7- Family Floater Coverage - Parivar Mediclaim (National Insurance Prospectus) |
|
Source: Website of National Insurance Company Limited |
|
2.2.1- |
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
|
|
2.3 |
Surgical Operation means manual and/or operative procedures for correction of deformities and defects, repair of injuries, diagnosis and cure of diseases, relief or suffering and prolongation of life. |
|
2.4 |
Expenses of Hospitalization for minimum period of 24 hours are admissible. However, this time limit is not applied to specific treatments i.e. day care treatment for stitching of wound/s, close reduction/s of fractures and application of POP casts, Dialysis, Chemotherapy, Radiotherapy, Arthroscopy, Eye surgery, ENT surgery, Laparoscopic surgery ,Angiographies, Endoscopies, Lithotripsy (Kidney stone removal) and minor surgical procedures, D & C, Tonsillectomy taken in the Hospital/Nursing Home and the Insured is discharged on the same day. The treatment will be considered to be taken under Hospitalization benefit. This condition will also not apply in case of stay in Hospital of less then 24 hours provided – |
|
|
(a.) |
The treatment is such that it necessitates hospitalization and the procedure involves specialized infrastructural facilities available in Hospitals. |
|
(b.) |
Due to technological advances hospitalization is required for less then 24 hours only. |
|
3. |
Any One Illness will be deemed to mean continuous period of illness and it includes relapse within 45 days from the date of last consultation with the Hospital/Nursing Home where treatment may have been taken. Occurrence of same illness after a lapse of 45 days as stated above will be considered as fresh illness for the purpose of this policy. |
|
|
3.1 |
Pre-Hospitalization : Relevant medical expenses incurred during period up to 15 days prior to hospitalization on disease/illness/injury sustained will be considered as part of claim mentioned under Hospitalization Expenses. |
|
|
|
3.2 |
Post-Hospitalization : Relevant medical expenses incurred during period upto 30 days after hospitalization on isease/illness/injury sustained will be considered as part of claim mentioned under Hospitalization Expenses |
|
|
|
3.3- |
Medical Practitioner means a person who holds a degree/diploma from a recognized institution and is registered by the Medical Council of India or the respective State Councils. The term Medical Practitioner would include Physician, Specialist and Surgeon. |
|
|
3.4 |
Qualified Nurse means a person who holds a certificate of a recognized Nursing Council and who is employed on the recommendations of the attending Medical Practitioner. |
|
|
3.5 |
TPA means a Third Party Administrator who is licensed by the Insurance Regulatory and Development Authority, and is engaged, for a fee or remuneration, by whatever name called as may be specified in the agreement with the Company, for the provision of health services. |
|
|
|
|
The Company shall not be liable to make any payment under this Policy in respect of any expenses whatsoever incurred by any Insured Person in connection with or in respect of : |
|
|
|
4.1 |
All diseases/injuries which are pre-existing when the cover incepts for the first time. However, those diseases will be covered after four continuous claim free policy years. For the purpose of applying this condition, the period of cover under Mediclaim policy taken from National Insurance Company only will be considered. Pre-existing disease like Diabetes and Hypertension will be covered from the inception of the policy on payment of additional premium by the insured. |
|
|
|