THE ORIENTAL INSURANCE COMPANY LIMITED, HEAD OFFICE, ASAF ALI ROAD, NEW DELHI CIRCULAR Deptt.

Health CIRCULAR NO.: HO/HID/ To All ROs / CMD Sectt./IAD/ Marketing Deptt./Accounts Deptt/I.T. Deptt./OSTC Faridabad Re: ADMINISTRATIVE GUIDELINES FORHAPPY FAMILY FLOATER INSURANCE POLICY Date:

SALIENT FEATURES OF THE POLICY: 14 A floater covering the proposer and his / her family under one sum insured under one policy. 15 The sum insured floats over all the beneficiaries under the policy. 16 No medical examination for persons upto the age of 60 years. 17 Pre-existing conditions cover after four consecutive renewals with the Company. 18 Coverage under two options SILVER and GOLD Covers. 19 SILVER offers sum insured slabs of 1 to 5 lacs 20 SILVER is subject to 10% Co-pay 21 GOLD offers sum insured slabs of 6 to 10 lacs. 22 Policy covers the hospitalisation expenses for the covered diseases / accident upto specific limits. 23 GOLD plan offers as an inbuilt cover daily cash allowance and attendant allowance upto limits specified. 24 Personal Accident cover is offered as add on cover under both the covers. In addition GOLD cover offers add on cover of life hardship survival benefit. 25 Discount in OMP premium when family floater policy is taken. 26 Option of TPA and non TPA services. 27 Discount in premium if TPA services not opted. TPA OPTION: The premium includes cashless facility through TPA. If services of TPAs are not opted 5% discount in premium is to be given under the policy.

PREMIUM CHART: SILVER Plan:

A. PRIMARY MEMBER PREMIUM
AGE BAND 21-35 100000 150000 200000 250000 300000 350000 400000 450000 500000 10000 15000 20000 25000 25000 25000 25000 25000 25000 1320 1940 2490 2980 3480 3910 4340 4770 5200 36-45 1580 2320 2980 3570 4160 4670 5180 5700 6210 46-55 2470 3640 4720 5720 6730 7640 8560 9480 10400

B. FAMILY MEMBER PREMIUM (PER PERSON)

AGE BAND 3m-20 100000 150000 200000 250000 300000 350000 400000 450000 500000 10000 15000 20000 25000 25000 25000 25000 25000 25000 240 350 450 540 630 700 780 860 940 21-35 260 390 500 600 700 780 870 950 1040 36-45 320 460 600 710 830 930 1040 1140 1240 46-55 490 730 940 1140 1350 1530 1710 1900 2080 56-60 700 1040 1350 1640 1930 2210 2480 2750 3020 61-70 1310 1940 2530 3080 3640 4160 4680 5200 5730 above70 1760 2630 3450 4230 5020 5750 6490 7230 7970

C. PERSONAL ACCIDENT Sum Insured

100000 200000 300000 60 120 180

400000 240

PREMIUM PER PERSON

Total premium will be the sum of A and B above. If add on cover is taken, premium under C is also to be added.

GOLD Plan (without add on covers)

A. PRIMARY MEMBER PREMIUM

AGE BAND 21-35 600000 700000 800000 900000 1000000 50000 50000 50000 50000 50000 7140 8320 9500 36-45 8520 9930 11340 46-55 14210 16570 18920 21280 23640

10670 12750 11850 14150

B. FAMILY MEMBER PREMIUM (PER PERSON)

AGE BAND

3m-20 21-35
600000 700000 800000 900000 1000000 50000 50000 50000 50000 50000 1290 1500 1710 1920 2130 1430 1660 1900 2130 2370

36-45 1700 1990 2270 2550 2830

46-55 2840 3310 3780 4260 4730

56-60 4120 4800 5490 6170 6860

61-70 7800 9100 10400 11700 13000

above70 10860 12660 14470 16280 18080

Total premium will be the sum of A and B. If Personal Accident to be opted the relevant premium from table (C) to be added.
C. PERSONAL ACCIDENT Sum Insured Premium 200000 400000 600000 800000 1000000

120

240

360

480

600

GOLD Plan (with add on covers)

D. GOLD WITH ADD-ON HARDSHIP PLAN 'A' PREMIUM FOR PRIMARY MEMBER
AGE BAND 21-35 600000 700000 800000 900000 1000000 50000 50000 50000 50000 50000 7350 8570 9790 36-45 8780 10230 11680 46-55 14640 17070 19490 21920 24350

10990 13130 12210 14570

E. GOLD WITH ADD-ON HARDSHIP PLAN 'A' FAMILY MEMBER PREMIUM (PER PERSON)
AGE BAND

3m-20 21-35
600000 700000 800000 900000 1000000 50000 50000 50000 50000 50000 1330 1550 1760 1980 2190 1470 1710 1960 2190 2440

36-45 1750 2050 2340 2630 2910

46-55 2930 3410 3890 4390 4870

56-60 4240 4940 5650 6360 7070

61-70 8030 9370 10710 12050 13390

above70 11190 13040 14900 16770 18620

Total premium will be the sum of D and E. If Personal Accident to be opted the relevant premium from table (C) to be added.
F. GOLD WITH ADD-ON HARDSHIP PLAN 'B' PREMIUM FOR PRIMARY MEMBER
AGE BAND 21-35 600000 700000 50000 50000 7500 8740 36-45 8950 10430 46-55 14920 17400

800000 900000 1000000

50000 50000 50000

9980

11910

19870 22340 24820

11200 13390 12440 14860

G. GOLD WITH ADD-ON HARDSHIP PLAN 'B' FAMILY MEMBER PREMIUM (PER PERSON)
AGE BAND

3m-20 21-35
600000 700000 800000 900000 1000000 50000 50000 50000 50000 50000 1350 1580 1800 2020 2240 1500 1740 2000 2240 2490

36-45 1790 2090 2380 2680 2970

46-55 2980 3480 3970 4470 4970

56-60 4330 5040 5760 6480 7200

61-70 8190 9560 10920 12290 13650

above70 11400 13290 15190 17090 18980

Total premium will be the sum of F and G. If Personal Accident to be opted the relevant premium from table (C) to be added.

AGE: The age of the proposer is taken as the entry age. The proposer plus at least one member of the family has to be necessarily an insured under the policy. The entry age of the proposer is from 21 to 55 years and no medical examination is to be insisted for the entry. Proposers above 55 years of age are not eligible to take the policy. However family members above 55 years and between 3 months to 21 years of age can be included provided they come under the definition of family of the policy. Such family members who are above 60 years of age will be included only on production of the medical examination from a qualified medical practitioner not below the rank of MD. The current guidelines under individual mediclaim policies will be applicable for the family policy also.
All members of the family as on the date of the first proposal has to be included in the first policy itself. Additional members can be included only at the time of renewal provided the additional members thus included become eligible to be a family member as defined under the policy during the currency of the policy or on the date of renewal of the policy. However, spouse can be included within three months of marriage or at the time of renewal of the policy. The premium chargeable for such midterm inclusion will be pro rata.

Coverage: The cover under the policy are both inbuilt and add on (optional).

The inbuilt cover under the SILVER plan is just the same as the individual mediclaim policy. However under the inbuilt cover the per illness limit is kept at maximum 40%, and for the specified major illness the limit is 60% of the sum insured. The limit for the day care cover will be 30% and 50% respectively. In the case of GOLD plan, the inbuilt cover also include the daily cash allowance and the attendant allowance. The limit of 40% and 60% or 30% and 50% as specified above will be applicable for the GOLD plan also. Such limits will also include the daily cash allowance and the attendant allowance. While settling the claims on the per illness limit, the definition of any one illness is to be observed. Add on covers are available at extra premium. The add on for the SILVER plan is the PA cover whereas for the GOLD Plan the add on include PA, Life hardship survival benefit. The cap of 40% and 60% are not applicable for the claims under the add on covers. Claims under the life hardship survival section will be applicable only if a claim under the hospitalization section is admitted. The payment will be made to the insured on a staggered basis depending the period of survival from the date of discharge (first) from the hospital. No bills are required to be produced for settlement of claims under daily hospital cash, attendant allowance or the life hardship survival benefit. SILVER policies are subject to 10% co pay in each and every claim. The co pay element is to be arrived as follows:

Illustration: Sum insured Claim for normal illness Claim admissible Less excess Net payable If the claim bill is Amount payable (25000-2500) Underwriting: The proposal form from the proposer and the health declaration form (from all the insured persons) are the basis for underwriting. Policy is to be issued for a period of one year and no short term policy is to be issued. However in rare cases if the policy is to be issued for a period of less than one year, it is permissible to do so, but the premium to be collected will be the one year premium. No claim discount / Loading in premium: A discount of 5% in renewal premium for every claim free year subject to maximum 20% is applicable under the policy. The discount earned once will be forfeited fully once a claim is admitted under the policy. The policy is also subject to a loading of 5% on renewal for each claim admitted year. 100000 50000/40000 4000 36000 25000 22500

Migration: The following guidelines have to be observed in case of migration: Migration is permitted only if the current policy is an individual mediclaim policy issued by the Company and is valid as on the date of migration. The migration is permitted only at the time of renewal of the existing individual mediclaim policy with the Company. The pre existing cover in case of such migration will be granted after the completion of four years of consecutive (without break) individual mediclaim policies with the Company including the Family floater policy. The benefit of the pre-existing will be restricted to those insureds who have completed four consecutive (without break) individual mediclaim policies with the Company including the family floater policy. The limit of liability for the pre existing cover will be the least of the sum insured of all the five policies considered for the pre existing cover (subject to the per illness cap of the family floater policy). Illustration: Individual Beneficiaries Sum insured Date of migration Limit of pre mediclaim policy Under the to family floater existing condition period / Family individual policy applicable under the family floater policy mediclaim policy / floater. period Family Floater policy. 01/05/2005-06 01/05/2006-07 A A B 01/05/2007-08 A B C 01/05/2008-09 A B C 01/05/2009-10 (fly A (Fly Flr) Flr) B (Fly Flr) C (Fly Flr) 01/05/2010s A (Fly Flr) B (Fly Flr) C (Fly Flr 75000 100000 100000 100000 100000 50000 100000 50000 100000 200000 200000 200000 200000 200000 200000 01/05/2009 -do-do-do-do-do-do-do01/05/2009 NA NA NA NA NA NA NA NA NA 75000 Not eligible Not eligible 100000 100000 50000

01/05/2010

Migration from SILVER to GOLD Policy: The migration from SILVER to GOLD policy is permitted at the time of renewal only provided the sum insured under the expiring SILVER policy was not less than 4 lacs.

Minimum Sum Insured: Under SILVER Plan Rs.100000/If the number of insured under the policy (including the proposer) is not more than 4 Rs.200000/if the number of insured under the policy (including the proposer) is more than 4 and less than 7 Rs.300000/- If the number of insured under the policy (including the proposer) more than 7.

Under GOLD Plan The above limits will be 6 lacs, 7 lacs and 8 lacs. Increase in Sum insured: The sum insured under the policy can be increased (under both the plans) only at the time of renewal and the following guidelines are to be observed. The increase in sum insured to the immediate higher slab of the sum insured under expiring policy is permitted. However if at the time of renewal, additional members are included in the policy, (as permitted by the policy), then if such addition is restricted to one member, the sum insured cannot be increased unless as required by the minimum sum insured clause. If such additional members are more than one, then the increase in sum insured can be upto 2 slabs or upto the minimum sum insured clause whichever is more.

Particulars SILVER Policy period 01/05/2009-10 No of persons covered 2 (including proposer) Sum insured opted 100000 If the no of persons opted 3 to be covered on renewal is Sum insured permissible 100000 If the no of persons opted 4 to be covered on renewal is Maximum Sum insured 150000 or upto 200000 permissible Condonation of Delay:

GOLD 01/05/2009-10 2 600000 3

600000 4

700000 / 800000

If the renewal of the policy is delayed due to reasons beyond the control of the proposer, such delays upto 7 (seven) can be condoned by an officer not below the rank of Scale III officer of the Company. Delay upto 15 days can be condoned by an officer not below the rank of Scale V.

MEDICLAIM WITH OMP: In case where THE WHOLE FAMILY covered under THE FAMILY FLOATER Policy goes abroad by taking Orientals Overseas Mediclaim Policy his / her FAMILY FLOATER Policy becomes suspended for the period he / she is abroad. AND may be extended by number of days, the insured FAMILY was abroad subject to written request being made by the insured before leaving India. THE EXTENSION WONT BE APPLICABLE UNLESS THE ENTIRE FAMILY TAKES THE OPMP POLICY FROM THE COMPANY. DISCOUNT ON OMP PREMIUM : A DISCOUNT OF 15% ON Overseas Mediclaim Policy PREMIUM WOULD BE ALLOWED WHEN EVEN A SINGLE FAMILY member COVERED under the Happy Family Floater Policy, takes the Overseas Mediclaim Policy from the Company, provided the happy family floater policy is valid as on the date of taking the Overseas Mediclaim Policy of the Company. The happy family policy can be extended by the number of days the insured takes the OMP policy from the Company provided all the members under the policy takes the OMP policy from the Company concurrently and the Happy family policy is valid as on the date of inception of the OMP policy. In case any of the member of this policy takes the OMP for different periods, such extension can be given only for the least of such periods.

SERVICE TAX As applicable. STAMP DUTY As per provisions. REBATE UNDER SECTION 80 D of Income Tax Act as per existing provisions.