| 7- Family Floater Coverage - Easy Health Family Floater Insurance Plan from Apollo Munich |
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| Source : Website of Apollo Munich Insurance Company Limited |
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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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| 12.Medical Practitioner means a person who holds a qualification in medicine from a recognised institution and is registered and licensed by a state council, governed by the Medical Council of India, in which he operates and is practicing within the scope of such license and will include (but is not limited to) physicians, specialists and surgeons who satisfy the aforementioned criteria. |
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| 13.Network means all the Hospitals or other institutions or persons with whom We or the appointed TPA have special agreements for the provision of medical services. |
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| 14.Outpatient Treatment means consultation, diagnosis or medical treatment taken by any Insured Person at an outpatient department of a Hospital, clinic or associated facility, provided that he is not Hospitalised. |
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| 15.Policy means Your statements in the proposal form, this policy wording (including endorsements, if any), Appendix 1 and the Schedule (as the same may be amended from time to time). |
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| 16.Policy Period means the period between the Commencement Date and the Expiry Date specified in the Schedule. |
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| 17.Policy Year means a year following the Commencement Date and its subsequent annual anniversary. |
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| 18.Pre-existing Condition means any sickness, illness, disease, injury, medical or nervous condition or related condition or symptom: |
- For which the Insured Person received any medical consultation, treatment, investigation or advice; or,
- Of which the Insured Person was aware or ought to have been aware;
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| within the 36 months period prior to the commencement of the Insured Person first being covered under an Easy Health Individual Health Insurance Plan or Easy Health Family Floater Insurance Plan issued by Us.” |
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| 19.Shared Accommodation means a Hospital room with two or more patient beds. |
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| 20.Sum Insured means the sum shown in the Schedule which represents Our maximum liability for each Insured Person for any and all benefits claimed for during the Policy Period, and in relation to a Family Floater represents Our maximum liability for any and all claims made by You and all of Your Dependents during the Policy Period. |
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| 21.Surgical Procedure means an operative procedure for the correction of deformities and defects, repair of injuries, cure of diseases, relief of suffering and prolongation of life. |
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| 22.TPA means the third party administrator that We appoint from time to time as specified in the Schedule. |
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| 23.We/Our/Us means the Apollo Munich Insurance Company Limited |
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| 24.You/Your/Policyholder means the person named in the Schedule who has concluded this Policy with Us. |
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