| 8- Oriental Insurance Company Limited - Family Floater Policy Wording |
|
| Source: Website of The Oriental Insurance Company Limited |
|
3.5 HOSPITALISATION PERIOD: The period for which an insured person is admitted in the hospital as inpatient and stays there for the sole purpose of receiving the necessary and reasonable treatment for the disease/ ailment contracted/ injuries sustained during the period of policy. The minimum period of stay shall be 24 (twenty four) hours |
|
3.6 PRE-HOSPITALISATION: Reasonable and necessary medical expenses incurred for the treatment of disease/ injury during the period upto 30 (thirty) days prior to date of admission in hospital sustained SHALL be considered as part of claim mentioned under item 1.2 above. |
|
3.7 POST-HOSPITALISATION: Reasonable and necessary medical expenses incurred for the treatment of disease/ injury for a period upto 60 (sixty) days from discharge from the date of discharge from hospital SHALL be considered as part of claim mentioned under item 1.2 above. |
|
3.8 MEDICAL PRACTITIONER: means a person who holds a effective degree/ diploma from a recognised institution and is registered by Medical Council of any State of India. The term Medical Practitioner shall include Physician, Specialist and Surgeon. |
|
3.9 QUALIFIED NURSE: means a person who holds a certificate in NURSING from a recognised Nursing Institute. |
|
3.10 PRE EXISTING HEALTH CONDITION OR DISEASE: means any condition, ailment or injury or related condition(s) for which the insured persons had signs or symptoms, and or were diagnosed, and or received medical advice/ treatment, within 48 months prior to his/ her first hospitalization benefit policy with the Company. |
|
3.11 IN-PATIENT: An Insured person who is admitted to hospital and stays for at least 24 hours for the sole purpose of receiving the treatment for suffered ailment/ illness/ disease/ injury/ accident during the currency of the policy. |
|
| 3.12 REASONABLE & NECESSARY EXPENSES: |
- For a networked hospital means the rate pre-agreed between Network Hospital and the TPA/ Company, for surgical/ medical treatment that is necessary for treating the insured person who was hospitalized.
- For any other hospital it shall mean the cost of surgical/ medical treatment that is necessary and reasonable for treating the condition for which insured person was hospitalized.
|
NOTE: Any expenses other than the above have to be borne by the insured person himself. |
|
3.13 CASHLESS FACILITY: The TPA may authorise upon the request of the insured for direct settlement of admissible claim as per agreed charges between Network Hospitals and the TPA./ Company In such cases, the TPA SHALL directly settle all bills of admissible amounts with the Network Hospitals and the Insured Person may not have to pay such admissible amounts to the Hospital to the extent the claim is covered under the policy. |
|
3.14 I.D. CARD: means the card issued to the Insured Person by the TPA to avail Cashless facility in the Network Hospital. |
|
3.15 DAY CARE PROCEDURE: means the course of Medical treatment/ surgical procedure listed at 2.3 (A) and 2.3 (C) carried out, in Network hospitals or network specialised Day Care Centre which is fully equipped with advanced technology and specialised infrastructure and where the insured is discharged on the same day after treatment. |
|
3.16 LIMIT OF INDEMNITY: means the amount stated in the schedule which represents maximum liability for any and all claims admissible during the policy period in respect of that insured family. |
|
|
|
