Oriental - Happy Family Floater

Let’s Get To Know The Plan Better!

Oriental Happy Family Floater Plan is a health insurance policy offered by the Oriental Insurance Company Limited. This plan is designed for families and aims to ease your financial worries during medical emergencies and safeguard the well-being of you and your loved ones. The plan comes in four variants - Silver, Gold, Diamond, and Platinum.

Eligibility Criteria

• Minimum Age Of Entry:

  • Adults: You, the primary insured, must be at least 21 years old. Other family members like your spouse, parents, and parents-in-law should be at least 18 years old.
  • Dependent children: As early as 3 months after birth.
• Maximum Age Of Entry:
  • Adults: 65 years.
  • Dependent children: 25 years.
     

An Overview Of The Benefits And Limits Of Oriental Happy Family Floater Plan

The Oriental Happy Family Floater Plan takes care of your inpatient hospitalisation costs like room boarding, nursing charges, medical practitioner fees, prescribed medication costs, ICU charges, etc. Besides that, here are some of the other expenses covered by this plan –

• Pre- & Post-Hospitalisation Coverage: If your doctor needs to conduct various tests before or after your hospital stay, the Oriental Happy Family Floater Plan will take care of the associated expenses up to the sum insured. This coverage extends up to 30 days before your hospitalisation and 60 days after you have been discharged. It is important to note that these expenses are covered only if they are linked to the medical condition/disease for which you are hospitalised and your claim for these expenses is approved as part of the inpatient hospitalisation cover.
   
• Daycare Treatment Coverage: The Oriental Happy Family Floater Plan  coverage for daycare treatments. They are medical procedures or surgeries that used to require a long period of hospital stay but can now be completed within 24 hours because of commendable medical advancements. The plan includes coverage for 116 daycare procedures up to the sum insured.
   
• Domiciliary Treatment Coverage: Domiciliary treatments are medical procedures for illnesses or injuries that necessitate immediate hospital attention but are given at home if the patient is too sick or injured and cannot be transported safely to a hospital, or there are no hospital beds available nearby. The plan covers domiciliary treatments, except for 15 specific illnesses. Also, you should keep in mind that sub-limits will apply based on the plan variant you select.
   
• Organ Donor Coverage: The Oriental Happy Family Floater Plan includes coverage for organ donor expenses where you are the recipient. It covers inpatient costs associated with organ transplantation, up to the sum insured.
   
• Modern Treatment Coverage: Advances in healthcare are paving the way for groundbreaking treatments that were once considered beyond reach. The Oriental Happy Family Floater Plan is designed in such a way to adapt to these changes, covering the costs of these modern treatments. You should, however, keep in mind that there are limits on specific modern treatments, which may vary based on the plan variant you select.
   
• Restoration Benefit: This feature replenishes your sum insured  if it is used up in a policy year. In the Oriental Happy Family Floater Plan, you have the option to choose the maximum limit for the restored sum insured (either 50% or 100%). The restore benefit kicks in when your base sum insured is completely or partially used up, and is available for subsequent claims in a policy year. You can use this benefit once each policy year for a lifetime, as long as you keep renewing your policy. You should keep in mind that this benefit covers unrelated illnesses and is available only under the gold and silver variants as an add-on.
   
• Room Rent Limit: The insurer sets a maximum amount they will cover for your hospital room, known as the room rent limit. If you choose a room within this limit, you will not have to pay any extra expenses. But, if you choose a room with a higher rent, you will face a proportionate deduction. This means that you will be responsible for a proportionate portion of the total bill, not just the difference in room rent. The Oriental Happy Family Floater Plan caps room rent under all four variants, up to 1% of the sum insured per day. However, you can eliminate 50% or 100% of this limit by paying an extra premium, depending on the variant you choose.
   

Other Notable Features of The Oriental Happy Family Floater Plan

• Worldwide Personal Accident Cover: This coverage provides financial assistance amidst life’s uncertainties. If you experience an injury due to an accidental event anywhere in the world, and it results in disability or unfortunate demise within a year, your nominee will receive a lump sum amount up to a specified limit based on the variant you select. However, this benefit is offered as an add-on under all four variants, with specific conditions related to coverage.

• Life Hardship Survival Benefit: If you face hospitalisation due to listed specific critical illnesses like cancer, kidney failure, a first heart attack, etc. after starting the policy, and you successfully overcome them, you will receive a lump sum amount, up to a certain limit. The total amount you’ll receive is determined by the plan you select when you start the policy. However, you should keep in mind that there are specific terms and conditions associated with the coverage.

• Organ Donor Expenses When You Are The Donor: When you choose to selflessly donate your organs, there are unforeseen costs involved, such as medical evaluations, post-operative care, etc. However, with the Oriental Happy Family Floater Plan, the insurer will help you ease the financial load of your noble act by providing a lump sum amount equivalent to 10% of the sum insured. You should, however, keep in mind that specific terms and conditions apply to this coverage.
   

Waiting Period

When you buy a health insurance policy, certain illnesses and diseases may not be covered for a specific period of time. This time frame is known as the waiting period . After this period, you can start claiming for these conditions. There are various types of waiting periods, including –

• Initial Waiting Period: For all medical conditions, excluding accidents, there is a 30-day initial waiting period. This means that you cannot file a claim for hospitalisation in the first 30 days, except when in the case of accidents.
   
• Waiting Period For Pre-existing Diseases: It is a health condition or injury you had in the 48 months before applying for a health insurance policy. In the Oriental Happy Family Floater Plan, there is a  48-month waiting period for pre-existing diseases. During this period, the policy will not cover any expenses related to your pre-existing conditions.
   
• Waiting Period For Specific Diseases: Insurers maintain a list of medical conditions, aside from your pre-existing diseases, for which they apply a waiting period irrespective of whether you have had those diseases before or not. The waiting period is solely decided by the insurer and isn't influenced by your current health status. In the Oriental Happy Family Floater Plan, the waiting period for specific diseases can be 3, 12, 24, or 48 months, based on the disease or treatment.
   

Exclusions

Exclusions are specific situations not covered by your health insurance policy. These include –

• Standard Permanent Exclusions: The IRDAI has set 'standard permanent exclusions' that all insurance companies must enforce. Some of these exclusions are –
  • Investigation And Evaluation: Hospital admission solely for observation or monitoring purposes.
  • Rest Cure, Rehabilitation, And Respite Care: Admission to a facility for bed rest, where no active treatment is provided.
  • Obesity/Weight Control: Treatment or surgery for weight control or obesity.
  • Change Of Gender Treatment: Treatment aimed at altering the body's characteristics to those of the opposite sex.
  • Plastic/Cosmetic Surgery: Treatment or surgery intended to modify body characteristics or appearance.
  • Profession In Hazardous Or Adventure Sports: Treatment expenses incurred while participating as a professional in adventure activities like river rafting, mountaineering, scuba diving, horse racing, etc.
  • Breach Of Law: Expenses related to the treatment of a person who has committed or attempted to commit a breach of law with criminal intent.
  • Excluded Providers: Treatment from a medical practitioner or hospital excluded by the insurance company.
  • Narcotics: Treatment for addictive conditions like alcohol addiction, drug usage, etc.
  • Treatments In Establishments Arranged For Domestic Purposes: Expenses of treatment undergone in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
  • Dietary Supplements, Substances Purchased Without Prescription: Vitamins, minerals, etc., not prescribed by a medical practitioner.
  • Refractive Error: Expenses associated with correcting refractive errors of up to 7.5 diopters for improved eyesight.
  • Unproven Treatments: Surgeries, medical procedures, or treatments that are not proven to be effective.
  • Expenses Related To Birth Control, Sterility Infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
  • Maternity Expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.
     
• Additional Permanent Exclusions: Other than the standard exclusions mentioned earlier, the insurer might apply extra exclusions for specific situations or health conditions. If you have certain diseases or severe medical conditions that insurers find risky to cover, they might permanently exclude them from your policy. However, it is essential to note that insurers can only apply permanent exclusions for illnesses listed by the Insurance Regulatory and Development Authority of India (IRDAI).
   
• Non-Standard Exclusions (Specific Exclusions): These are specific exclusions that go beyond the standard permanent exclusions set by the IRDAI. These exclusions can differ among insurance companies and may rely on the specific terms and conditions of your policy. Here is a list of some notable specific exclusions under the Oriental Happy Family Floater Plan –
  • Expenses related to hormone replacement therapy, unless part of medically necessary treatment, except for puberty and menopause-related disorders.
  • Expenses for treating general debility, congenital external anomaly.
  • Treatments done for intentional self-inflicted injury, attempted suicide.
  • Expenses related to stem cell surgery, except hematopoietic stem cells for bone marrow transplant for haematological conditions.
  • Circumcision, unless necessary for the treatment of a disease (if not excluded otherwise) or necessitated due to an accident.
  • Massages, steam bath, expenses for alternative or AYUSH treatments (other than Ayurveda and Homeopathy), acupuncture, acupressure, magneto-therapy, and similar treatments.
  • Dental treatment, unless necessitated due to an injury.
  • Spectacles, contact lenses, hearing aids, cochlear implants.
  • War-like occurrences, invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints, and detainment of all kinds.
  • External/durable medical/non-medical equipments/instruments of any kind used for diagnosis/treatment, including CPAP, CAPD, infusion pump, ambulatory devices such as walkers, crutches, belts, collars, caps, splints, slings, braces, stockings, diabetic footwear, glucometer, thermometer, and similar related items (as listed in respective Appendix-II) and any medical equipment that could be used at home subsequently.
     

Summary

Access Helpful Information About The Happy Family Floater Plan

• Policy Wording Link: https://orientalinsurance.org.in/documents/10182/10124775/HFF+2021-POLICY.pdf/58a602a5-364b-7e3f-74bc-69affe7e3511

FAQs

1. How much maximum coverage can you get under the Oriental Happy Family Floater Plan?
   The maximum coverage you can choose depends on the plan variant you choose –

2. Is AYUSH treatment covered in the Oriental Happy Family Floater Plan?
   Yes, the Oriental Happy Family Floater Plan includes coverage for AYUSH treatments. This encompasses alternative or non-allopathic treatments like Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy.
    
3. Does the Oriental Happy Family Floater Plan cover consumables?
   No, unfortunately the plan does not provide coverage for expenses related to consumables such as gloves, masks, syringes, etc.
    
4. Do the maternity benefits come with the Oriental Happy Family Floater Plan?
   Yes, the Diamond and Platinum variants of the Oriental Happy Family Floater Plan include coverage for pregnancy-related expenses, up to the specified limits mentioned in the policy.
    
5. Is there a limit on room rent in the Oriental Happy Family Floater Plan?
   Yes, the plan restricts room rent to 1% of the sum insured under all variants. However, you can eliminate 50% or 100% of this limit by paying an extra premium, depending on the variant you choose.