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| Senior Citizens Health Insurance (Mediclaim Policy) in India |
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| 6- Senior Citizens Mediclaim Policies -National Insurance Company Limited |
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| VARISTHA Mediclaim for Senior Citizens |
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| 2. Definitions |
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2.1. Hospital/Nursing Home‚ means any institution in India established for indoor care and treatment of sickness and injuries and which either
(a) has been registered either as a Hospital or Nursing Home with the local authorities and is under the supervision of the registered and qualified medical practitionerOR
(b) should comply with minimum criteria as under:
i. It should have at least 15 inpatient beds. In Class "C" towns condition of number of beds may be reduced to 10
ii. Fully equipped Operation Theatre of its own wherever surgical operations are carried out.
iii. Fully qualified nursing staff under its employment round the clock
iv. Fully qualified Doctor(s) should be in charge round the clock |
2.1.1 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 place of alcoholics, a hotel or a similar place.
2.2Surgical Operationmeans manual and/or operative procedures for correction of deformities and defects, repair of injuries, diagnosis and cure of diseases, relief of suffering and prolongation of life
2.3 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 and application of POP casts, Dialysis, Chemotherapy, Radiotherapy, Arthroscopy, Eye surgery, ENT surgery, Laparoscopic surgery, Angiographies, Endoscopies, Lithotripsy (Kidney stone removal), 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.
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(b) Due to technological advances hospitalization is required for less then 24 hours only.
2.4 Domiciliary Hospitalization benefit means medical treatment for a period exceeding three days for such illness/disease/injury which in the normal course would require care and treatment at a Hospital/Nursing Home but actually taken whilst confined at home in India under any of the following circumstances, namely:
i) The condition of the patient is such that he/she cannot be removed to the Hospital/Nursing Home or
ii) The patient cannot be removed to Hospital/Nursing Home for lack of accommodation therein
Subject to however that domiciliary hospitalisation benefits shall not cover:
i) Expenses incurred for pre and post hospital treatment and
ii) Expenses incurred for any of the following diseases;
1. Asthma
2. Bronchitis
3. Chronic Nephritis and Nephritic Syndrome
4. Diarrhea and all type of dysenteries including Gastroenteritis
5. Diabetes Mellitus and Insipidus
6. Epilepsy
7. Hypertension
8. Influenza, Cough and Cold
9. All Psychiatric or Psychosomatic Disorders
10. Pyrexia of unknown Origin for less than 10 days
11. Tonsillitis and Upper Respiratory Tract Infection including Laryngitis and Pharingitis
12. Arthritis, Gout and Rheumatism
Note: When treatment such as Dialysis, Chemotherapy, Radiotherapy is 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 section. Liability of the Company under this clause is restricted as stated in the Schedule attached hereto. |
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3.0 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 30 days prior to hospitalization/domiciliary hospitalization on disease/illness/injury sustained will be considered as part of claim mentioned under item 1.0 above
3.2 Post Hospitalization: Relevant Medical Expenses incurred up to 60 days after hospitalization/ domiciliary hospitalization on disease/illness/injury sustained will be considered as part of claim mentioned under item 1.0 above |
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