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| Senior Citizens Health Insurance (Mediclaim Policy) in India |
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| 6- Senior Citizens Mediclaim Policies - The New India Assurance Co. Ltd. |
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| 3.0 DEFINITIONS: |
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3.1 Pre- Existing Condition: means any sickness/ illness, which existed prior to the effective date of this insurance, whether or not the insured person had any knowledge of symptoms related to the sickness/illness. Complications arising from a pre-existing condition will also be considered as a part of that pre-existing condition.
3.2 Hospital/Nursing Home: means any institution in India established for indoor care and treatment of sickness and injuries and which has been registered either as a hospital or nursing home with the local authorities and is under the supervision of a registered and qualified medical practitioner,
Or
Complies with minimum criteria as under:
(a) Must have a minimum of:
10 in-patient beds if located in towns having population of less than 10 Lacs
Or
15 in-patient beds if located in other towns.
(b) Fully equipped operation theatre of its own wherever surgical operations are carried out.
(c) Fully qualified Nursing Staff under its employment round the clock.
(d) Fully qualified Medical Practitioner should be in-charge round the clock.
(e) Maintains daily medical record for each of its patients.
Note: In case of Ayurvedic/ Homeopathic/ Unani Treatment (b) is not applicable.
In case of Day Care Centre, (a) is not applicable
For the purpose of this definition the term Hospital/Nursing Home/Day Care Center 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 any other like place.
3.3 Surgical Operation means manual and/ or operative procedures for correction of deformities/ defects, repair of injuries, cure of diseases, relief of suffering and prolongation of life.
3.4 Hospitalisation means admission in any Hospital/Nursing Home in India upon the written advice of a Medical Practitioner for a minimum period of 24 consecutive hours. The time limit of 24 hours will not be applicable for following surgeries/ procedures. |
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| The time limit of 24 hours will not be applicable for following surgeries procedures. |
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| Anti Rabies Vaccination |
Hysterectomy |
| Appendectomy |
Inguinal/Ventral/Umbilical/Femoral Hernia repair |
| Coronary Angiography |
Lithotripsy (Kidney Stone Removal) |
| Coronary Angioplasty |
Parenteral Chemotherapy |
| Dental surgery following an accident |
Piles/ Fistula |
| Dilatation & Curettage (D & C) of Cervix |
Prostate |
| Eye surgery |
Radiotherapy |
| Fracture/ dislocation excluding hairline fracture |
Sinusitis |
| Gastrointestinal Tract system |
Stone in Gall Bladder, Pancreas, and Bile Duct |
| Haemo-Dialysis |
Tonsillectomy |
| Hydrocele |
Urinary Tract System |
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| OR |
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Any other Surgeries/ Procedures agreed by TPA/ COMPANY which require less than 24 hours hospitalization due to subsequent advancement in Medical Technology.
3.5 Any one illness will be deemed to mean continuous period of the illness for which treatment is undergone and includes relapse within 45 days from the date of last consultation with the Hospital/ Nursing Home where treatment was taken. Occurrence of same illness after a lapse of 45 days as stated above will be considered as fresh illness.
3.6 Medical Practitioner 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 and shall not include INSURED person and members of his family covered under this insurance.
3.7 Qualified Nurse means a person who holds a certificate of recognized Nursing Council and is employed on recommendations of the attending Medical Practitioner.
3.8 Third Party Administrator (TPA) means a third party administrator as mentioned in the policy schedule, licensed by the Insurance Regulatory and Development Authority (IRDA) and engaged by the COMPANY for a fee or remuneration for providing “Cashless Facility and or reimbursement claim to insured person under the policy.
3.9 Network Hospital means the Hospital, Nursing Home, Day Care Centre or such other Medical Aid provider that has agreed with the TPA to participate for providing cashless facility to policyholders. Non-network provider shall mean any other Hospitals/Nursing Home/Day Care Center, or such other Medical Aid provider, who has not agreed to provide such cashless facility.
3.10 Cashless Facility means facility whereby the TPA agrees, on the insured’s request, to settle the admissible claim directly to the network hospital. Any expense in excess of the admissible claim amount will, however, be borne by the insured himself.
3.11 ID Card means the Identity Card issued to the insured person by the TPA to avail cahless facility in network hospitals.
3.12 Daycare Procedure means the course of medical treatment/ surgical procedure in specialized Day Care Centre which enables the insured to be discharged on the same day. |
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