Plan details
Plan *
Start date *
End date
Deductible *
Sum Insured *
Primary insured details
Date of birth *
Gender *
Whether suffering from pre-existing disease(PED)? *help
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Upload a photograph of the person to be insured *
Please upload the passport size (preferred) photograph while proceeding to buy policy.
Do you want to add nominee?help
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Do you wish to insure your spouse?
Do you wish to insure your dependent children?
Do you wish to insure your father?
Do you wish to insure your mother?
Do you wish to insure your father-in-law?
Do you wish to insure your mother-in-law?
Declaration
1. I hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by me are true and complete in all respects to the best of my knowledge and that I am authorized to propose on behalf of these other persons.
2. I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting policy of the insurance company and that the policy will come into force only after full receipt of the premium chargeable.
3. I further declare that I will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the proposal has been submitted but before communication of the risk acceptance by the company.
4. I declare and consent to the company seeking medical information from any doctor or from a hospital who at any time has attended on the life to be insured/proposer or from any past or present employer concerning anything which affects the physical or mental health of the life to be assured/proposer and seeking information from any insurance company to which an application for insurance on the life to be assured/proposer has been made for the purpose of underwriting the proposal and/or claim settlement.
5. I authorize the company to share information pertaining to my proposal including the medical records for the sole purpose of proposal underwriting and/or claims settlement and with any Governmental and/or Regulatory authority.
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OICL Office State *
City/Town *
Branch/Office *
Declaration
Pre-existing Diseases are covered after three consecutive Policy periods. All Pre-existing Diseases (whether treated / untreated, declared or not declared in the Proposal Form), are excluded upto 36 months of the Policy being in force and shall be covered only after the Policy has been continuously in force for 36 months. For the purpose of applying this condition, the date of inception of the first OBC-Oriental Mediclaim Policy shall be considered, provided the Renewals have been continuous and without any break in the policy period. This exclusion shall also apply to any complication(s) arising from Pre-existing Diseases. Such complications will be considered as part of the Pre-existing health condition or Disease.
Notification
Policy not available for age greater than 55 years
Notification
The maximum age for Dependent male child is 26 years.
Notification
Dependent age must be between the ages of 91 days to18 years
Notification
Dependent age must be greater than 91 days
Notification
Minimum Age must be greater than 18
Notification
Please contact OICL office as the entry age is crossing > 65, additional 10% overage loading will be charged automatically on applicable rates. There will not be any overage 10% loading will be charged if the entry age is <=65 and subsequent renewal.
Notification
The policy is not allowed if age >70 years
Notification
These proposals are not allowed online, please contact OICL office
Please select a role to continue
Whether any agent is involved for this proposal?
* If 'NO' is selected, the policy will be issued under code of Development Officer without an Agent.
Pre Existing Diseases
Since you are suffering from Pre Existing Disease(PED), you are requested to contact the nearest OICL office for policy issuance.
Dependent on the proposer
Since you are not dependent on the proposer, you are requested to contact the nearest OICL office for policy issuance.
Alert
Since you are married, you are requested to contact the nearest OICL office for policy issuance.