THE ORIENTAL INSURANCE COMPANY
LIMITED
Regd. Office: Oriental House, A-25/27, AsafAli
Road, New Delhi-110002 CIN
No.U66010DL1947GOI007158
Customer Information Sheet
Description is illustrative and not exhaustive
.
SI. Title Description Refer to
No Policy
Clause No.
1 Product ORIENTAL CANCER PROTECT
Name
2 Policy No
3 Type of insurance Indemnity (Where Insured Losses are covered up Clause 2
product/ policy to Sum Insured under the policy)/ BENEFIT
4 Sum Insured Sum Insured (SI) Rs.5 lacs to Rs.50 lacs
(Basis )
Along with
Amount
5. Policy Coverage The policy shall cover treatment for Cancer
(what the Policy taken as Inpatient or Outpatient or Day
covers) Care. Following Conventional and
Advanced Treatment shall be covered in Clause 2.1
the Policy:
o Chemotherapy
o Radiotherapy
o Organ transplant, as part of Cancer
treatment
o Onco-surgery (Surgeries for
excision of cancerous tissue or
removal of organs/ tissues)
o Proton Treatment
o Personalised & Targeted therapy
o Hormonal Therapy or Endocrine
manipulation
o Immunotherapy including
immunology agents
o Stem cell transplantation
o Bone marrow transplantation
Clause 2(ii)
ORIENTAL CANCER PROTECT
UIN: U66010DL1947GOI007158
Room Rent, boarding and nursing
expenses, Clause 2(v)
Intensive Care Unit (ICU) expenses, as
actuals Clause 2.2
Surgeon, Anaesthetist, Medical Clause 2.3
Practitioner, Consultants’ Specialist fees
Anaesthesia, Blood, Oxygen, Operation Clause 2.4
Theatre Charges, Surgical Appliances,
Medicines & Drugs, Dialysis, Clause 2.5
Chemotherapy, Radiotherapy, Cost of
Prosthetic devices implanted during Clause 2.6
Surgery, Relevant Laboratory / Diagnostic
test, X-Ray and other medical expenses Clause 2.7
related to the treatment of Cancer
Road Ambulance Clause 2.8
Air Ambulance Services
Medical Expenses incurred for the Clause 2.9
reconstruction of affected body part to
restore your essential physical functioning
as a direct result of Cancer Surgery Clause 2.10
Medical Expenses for Organ Transplant,
as part of Cancer treatment
Clause 2.11
Pre-Hospitalization Medical expenses, up
to 45 days
Post-Hospitalization Medical expenses, up
to 90 days
Second Opinion for Surgery, the expenses
incurred towards consultation with another
Medical Practitioner to seek advice on the Clause 2.12
Surgery shall be payable up to INR 5,000
for Sum Insured of INR 5, 10 & 15 Lakhs
and up to Rs. 10,000 for Sum Insured of Clause 2.13
INR 20,25 & 50 Lakhs .
Medical Expenses incurred on follow up
check-up shall be payable up to Rs.
10,000 once in a Period of Insurance. Clause 2.14
Cancer Care Benefit: If during the Period
of Insurance any Insured Person is
diagnosed for Cancer for first time and is in
Stage IV (based on TNM classification) or
advanced metastatic cancer, 50% of the
Sum Insured would be paid as Critical
Care Benefit in addition to the admissible
claim amount
ORIENTAL CANCER PROTECT
UIN: U66010DL1947GOI007158
Geographical Extension to SAARC
Countries
Telemedicine/Teleconsultation
6 Exclusions 1. Any Treatment other than for Cancer.
(what the 2. Pre-Existing Condition for Cancer for which Clause
4.1 to 4.23
policy does Insured Person had signs or symptoms,
not cover ) and/or was diagnosed, and/or received
medical advice / treatment forty eight
months prior to the first policy issued by Us
(as mentioned in the Schedule).
3. Cancer diagnosed/contracted by the
Insured person during the first Seventy
Five days of the commencement date of
first Policy.
4. Any treatment directly or indirectly caused
by or arising from or attributable to War,
invasion, Act of Foreign enemy, War like
operations (whether war be declared or
not), nuclear weapon / ionising radiation,
contamination by Radioactive material,
nuclear fuel or nuclear waste or from the
combustion of nuclear fuel.
5. Plastic Surgery, cosmetic, aesthetic
treatment.
6. Cost of external prosthetic devices, non-
durable implants external medical
equipment.
7. Dental treatment or Surgery of any kind
unless necessitated due to treatment of
Cancer.
8. Kaposi Sarcoma.
9. Charges incurred at Hospital primarily for
diagnosis, x-ray or Laboratory
examinations or other diagnostic studies
not consistent with or incidental to the
diagnosis and treatment of positive
existence or presence of Cancer for which
confinement is required at a Hospital.
10. Expenses on vitamins and tonics unless
forming part of treatment for Injury or
Illness as certified by the attending Medical
Practitioner.
11. Non-Allopathic treatment.
ORIENTAL CANCER PROTECT
UIN: U66010DL1947GOI007158
12. Any expenses relating to cost of items
detailed in Annexure II.
13. Unproven/Experimental Treatment and
pharmacological regimens.
14. Any kind of Service charges, Surcharges,
Luxury Tax and similar charges levied by
the Hospital.
15. Treatment including investigation /
diagnostic services availed outside India.
16. Rest Cure, Rehabilitation and Respite
care.
17. Expenses related to any admission
primarily for enforced bed rest and not for
receiving treatment. This also includes:
Custodial care either at home or in a
Hospital / nursing facility for personal care
either by skilled nurses or assistants or
unskilled persons.
Any services for people who are terminally
ill to address medical, physical, social,
emotional and spiritual needs.
18. Specified healthcare providers :
Treatment rendered by a Medical
Practitioner, which is outside his discipline
or the discipline for which he is licensed.
Treatments rendered by a Medical
Practitioner, who is a member of the
Insured Person’s family or stays with him,
however proven material costs are eligible
for reimbursement in accordance with the
applicable cover.
Any treatment or part of a treatment that is
not of a reasonable charge, not Medically
Necessary; drugs or treatments that are
not supported by treating doctor’s
prescription.
Charges related to a Hospital stay not
expressly mentioned as being covered in
this Policy, including but not limited to
charges for admission, discharge,
administration, registration, documentation
and filing.
ORIENTAL CANCER PROTECT
UIN: U66010DL1947GOI007158
Any non-medical expenses mentioned on
our website and or attached with this
policy.
(Note: the above is a partial listing of the
policy exclusions. Please refer to the policy
clauses for the full listing).
7 Waiting period 1. Initial waiting period: 30 days for all 4.1
illnesses (not applicable on renewal or for
-Time period accidents) 4.2
during which 2. Specific waiting periods: 24 months for
specified named diseases 4.3
diseases/treatmen 3. Pre-existing diseases: Covered after 12
ts are not covered months
-It is counted from
the beginning of
the policy
coverage
8 Financial Limit of Upto sum insured.
Coverage. Sr. INSURED LIMIT OF INDEMNITY
No. COVERAGE/
BENEFIT Clause 2
I Sub-Limit (it is pre IN PATIENT HOSPITALISATION
defined limit and the EXPENSES/BENEFITS
insurance company i. Sum Insured INR 5/10/15/20/25 & 50
will not pay any Lakhs
amount in excess of ii. Room, Boarding a) For Sum Insured of
this limit ) and Nursing 5, 10 and 15 Lakhs -
Expenses as 1% of Sum Insured
ii) Co-payment (it is provided by the subject to maximum of
a specified amount Hospital /Nursing INR 10000/- per Day or
/percentage of the Home including actual expenses
admissible claim nursing care, incurred, whichever is
amount to be paid RMO charges,
less
by policy BMW Charges, IV
holder/insured Fluids/ Blood b) For Sum Insured
transfusion/ of 20,25 and 50 Lakhs
iii) Deductible (it is a injection & - 1% of Sum Insured
specified amount : administration subject to maximum of
charges INR 25000/- per Day or
Upto which an
actual expenses
insurance company
will not pay any incurred, whichever is
claim and less
ORIENTAL CANCER PROTECT
UIN: U66010DL1947GOI007158
Which will be iii. Intensive Care Actuals
deducted from total Unit (ICU) or
claim amount (if Specialised
claim amount is Expenses as
more than the provided by the
specified amount) Hospital/Nursing
iv) any other
Home.
limit (as
applicable ) iv. Surgeon, As per the limits of Sum
Anesthetist, Insured & subject to
Medical Proportionate Clause
Practitioner, wherever applicable
Consultants,
Specialists Fees
v. Anesthesia, As per the limits of
Blood, Oxygen, Sum Insured subject
Operation Theatre to Proportionate Clause
Charges, Surgical wherever applicable
Appliances,
Medicines &
Drugs, Dialysis,
Chemotherapy,
Radiotherapy,
Cost of Prosthetic
devices implanted
during Surgery,
Relevant
Laboratory /
Diagnostic test, X-
Ray and similar
expenses related
to the treatment of
Cancer
vi. Road Ambulance a) For Sum Insured
Cover of 5, 10 and 15 Lakhs
– INR 3000/- per Clause 2.2
Hospitalization or
actuals, whichever is
less
b) For Sum Insured
of 20, 25 and 50
Lakhs
- INR 5000/- per
ORIENTAL CANCER PROTECT
UIN: U66010DL1947GOI007158
Hospitalization or
actuals whichever is
less
vii. Air Ambulance 5% of Sum Insured
Cover
Clause 2.3
viii. Emergency a) For Sum Insured of
Medical 5, 10 and 15 Lakhs –
Evacuation Cover 2 % of Sum Insured Clause 2.4
limited to INR 25000/-
b) For Sum Insured
of 20, 25 and 50
Lakhs – 2% of Sum
Insured limited to INR
50000/-
ix. Reconstruction Within the aggregate of
of Affected the Sum Insured and
Body Part Post Cumulative Bonus, if Clause 2.5
Cancer Surgery any, of the Insured
Person receiving the
organ.
x. Organ Donor Within the aggregate of
Clause 2.6
Expenses – the Sum Insured and
When Insured Cumulative Bonus, if
Personis any, of the Insured
Recipient Person receiving the
organ.
PRE AND POST HOSPITALISATION
EXPENSES/BENEFITS
xi. Pre and Post Medical expenses
Hospitalisation incurred 45 days prior Clause
expenses to hospitalisation and 2.7 & 2.8
upto 90 days post
hospitalisation.
ORIENTAL CANCER PROTECT
UIN: U66010DL1947GOI007158
OUT PATIENT DEPARTMENT (OPD)
EXPENSES/BENEFITS
xii. Expenses Within the aggregate
incurred on of the Sum Insured
Treatment of and Cumulative Bonus,
Cancer in OPD if any.
DAY CARE CENTRE EXPENSES/BENEFITS
xiii.Expenses Within the aggregate
incurred on of the Sum Insured
Treatment of and Cumulative Bonus,
Cancer in Day if any.
Care
OTHER ADMISSIBLE EXPENSES/BENEFITS
xiv. Second Opinion a) For Sum Insured
for Surgery of 5, 10 and 15 Lakhs –
INR 5000/- subject to
terms & conditions as Clause 2.9
per Clause
b) For Sum Insured
of 20, 25 and 50 Lakhs
- INR 10000/- subject
to terms & conditions
as per Clause.
xv. Post Treatment a) For Sum Insured of
Follow Up 5, 10 and 15 Lakhs –
INR 5000/-
Clause 2.10
b) For Sum Insured of
20, 25 and 50 Lakhs
- INR 10000/-
xvi. CANCER CARE 50% of the aggregate
BENEFIT Sum Insured and
Cumulative Bonus, if
any. Limited to INR 10 Clause 2.11
Lacs.
xvii CUMULATIVE 5% of Sum Insured at
. BONUS each renewal in
respect of each claim
Clause 2.12
free year of Insurance,
subject to maximum of
50%.
ORIENTAL CANCER PROTECT
UIN: U66010DL1947GOI007158
xvii Geographical Within the aggregate of
i. Extension to the Sum Insured and
SAARC Countries Cumulative Bonus, if Clause 2.13
any, of the Insured
Person receiving the
organ.
xix. Telemedicine & a) For Sum Insured
Teleconsultation of 5, 10,15 and 20
Expenses Lakhs – INR 2000/- per
insured for a policy Clause 2.14
period.
b) For Sum Insured
of 25 and 50 Lakhs -
INR 5000/- per insured
for a policy period.
9 Claims/ claim Insured must send all communications and
Procedure papers regarding a claim to the TPA at the Clause 5.6
address shown in the Schedule.
Intimate TPA in writing on detection of
Cancer immediately or forty-eight hours
before Hospitalization.
Intimate within twenty-four hours from the
time of Hospitalization in case of
Hospitalization due to Medical emergency.
Submit the Claim Document within fifteen
days from the date of Discharge from
Hospital
Cashless Service: Contact the TPA or visit our
Website at https://orientalinsurance.org.in/ for
the list of Hospitals where cashless facility is
available
Web link for following :
1. Network Hospital Details:
https://orientalinsurance.org.in/en/network-
hospitals?isSelected=locator&isRefresh=true
2. Help Line Number:
Toll free : 1800118485/011-33208485
3. Hospitals which are blacklisted or from
where no claims will be accepted by insurer.
https://orientalinsurance.org.in/en/network-
ORIENTAL CANCER PROTECT
UIN: U66010DL1947GOI007158
hospitals
4. Download/getting claim form
https://orientalinsurance.org.in/en/download-
claimform?isSelected=policyDownload&isRefre
sh=true
10 Policy servicing 1.Company officials :
Website: www.orientalinsurance.org.in
2. . Toll free: 1800118485 Or 011-33208485
3.Policy issuing office
11 Grievances/ www.orientalinsurance.org.in
Complaints E-mail:
[email protected] IRDAI Integrated Grievance Management
System https://igms.irda.gov.in
Insurance Ombudsman - Contact details of
the
Insurance Ombudsman have been provided
in Annexure I of the policy document.
Ombudsman website:
http://ecoi.co.in/ombudsman.html
12 Things to Insured will be allowed a period of fifteen days
remember from the date of receipt of the Policy to review Clause 6.6
the terms and conditions of the Policy and to
return the same if not acceptable.
Renewal of the Policy if insured remits the
Premium to insurer prior to expiry of the Policy Clause6.8(i)
or within 30 days from expiry of Policy.
This policy is subject to portability guidelines
issued by IRDAI and as amended from time to Clause 6.9
time. Subject to the above, Portability will be
allowed only from any other Critical Illness or
similar Cancer product offered by Us or other
companies. Porting will not be allowed from
any other product. Migration will not be
allowed from any of our other products to this
product
ORIENTAL CANCER PROTECT
UIN: U66010DL1947GOI007158
Insurer shall settle or reject a claim, as may
be the case, within thirty days of the receipt of Clause 5.6
the last ‘necessary’ document. (F)
In the case of delay in the payment of a claim,
Insurer shall be liable to pay interest from the
date of receipt of last necessary document to
the date of payment of claim at a rate 2%
above the bank rate.
However, where the circumstances of a claim
warrant an investigation in the opinion of the
Insurer, insurer 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,
insurer shall settle the claim within 45 days
from the date of receipt of last necessary
document.
In case of delay beyond stipulated 45 days,
Insurer shall be liable to pay interest at a rate 2%
above the bank rate from the date of receipt of
last necessary document to the date of payment
of claim.
13 Insured’s The policy shall be null and void, and no Clause 5.12
Obligations benefits shall be payable in the event of
misrepresentation, mis-description or
nondisclosure of any material fact / particular
if such claim be in any manner fraudulent or
supported by any fraudulent means or device
whether by the Insured Person or by any other
person acting on his / her behalf.
(LEGAL DISCLAIMER) NOTE: The information must be read in conjunction with the
Prospectus and Policy Document. In case of any conflict between the CIS and the Policy
Document the terms and conditions mentioned in the Policy Document shall prevail.
Declaration by the Policy Holder:
I have read the above and confirm having noted the details
Place:
ORIENTAL CANCER PROTECT
UIN: U66010DL1947GOI007158
Date: Signature of the Policy Holder
ORIENTAL CANCER PROTECT
UIN: U66010DL1947GOI007158
