A hospital/Nursing home means any institution established for in- patient care and day care treatment of sickness and/or injuries and which has been registered as a hospital with the local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments specified under the Schedule of Section 56(1) of the said Act OR complies with all minimum criteria as under: (a) has at least 10 inpatient beds, in those towns having a population of less than 10,00,000 and 15 inpatient beds in all other places; (b) has qualified nursing staff under its employment round the clock; (c) has qualified medical practitioner (s) in charge round the clock; (d) has a fully equipped operation theatre of its own where surgical procedures are carried out (e) maintains daily records of patients and will make these accessible to the Insurance company’s authorized personnel. Note: In case of Ayurvedic/Homeopathic/Unani treatment, Hospitalization expenses are admissible only when the treatment is taken as in-patient, in a Government Hospital/Medical College Hospital.

Means admission in a Hospital for a minimum period of 24 in patient care consecutive hours except for specified procedures/treatments where such admission could be for a period of less than 24 consecutive hours.

To avail the benefit of cashless facility, insurers shall issue an identification card to the insured within 15 days from the date of issue of a policy. The identification card shall, at the minimum, carry details of the policyholder and the logo of the insurer. ID card to have logo of Insurance company (not of TPA)* and the card may be permanent, as per Sec 30(f) of HIR 2016

Illness means a sickness or a disease or pathological condition leading to the impairment of normal physiological function which manifests itself during the Policy Period and requires medical treatment.

Injury means accidental physical bodily harm excluding illness or disease solely and directly caused by external, violent and visible and evident means which is verified and certified by a Medical Practitioner.

Inpatient care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.

Means an identified section ward or wing of a hospital which is under the constant supervision of a dedicated medical practitioner(s) and which is specially equipped for the continuous monitoring and treatment of patients who are in a critical condition, or require life support facilities and where the level of care and supervision is considerably more sophisticated and intensive than in the ordinary and other wards.

Maternity expenses/treatment shall include the following Medical treatment expenses: Medical Expenses for a delivery (including complicated deliveries and caesarean sections) incurred during Hospitalization.The lawful medical termination of pregnancy during the Policy period limited to 2 deliveries or terminations or either during the lifetime of the Insured person.Pre-Natal and post-natal Medical expenses for delivery or termination.Common Clauses Health Insurance : Medical Advice : Any consultation or advice from a Medical Practitioner including the issue of any prescription or repeat prescription.

Medical Expenses means those expense that an insured person has necessarily and actually incurred for medical treatment on account of Illness or Accident on the advice of a Medical Practitioner, as long as these are no more than would have been payable if the Insured Person had not been insured and no more than other hospitals or doctors in the same locality would have charged for the same medical treatment.

A Medical practitioner is a person who holds a valid registration from the Medical Council of any state of India or Council for Indian Medicine or for Homeopathy set up by the government of India or a State Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of his license.