| 9- Family Floater Coverage - United India Insurance Company Ltd. |
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| Universal Health Insurance Scheme for (BPL) Below Poverity Line Families - Prospectus |
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| UNITED INDIA INSURANCE COMPANY LIMITED
Reg. & Head Office: 24, Whites Road, Chennai - 14. |
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| (iii) |
DEFINITIONS |
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| 1. |
HOSPITAL / NURSING HOME means any institution in India established for indoor care and treatment of sickness and injuries and which:
has been registered as a Hospital or Nursing Home with the local authorities and is under the supervision of a registered and qualified Medical Practitioner. |
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| (a) |
Hospital /Nursing Home run by NGOs / Government |
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| (b) |
Should comply with minimum criteria as under:- |
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(i)It should have at least 15 inpatient beds.
(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.
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N.B: In class 'C' towns condition of number of beds be reduced to 10. |
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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. |
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| 2. |
'Surgical Operation' means 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. |
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| 3. |
Expenses on Hospitalisation for minimum period of 24 hours are admissible. However, this time limit is not applied to specific treatments, i.e, Dialysis, Chemotherapy, Radiotherapy; Eye Surgery, Dental Surgery, Lithotripsy (Kidney Stone removal), D&C, |
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Tonsillectomy taken in the Hospital / Nursing Home and the Insured is discharged on the same day, such treatment will be considered to be taken under hospitalisation Benefit. This condition will also not apply in case of stay in Hospital of less than 24 hours provided: |
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The treatment is such that it necessitates hospitalisation and the procedure involves specialised infrastructural facilities available in hospitals. |
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Due to technological advances hospitalisation is required for less than 24 hours only. |
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Note: When treatment such as dialysis, Chemotherapy, Radiotherapy., etc 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 hospitalisation benefit section. |
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Liability of the company under this clause is restricted as stated in the Schedule attached hereto. |
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| 4. |
MATERNITY BENEFIT means expenses incurred in Hospital/Nursing Home arising from or traceable to Pregnancy, childbirth including normal Caesarean Section. This also includes medical expenses incurred in respect of new born child upto 3 months. |
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| 5. |
ANY ONE ILLNESS Any one illness will be deemed to mean continuous period of illness and it includes relapse within 60 days from the date of discharge from the Hospital / Nursing Home from where treatment was taken. Occurrence of same illness after a lapse of 60 days as stated above will be considered as fresh illness for the purpose of this policy.
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| 6. |
MEDICAL PRACTITIONER means a person who holds a degree / diploma of a recognised institution and is registered by Medical Council of respective State of India. The term Medical Practitioner would include Physician, Specialist and Surgeon. |
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| 7. |
QUALIFIED NURSE means a person who holds a certificate of a recognised Nursing Council and who is employed on recommendation of the attending Medical Practitioner. |
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| 8. |
TPA means a Third Party Administrator who, for the time being, is licensed by the Insurance Regulatory and Development Authority, and is engaged, for a fee or remuneration, by whatever name called as may be specified in the agreement with the company, for the provision of health services. |
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