HEALTH TECHNICAL TERMS
Disability
“Disability” is a physical or a mental impairment that limits one or more major life activities of an individual. It may be partial or total, permanent or temporary. (Also see Permanent Partial Disability, Permanent Total Disability, Temporary Total Disability.)
Health Insurance
“Health Insurance” offers protection against financial losses by paying specific amounts towards medical expenses and treatments resulting from sickness or accidental bodily injury.
Hospital/Nursing Home
“Hospital/Nursing Home” is an establishment that provides indoor medical care, surgical care, treatment of sick, and injured.
Medical Examination
“Medical Examination” includes few medical tests presented by the insurer and executed by a qualified physician to determine insurability of an applicant. A medical examination can confirm disability, pre existing diseases, etc.
Miscellaneous Expenses
“Miscellaneous Expenses” also known as ancillary charges are cost incurred towards hospital insurance, hospital charges except room and board, such as X-rays, drugs, laboratory fees, and other charges.
Permanent Partial Disablement
“Permanent Partial Disablement” is a state when an insured person loses either of limbs or organs of the body due to accidental, external, violent and visible means.
Permanent Total Disablement
“Permanent Total Disablement” is a state when an insured person incurs injury due to accidental, external, violent and visible means, leading to inability to work, attend business or occupation and do usual and normal duties for a continuous period of 12 months from the date of the accident.
Reimbursement
“Reimbursement” means payment of compensation to the insured for expense incurred as a result of accident or sickness, not exceeding the amount specified in the policy.
Policy
“Policy” is an integrated contract including all forms associated with the agreement between the insured and insurer.
Post-hospitalisation expenses
“Post-hospitalisation expenses” are the medical expenses incurred during a period after hospitalisation for any disease / illness / injury sustained which is covered under health insurance policy.
Pre-existing condition
“Pre-Existing Condition” means any condition, ailment or injury for which the insured person had signs or symptoms, is diagnosed and have received medical advice/ treatment, within 48 months prior to first health insurance policy with the company.
Pre-hospitalisation expenses
“Pre-Hospitalisation Expenses” are the medical expenses incurred during a period before hospitalisation for any disease / illness / injury sustained which is covered under health insurance policy.
Temporary Total Disablement
“Temporary Total Disablement” is a state where the insured has incurred injury caused by accidental, external, violent and visible means and the consequence has prevented attending business or occupation, attending to his/her normal duties and lasts temporarily for a period within twelve calendar months from the date of the accident.
Accident
"Accident" means a sudden, unforeseen and unexpected physical event caused by external, visible and violent means resulting in bodily injury of the insured person.
Bodily Injury
"Bodily Injury" means any accidental physical bodily harm caused by external, violent and visible means certified by a physician. It does not include any sickness or disease.
Day care treatment
"Day Care treatment" means treatment undertaken in a Hospital/Nursing Home on the recommendation of a medical practitioner for diseases, illness or injury which requires hospitalisation for less than 24 hours due to technologically advanced treatment practices.
Disease
"Disease" means a change in the state of body or its organs interrupting general functions, and causing pain and weakness or physical or mental disorder and certified by a Medical Practitioner.
Domiciliary hospitalisation
"Domiciliary Hospitalisation" means medical treatment for a period exceeding three days for any disease, illness or injury which in the normal course would require care and treatment at a hospital/nursing home but is actually taken at home.
Family Floater Policy
“Family Floater Policy” is a policy which insures both the policyholder and his/her immediate dependents (usually spouse and children) under one policy with one sum insured and premium applicable for the entire family.
Hospitalisation expenses
"Hospitalisation expenses" means expenses incurred on hospitalisation for minimum period of 24 hours admissible under Health Insurance Policy. However, this is not applicable for specific treatments defined under Day Care treatment taken in a hospital/nursing home during the period of insurance.
