Oriental Insurance Sampoorna Swasthya Suraksha Policy is a newly launched Health Insurance Policy designed to offer comprehensive coverage with a high level of flexibility. One of the key highlights of this policy is that it allows you to customise the coverage based on your needs.
The policy is available in three variants – Premium, Elite, and Royal.
Among these, the Royal Plan offers the most extensive coverage with the widest range of benefits. However, the Premium and Elite plans are also worth considering, especially if you are looking for a balanced option with reasonable coverage at a lower premium.
To help you understand the features better whether you are planning to buy this policy or have already purchased it and want clarity on the coverage I have simplified the key benefits of all three plans in the tables below.
Coverage Under the Premium Plan of OSSP
| Policy Terms | PREMIUM PLAN (Oriental Sampoorna Swasthya Policy) |
|---|---|
| Sum Insured (Cover Limit) | 3 Lakh to 10 Lakh |
| Hospital Room Boarding and Nursing expenses | 1% of policy Sum Insured, per day. For example if you Opt 10L policy then 10K per day Hospital room rent is covered. |
| ICU expenses | 2% of Policy Sum Insured, per day |
| Cataract Limit | For Policy Up to 4L – Max. 30k Per Eye For Policy 5L to 10L – Max. 40K per eye |
| Road Ambulance Expenses | 3K Per illness 5K in a Policy year |
| Daily Hospital Cash Allowance | 0.1% of Sum Insured per day (max ₹500/day) Max 10 days per illness and first 5 days of Hospitlisation not payable. Max ₹5,000 per year |
| Attendant allowance (If only insured person up to age 10 yrs is Hospitalised) | ₹ 500/- per day of Hospitalisation Max 10 days per illness and first 5 days of Hospitlisation not payable. Overall in a policy period – Max 15 Days |
| Maternity Benefit | Not Covered |
| New Born Baby cover | Covered from Day 1 up to SI limit on Payment of Premium |
| Assisted Reproduction Treatment | Not Covered |
| Organ Donor Expenses when Insured is Organ Donor | Up to 10% of Policy Sum Insured |
| Hospitalsiation Expenses when Insured Person is Organ Recipient. | Up to Full Sum Insured |
| Restoration of the Sum Insured | Up to 3 times of Policy Base Sum Insured, in a Policy year |
| Medical Second Opinion for 11 specified critical illnesses, taken from anywhere in the world. | Not Covered |
| Air Ambulance Cover (Once In lifetime of Policy) | Max 1 Lakh |
| Accidental Death and permanent total Disability (Benefit Cover) | Not Covered |
| Dental and Opthalmic OPD cover | Not Covered |
| Additional Sum Insured for Critical illness (on indeminity basis only) | Not available |
| Pre and Post Hospitalization expenses | 30 Days Pre-Hospitalisation expenses 60 Days Post-Hospitalisation expenses |
| Specialised Oncology Test/ Investigation (Outside India) (Once in a lifetime for each member) | Not Covered |
| Limit on Modern Treatment | Up to 20% of Policy Sum Insured |
| Limit on Mental Illness | Up to 20% of Policy Sum Insured |
| Health Check-Up | Not Covered |
| Bonus for claim free year (Policyholder can chose the between yearly Bonus or 2% discount on renewal premium) | 10% increase in SI per claim-free year, subject to a maximum of 100% of the Sum Insured. |
| Pre-existing Disease Waiting Period | 3 years |
| Tele consultation | Individual/Floater: One consultation max ₹ 500/1000 |
| AYUSH Coverage | Up to 100% of the Sum Insured |
| Treatment in Non-Network Hospitals | If you take treatment in a Hospital that is not on insurance company or TPA network then 10% of admissible claim amount has to be paid by You. |
| Personal Accident (Optional cover) | Age 18 and above – 10L SI Age below 18 – 5L SI |
| Room Rent Up gradation (optional cover) | Option to increase per day Room rent to 50% and 100% |
| Pre-Existing Disease (PED) Waiting Period Buyback Option(Only for fresh proposals) | Default PED waiting period is 3 years, which can be reduced to 2, 1 or 0 year (Day 1 Coverage) |
| Domiciliary Hospitlisation | Upto 10% of SI, Max. ₹25000/- per policy year. |
| Treatment for animal bite | Max 5K |
| Home Care Treatment | Not Covered |
Coverage Under the Elite Plan of OSSP
Elite Plan of the Oriental Sampoorna Swasthya Policy gives you more benefits and wider coverage than the Premium Plan. Along with everything covered under the Premium Plan, the Elite Plan also includes:
- Maternity expenses (pregnancy and childbirth coverage)
- ART treatment (assisted reproductive treatments)
- Medical second opinion from experts
- OPD coverage for eye care and dental treatment
- Extra coverage for hospitalization due to critical illness
- Free health check-ups
- Higher limits for modern treatments
- Home care treatments (treatment at home when advised by a doctor)
| Policy Terms | ROYAL PLAN (Oriental Sampoorna Swasthya Policy) |
|---|---|
| Sum Insured | 5L to 50L |
| Hospital Room Boarding and Nursing expenses | 1% of SI per day up to 10L policy. Above 10L SI -Actual expenses covered |
| ICU expenses | 2% of SI per day up to 10L policy. Above 10L SI -Actual expenses covered |
| Cataract Limit | If Policy Sum insured 7L or less – Max. 50k Per Eye If Policy Sum insured 10L or more – Max. 1L per eye |
| Road Ambulance Expenses | 5K Per illness, 10K in a Policy year |
| Daily Hospital Cash Allowance | 0.1% of Sum Insured per day (max ₹1000/day) Max 10 days per illness and first 5 days of hospitlisation not payable. Max ₹10,000 per year |
| Attendant allowance (If only insured person up to age 10 yrs is Hospitalised) | ₹ 750/- per day of Hospitalisation Max 10 days per illness and first 5 days of Hospitlisation not payable. Overall in a policy period – Max 15 Days |
| Maternity Benefit | 2 Deliveries or Terminations Waiting period of 24 months 5% of Sum Insured and max. 50K Per Delivery |
| New Born Baby cover | Covered from Day 1 up to SI limit on Payment of Premium |
| Assisted Reproduction Treatment | 36 Months waiting period Max 1 Lakh once in lifetime of insured |
| Organ Donor Expenses when Insured is Donor | Up to 10% of SI, Max 1 Lakh |
| Donor Expenses when Insured Person is Recipient. | Up to Full Sum Insured |
| Restoration of the Sum Insured | Up to 5 times of Policy Base Sum insured during a Policy year. |
| Medical Second Opinion for 11 specified critical illnesses, taken from anywhere in the world. | 5k for individual SI policy 10k for family floater basis policy |
| Air Ambulance Cover (Once In lifetime) | 2.5 Lakh |
| Accidental Death and permanent total Disability (Benefit Cover) | Covered only for SI 15 Lakh and Above up to 10% of Sum insured |
| Dental and Opthalmic OPD cover | Reimbbursed in a Block of 3 continuous claim free years. Individual SI policy 20 & 25 L SI only – 2000 Floater SI policy 20 & 25 L SI only – 5000 |
| Additional Sum Insured for Critical illness (on indeminity basis only) | Only for policies with SI 20L and above 10% of SI |
| Pre and Post Hospitalization expenses | Pre Hospitalisation expenses up to 45 Days Post Hospitalisation expenses up to 90 Days |
| Specialised Oncology Test/ Investigation (Outside India) (Once in a lifetime for each member) | Not Covered |
| Limit on Modern Treatment | Up to 50% of Sum Insured |
| Limits on Mental Illness | Up to 50% of Sum Insured |
| Health Check-Up | After continuous 2 claim free yrs Individual SI policy – 1K to 2K Floater SI policy – 2K to 4k |
| Bonus for claim free year (Policyholder can chose the between yearly Bonus or 2% discount on renewal premium) | 20% increase in SI per claim-free year, subject to a maximum of 100% of the Sum Insured. |
| Pre-existing Disease Waiting Period | 2 Years |
| Tele-consultation | Individual/Floater: Two consultations max ₹ 1000/2000 |
| AYUSH Coverage | Up to 100% of the Sum Insured |
| Treatment in Non-Network Hospitals | If you take treatment in a Hospital that is not on insurance company or TPA network then 5 % of admissible claim amount has to be borne by You. |
| Personal Accident (optional cover) | For individuals Age 18 and above – 20L Cover is available For individuals Age below 18 – 10L SI Cover is available |
| Room Rent Up gradation (optional cover) | Option to increase per day Room rent to 150% and 200%. Available only for Policy with Sum Insured 10 Lakh or Less |
| Pre-Existing Disease (PED) Waiting Period Buyback Option (Only for fresh proposals) | Default PED waiting period is 2 years, which can be reduced to 1 or 0 year (Day 1 Coverage) |
| Domiciliary Hospitlisation | Maximum ₹50,000/- per policy year |
| Treatment for animal bite | Covered up to 10K |
| Home Care Treatment | Covered up to 50K |
Coverage Under the Royal Plan of OSSP
Royal Plan of Sampoorna Swasthya Policy offers the most comprehensive coverage with wider and enhanced limits. In some cases, it even provides coverage without any limits.
For example, in case of modern treatments, there is no limit. Similarly, for hospital room rent, there is no cap. Since most hospitalization expenses are directly or indirectly linked to the type of room chosen, having no room rent limit becomes a very significant advantage. When a policy does not restrict room rent, it automatically avoids proportionate deductions on other related expenses.
Other wider and enhanced benefits offered under this plan are listed in the table below.
| Policy Terms | ROYAL PLAN (Oriental Sampoorna Swasthya Policy) |
|---|---|
| Sum Insured You can Opt | 10 Lakh to 5 Cr |
| Hospital Room Boarding and Nursing expenses | Actual expenses |
| ICU expenses | Actual expenses |
| Cataract Limit | Max 1.5L per eye |
| Road Ambulance Expenses | Subject to claim admissibility. No Limit mentioned |
| Daily Hospital Cash Allowance | 0.1% of Sum Insured per day (max ₹2000/day) Max 10 days per illness and first 5 days of hospitlisation not payable. Max ₹20,000 per year |
| Attendant allowance (If only insured person up to age 10 yrs is Hospitalised) | SI <1 Cr – ₹ 2000/- per day of Hospitalisation. SI 1Cr or More. – 5K per day Max 10 days per illness and first 5 days of Hospitlisation not payable. Overall in a policy period – Max 15 Days |
| Maternity Benefit | 2 Deliveries or Terminations Waiting period of 24 months 10% of Sum Insured and max. 2 Lakh Per Delivery |
| New Born Baby cover | Covered from Day 1 up to SI limit on Payment of Premium |
| Assisted Reproduction Treatment | 36 Months waiting period Max 2 Lakh once in lifetime of insured |
| Organ Donor Expenses when Insured is Donor | Up to 10% of Sum Insured , Max 2 Lakh |
| Donor Expenses when Insured Person is Recipient. | Up to Full Sum Insured |
| Restoration of the Sum Insured | Unlimited times However Coverage under this term is more extensive for 50L and Above Sum insured options |
| Medical Second Opinion for 11 specified critical illnesses, taken from anywhere in the world. | Individual SI policy – SI 50L or less – 7.5k SI more than 50L – 15K Family Floater Policy – SI 50L or less – 15K SI more than 50L – 30k |
| Air Ambulance Cover (Once In lifetime of policy) | SI 7 Lakh to 25 Lakh – Up to 5 Lakh SI Above 25 Lakh – 7.5 Lakh |
| Accidental Death and permanent total Disability (Benefit Cover) | 10% of Policy Sum Insured is paid irrespective of Hospitalisation expenses. |
| Dental and Ophthalmic OPD cover | Reimbursed in a Block of 2 continuous claim free years. Individual SI policy 20 & 25 L SI only – 2000 Individual SI policy 50L to 100L SI only – 5000 Individual SI policy Above 100L SI – 10000 Floater SI policy 20 & 25 L SI only – 5000 Floater SI policy 50L to 100L SI only – 10000 Floater SI policy Above 100L SI – 20000 |
| Additional Sum Insured for Critical illness (on indeminity basis only) | 10% of Policy Sum Insured, |
| Pre and Post Hospitalization expenses | 90/180 Days |
| Specialised Oncology Test/ Investigation (Outside India) (Once in a lifetime for each member) | If Policy Sum Insured is 20L – 25L SI – 50K Expenses Payable SI 50L-75L – 1 Lakh Payable Above 75 Lakh – 1.5 Lakh Payable |
| Limit on Modern Treatment | Covered up to Full Sum Insured |
| Limits on Mental Illness | Covered up to Full Sum Insured |
| Health Check-Up | After continuous 2 Claim free yrs Individual SI policy – 2K to 4K Floater SI policy – 5K to 10k |
| Bonus for claim free year (Policyholder can chose the between yearly Bonus or 2% discount on renewal premium.) | Up to 25 Lakh SI – 25% increase in SI per claim-free year, subject to a maximum of 200% of the Sum Insured. Above 25 Lakh SI policy – 50% increase in SI per claim-free year, subject to a maximum of 200% of the Sum Insured. |
| Waiting Period for Pre-existing Disease | 1 year for Insured upto age of 45 Years & 2 Yrs for age above 45 Yrs |
| Teleconsultation | Individual/Floater: Three consultations Max payable ₹ 2500/5000 |
| AYUSH Coverage | Up to 100% of the Sum Insured |
| Treatment in Non-Network Hospitals | You can take treatment in any Hospital. No co-payment apply |
| Personal Accident (Optional cover) | For individuals Age 18 and above – 50L Cover is available For individuals Age below 18 – 20L SI Cover is available |
| Pre-Existing Disease (PED) Waiting Period Buyback Option(Only for fresh proposals) | Can be reduced to 1 Yr or 0 Year (Day 1 Coverage) |
| Domiciliary Hospitlisation | Maximum ₹1,00,000 per policy year |
| Treatment for animal bite | Covered up to 10K |
| Home Care Treatment | Covered up to 1 Lakh |
Features of Oriental Sampoorna Swasthya Policy that stands out
• This policy offers a very wide range of Sum Insured options. You can opt cover limit as low as ₹2 Lakhs and go up to ₹5 Crores which is honestly rare, especially among Public Sector General Insurance companies. It gives real flexibility based on your needs and budget.
• One feature I personally find very practical is the Floater – Floater Option. Under a single policy, you can create separate floater groups, each with its own Sum Insured. Every floater group must have at least two members. For example, you can opt for a ₹10 lakh floater for self and spouse, and at the same time take a separate ₹5 lakh floater for your children all within one single policy document. This gives much better financial planning flexibility compared to standard family floater plans where everyone shares one common limit.
• The policy allows coverage for up to 4 generations under one single plan. You can include siblings, parents, parents-in-law, and even grandparents – all in the same policy. It truly supports the concept of a complete family cover.
• Room rent options are also very flexible. Depending on the plan, it ranges from 1% of the Sum Insured to actual expenses. Additionally, you can enhance the room rent limit up to 150% or even 200% by opting for optional covers. So you’re not restricted during hospitalization.
• It offers comprehensive maternity coverage along with ART (Assisted Reproductive Treatment) cover, which is a valuable addition for young families planning ahead.
• In the higher variant – the Royal Plan, the policy covers specialized oncology (cancer) tests, even if they are done outside India. Many policies still lack this feature, so this is a strong advantage.
• Under the Royal Plan, there is no limit on modern treatments. This is again a rare feature compared to most health insurance plans in the market.
• There is also an optional PED (Pre-Existing Disease) Buyback cover. By opting for this, you can get coverage for pre-existing diseases from Day 1 itself – which can be a big relief for many customers.
• Higher plans also include home care treatment coverage, giving you the convenience of receiving medical care at home when medically advised.
• Another strong point – the policy covers treatment expenses in SAARC countries without charging any additional premium
Important Terms to Know Before Making a Decision
• The policy has sub-limits for various diseases. The detailed table of sub-limits is mentioned in the policy document.
• OPD cover is available, but the limit is quite low and comes with multiple conditions. Even if you opt for a higher Sum Insured like ₹50 Lakhs or more, the OPD benefit remains restricted and may not be very meaningful in practical situations.
• Health check-up expenses are also limited and come with restrictions. They are generally available only after a claim-free year, and the amount offered is relatively low compared to the premium paid.
• If treatment is taken in a non-network hospital, a co-payment clause applies, depending on the plan you choose. So it becomes important to check the network hospital list beforehand to avoid out-of-pocket expenses.
• The policy does offer restoration of Sum Insured, which sounds attractive. However, it comes with several conditions. In Premium and Elite plans especially, the restoration may not be as freely usable as it appears, due to the attached terms and eligibility triggers.
Oriental Sampoorna Swasthya Policy is a feature-rich and flexible health insurance plan offering wide Sum Insured options, multi-generation coverage, and strong benefits especially under the Royal Plan. It stands out for its modern treatment coverage, maternity with ART benefits, and structured floater flexibility.
However, like any policy, it comes with certain sub-limits and conditions that must be carefully reviewed before buying.
Overall, it is a strong option for families looking for comprehensive coverage provided you understand the terms and choose the right variant as per your needs.
