No Claim Discount at the rate of 5% of the renewal premium payable after every claim free policy year, subject to a maximum of 20%, as per table below, provided the policy is renewed without any break: ... No Claim Discount shall become ‘nil’ once a claim is paid or becomes payable under the policy, irrespective of the amount of claim.","sources":[{"clause":"Row 2(X)(b)(v)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-row-2-x-b-v"}],"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 access is available through the Company or TPA for admission in a listed network hospital or nursing home, subject to pre-admission authorisation. The Company or TPA issues a pre-authorisation or guarantee of payment letter after verifying eligibility and information.","display":"Available in listed network hospitals with Company/TPA pre-authorisation","note":"The prospectus also states: “Cashless Service through TPA only and limited to Rs. 1 lakh.”","quote":"Claim in respect of Cashless Access Services shall be through the Company/TPA provided admission is in a listed hospital in the agreed list of the networked Hospitals / Nursing Homes and is subject to pre admission authorization. ... after satisfying itself shall issue a pre-authorisation letter / guarantee of payment letter to the Hospital / Nursing Home mentioning the sum guaranteed as payable","sources":[{"clause":"Row 2(g)(i)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-row-2-g-i"}],"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":"The policy may be serviced by a Third Party Administrator or by the Company, as the case may be.","display":"TPA or the Company","note":null,"quote":"such insurance to be serviced by Third Party Administrator (hereinafter called the TPA) or the Company as the case may be.","sources":[{"clause":null,"heading":"HEALTH OF PRIVILEGED ELDERS 2024","page":1,"url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744#c-health-of-privileged-elders-2024"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]}],"documents":[{"kind":"wording","label":"Health_of_Privileged_Elders_Policy_Wordings_PDF_3_60ea81f0bd.pdf","pages":34,"fetched_at":"2026-10-17 19:51:42+00","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/Health_of_Privileged_Elders_Policy_Wordings_PDF_3_60ea81f0bd_2e04149d9b.pdf","url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13744"},{"kind":"prospectus","label":"HEALTH_P_ELDERS_PROSPECTUS_WORD_3_cbb0855140.pdf","pages":21,"fetched_at":"2026-10-17 19:51:31+00","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/HEALTH_P_ELDERS_PROSPECTUS_WORD_3_cbb0855140_3ed6974729.pdf","url":"https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425/document/13715"}],"versions":[],"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":"HEALTH OF PRIVILEGED ELDERS (HOPE) 2024 (UIN OICHLIP25039V042425), IndiaInsurances, https://indiainsurances.com/policy/oriental-insurance/health-of-privileged-elders-hope-2024-oichlip25039v042425"}