| 7- (a) Family Floater Coverage - Apollo DKV Insurance |
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| Easy Health Individual Health Insurance Plan / Easy Health Family Floater Insurance Plan from Apollo DKV |
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| 5.Dependents means only the family members listed below: |
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- Your legally married spouse as long as she continues to be married to You;
- Your children Aged between 91 days and 21 years if they are unmarried, still financially dependant on You and have not established their own independent households;
- Your natural parents or parents that have legally adopted You, provided that:
- The parent was below 60 years at his initial participation in the Easy Health Individual Health Insurance Plan or Easy Health Family Floater Insurance Plan, and
- Parents shall not include Your spouse’s parents.
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6.Family Floater means a Policy described as such in the Schedule whereunder You and Your Dependents named in the Schedule are insured under this Policy as at the Commencement Date. The Sum Insured for a Family Floater means the sum shown in the Schedule which represents Our maximum liability for any and all claims made by You and/or all of Your Dependents during the Policy Period. |
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7.Hospital means any institution in India (including nursing homes) established for Medical Treatment which: |
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- Either:has been registered and licensed as a hospital with the appropriate local or other authorities competent to register hospitals in the relevant area and is under the constant supervision of a Medical Practitioner and is not, except incidentally, a clinic, rest home, or convalescent home for the addicted, detoxification centre, sanatorium, home for the aged, mentally disturbed, remodelling clinic or similar institution.
- Or
(i) is under the constant supervision of a Medical Practitioner,
(ii) has fully qualified nursing staff (that hold a certificate issued by a recognised nursing council) under its employment in constant attendance , and
(iii) maintains daily records of each of its patients, and
(iv) has at least 10 Inpatient beds, and
(v) has a fully equipped and functioning operation theatre.
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8.Hospitalisation or Hospitalised means the Insured Person’s admission into a Hospital for Medically necessary Treatment as an inpatient for a continuous period of at least 24 hours following an Illness or Accident occurring during the Policy Period. |
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| 9.Insured Person means You and the persons named in the Schedule. |
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10.Illness means a sickness (a condition or an ailment affecting the general soundness and health of the Insured Person’s body) or a disease (affliction of the bodily organs having a defined and recognised pattern of symptoms) or pathological condition leading to the impairment of normal physiological function which manifests itself during the Policy Period and requires medical Treatment. For the avoidance of doubt, Illness does not mean and this Policy does not cover any mental illness or sickness or disease (including but not limited to a psychiatric condition, disorganisation of personality or mind, or emotions or behaviour) even if caused by or aggravated by or related to an Accident or Illness. |
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11.Medical Expenses means those reasonable and customary medical expenses that an Insured Person has necessarily and actually incurred for medical treatment during the Policy Period on the advice of a Medical Practitioner due to Illness or Accident occurring during the Policy Period, as long as these are no more than would have been payable if the Insured Person had not been insured and no more than other hospitals or doctors in the same locality would have charged for the same medical treatment. |
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