| 8- Oriental Insurance Company Limited - Family Floater Policy Wording |
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| Source: Website of The Oriental Insurance Company Limited |
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2.4 DOMICILIARY HOSPITALISATION 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 as in-patient but actually taken whilst confined at home in India under any of the following circumstances namely: |
| The MEDICAL condition of the patient is such that the patient cannot be removed to the Hospital/ Nursing Home |
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| The patient cannot be removed to Hospital/Nursing home due to lack of accommodation in any hospital in that city/ town/ village. |
| Subject however to the condition that Domiciliary Hospitalisation benefit shall not cover |
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(a) Expenses incurred for pre and post hospital treatment and
(b) Expenses incurred for treatment for any of the following diseases : |
- Asthma
- Bronchitis,
- Chronic Nephritis and Nephritic Syndrome,
- Diarrhoea and all types of Dysenteries including Gastro-enteritis,
- Diabetes Mellitus and Insipidus,
- Epilepsy,
- Hypertension,
- Influenza, Cough and Cold,
- All Psychiatric or Psychosomatic Disorders,
- Pyrexia of unknown origin for less than 10 days,
- Tonsillitis and Upper Respiratory Tract infection including Laryngitis and Pharingitis,
- Arthritis, Gout and Rheumatism.
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2.5 AMBULANCE SERVICES: Means ambulance service charges reasonably and necessarily incurred in case the insured person is to be shifted from residence to hospital or from one hospital to another hospital. The ambulance service charges are payable only if the hospitalisation expenses are admissible. Further the ambulance service charges are admissible only if such expenses are paid to registered ambulance services providers. |
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| 3. OTHER DEFINITIONS AND INTERPRETATIONS: |
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3.1 INSURED PERSON: Means Person(s) named on the schedule of the policy which includes family comprising of the proposer, his/her legally wedded spouse, dependent unemployed children between 3 (three months) to the age of 25 years, unmarried daughters including divorcee, and widowed daughters and dependent Parents or parents-in-law (either of them only). The minimum number of persons to be covered under the policy shall be the proposer plus one family member. |
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3.2 ENTIRE CONTRACT: This POLICY, SCHEDULE, PROPOSAL/ DECLARATION given by the insured constitute a complete contract. Only Insurer may alter the terms and conditions of the policy and such alterations made by the insurer shall only be evidenced by a duly signed endorsement on the policy with the Company stamp. |
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3.3 TPA (THIRD PARTY ADMINISTRATOR): means any company/ body who has obtained licence from IRDA to practice as a third party administrator and is appointed as TPA by the Company. |
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3.4 NETWORK HOSPITAL: means hospital that has agreed with the Company/ TPA to participate in providing cashless health services to the insured persons. The list is maintained by and available with the TPA and the same is subject to amendment from time to time without any notice to the insured. |
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