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Definations |
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HOSPITAL / NURSING HOME means any institution in India established for indoor care and treatment of sickness and injuries and which Either
- has been registered as a Hospital or Nursing Home with the local authorities and is under the supervision of a registered and qualified Medical Practitioner.
Or
- Should comply with minimum criteria as under:
- It should have at least 15 inpatient beds.
- Fully equipped operation theatre of its own wherever surgical operations are carried out.
- Fully qualified Nursing Staff under its employment round the clock.
- Fully qualified Doctor (s) should be in-charge round the clock
N.B: In class ‘C’ towns condition of number of beds be reduced to 10...
- The term ‘ Hospital / Nursing Home ‘ shall not include an establishment which is a place of rest, a place for the aged, a place for drug-addicts or place for alcoholics a hotel or a similar place.
- ‘Surgical Operation’ means manual and I or operative procedures for correction of deformities and defects, repair of injuries, diagnosis and cure of diseases, relief of suffering and prolongation of life.
- Expenses on Hospitalization for minimum period of 24 hours are admissible. However, this time limit is riot applied to specific treatments, i.e., Dialysis. Chemotherapy, Radiotherapy, Eye Surgery. Dental Surgery, Lithotripsy (Kidney Stone removal), b&c, Tonsillectomy taken in the Hospital / Nursing Home and the Insured is discharged on the same day; such treatment will be considered to be taken under hospitalization Benefit. This condition will also not apply in case of stay in Hospital of less than 24 hours provided
- The treatment is such that it necessitates hospitalization and the procedure involves specicilised infrastructural facilities available in hospitals.
- due to technological advances hospitalization is required for less than 24 hours only.
Note: Procedures/treatments usually done in out patient department are not payable under the policy even if converted as an in-patient in the hospital for more than 24 hours
- DOMICILIARY HOSPITALISATION BENEFIT EXCLUDED FROM THIS POLICY.
- ANY ONE ILLNESS:
Any one illness will be deemed to mean continuous period of illness and it includes relapse within 105 days from The date of discharge from the Hospital / Nursing Home from where treatment was taken. Occurrence of same illness after a lapse of 105 days as stated above will be considered as fresh illness for the purpose of this policy.
- PRE - HOSPITALISATION:
Relevant medical expenses incurred during period up to 30 days prior to Hospitalization on disease / illness / injury sustained will be considered as port of claim as mentioned under item 1.2 above.
- POST HOSPITALISATION:
Relevant medical expenses incurred during period up to 60 days after Hospitalization on disease / illness / injury sustained will be considered as port of claim mentioned under item 1.2 above. MEDICAL PRACTIONER means a person who holds a degree/diploma of a recognized institution and is registered by Medical Council of respective State of India. The term Medical Practitioner would include Physician, Specialist and Surgeon.
- QUALIFIED NURSE
means a person who holds a certificate of recognised Nursing Council and who is employed on recommendation of the attending Medical Practitioner.
- MATERNITY EXPENSES BENEFIT exclused from this Policy.
- TPA means a Third Party Administrator who holds a valid License from Insurance Regulatory and development Authority to act as a THIRD PARTY ADMINISTRATOR and is empanelled by the Company for the provision of health services as specified in the agreement between the Company and TPA.
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