| 8- Universal Health Insurance Policy from United India - Health Insurance Below Poverity Line (BPL) Families |
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| Source: Website of Universal Sompo General Insurance Company Limited |
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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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| IV. |
EXCLUSIONS:- |
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Applicable to Section –1 |
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The company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any Insured Person in connection with or in respect of: |
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| 4.1 |
Injury/ disease directly or indirectly caused by or arising from or attributable to invasion, Act of Foreign enemy, War like operations (whether war be declared or not) |
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| 4.2 |
Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as apart of any illness. |
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| 4.3 |
Cost of spectacles and contact lenses, hearing aids. |
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| 4.4 |
Dental treatment or surgery of any kind unless requiring hospitalisation. |
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| 4.5 |
Convalescence, general debility; run-down condition or rest cure, Congenital external disease or defects or anomalies, Sterility, Venereal disease, intentional self injury and use of intoxication drugs/ alcohol |
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| 4.6 |
All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus Type III (HTLB - III) or lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or Variation Deficiency Syndrome or any syndrome or condition of a similar kind commonly referred to as AIDS. |
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| 4.7 |
Charges incurred at Hospital or Nursing Home primarily for diagnosis x-ray or Laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive existence of presence of any ailment, sickness or injury, for which confinement is required at a Hospital/ Nursing Home. |
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| 4.8 |
Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the attending physician |
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| 4.9 |
Injury or Disease directly or indirectly caused by or contributed to by nuclear weapon/ materials |
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| 4.10 |
Naturopathy Treatment |
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