| 8- Family Floater Coverage -Oriental Insurance Company Limited - Policy Wording |
|
THE ORIENTAL INSURANCE COMPANY LIMITED,
Regd. Office: Oriental House, P.B. No. 7037, A-25/27, Asaf Ali Road, New Delhi- 110 002 |
|
| The term ‘Hospital/Nursing Home’ shall not include an establishment which is a place of rest and / or recuperation, a place for the aged persons, a rehabilitation centre for drug addicts or alcoholics, a hotel or a similar place. |
|
| Note: In case of Ayurvedic / Homeopathic / Unani treatment, the liability of the Company SHALL be restricted to 10% of the Sum Insured for the entire policy period for the family as a whole if the treatment is taken in hospitals other than Government hospitals and Medical college hospitals. |
|
| 2.2Surgical Operation means manual and/ or operative procedures for correction of deformities / defects and injuries, cure of diseases, relief of suffering and prolongation of life. |
|
| 2.3 HOSPITALISATION PERIOD: Expenses on Hospitalisation are admissible only if hospitalisation is for a minimum period of 24 (twenty four) hours.However, |
|
| (A)This time limit SHALL not apply to following specific treatments taken in the Network Hospital / Nursing Home where the Insured is discharged on the same day. Such treatment SHALL be considered to be taken under Hospitalisation Benefit. |
|
- Dialysis (haemo dialysis, Peritoneal dialysis)
- Parental Chemotherapy (injectible)
- Radiotherapy,
- Eye Surgery,
- Lithotripsy (kidney stone removal),
- Tonsillectomy,
- Dilation and Curettage (D&C)
- Dental surgery following an accident
- Hysterectomy
- Coronary Angioplasty
- Coronary Angiography
- Surgery of Gall bladder, Pancreas and bile duct
- Surgery of Hernia
- Surgery of Hydrocele.
- Surgery of Prostrate.
- Gastrointestinal Surgery.
- Genital Surgery.
- Surgery of Nose.
- Surgery of throat and ear.
- Surgery of Appendix.
- Surgery of Urinary System.
- Treatment of fractures / dislocation excluding hair line fracture, Contracture releases and minor reconstructive procedures of limbs which otherwise require hospitalisation.
- Arthroscopic Knee surgery.
- Laproscopic therapeutic surgeries.
- Any surgery under General Anaesthesia.
- Any such disease / procedure agreed by TPA/Company before treatment.
|
| (B)Further if the treatment / procedure / surgeries of above diseases/ bodily inuries are carried out, in Network specialised Day Care Centre which is fully equipped with advanced technology and specialised infrastructure where the insured is discharged on the same day, the requirement of minimum beds SHALL be overlooked provided following conditions are complied with. |
- The operation theatre is fully equipped for the surgical operation required in respect of the above diseases.
- Day Care nursing staff is fully qualified.
- The doctor performing the surgery or procedure as well as post operative attending doctors should be fully qualified for the specific surgery / procedure.
|
|
|
|
