Break in Policy means the period of gap that occurs at the end of the existing policy term, when the premium due for renewal on a given policy is not paid on or before the premium renewal date or within 30 days thereof.

As per Section 2.f of Health Insurance Regulations 2016 Cashless facility means a facility extended by the insurer or TPA on behalf of the insurer to the insured, where the payments for the costs of treatment undergone by the insured in accordance with the policy terms and conditions, are directly made to the network provider by the insurer to the extent pre-authorization is approved.

Expenses on hospitalization are generally admissible only if the same is for a minimum period of 24 hours. However, there is an exception for cases of specialized treatment which cannot be undertaken in a shorter time (less than 24 hours) due to technological advance called day care procedures. It usually includes hemodialysis, chemotherapy, eye surgery, D&C, angioplasty, hernia, hydrocele, surgery related to ENT etc. Note: Procedures/treatments usually done in outpatient department are not payable under the policy even if converted to day care surgery/procedure or as in patient in the hospital for more than 24 hours.

An accident is a sudden, unforeseen and involuntary event caused by external and visible means. (Insurers may define the term accidental injury in the context of the term “accident”.

Acute condition is a disease, illness or injury that is likely to respond quickly to treatment which aims to return the person to his or her state of health immediately before suffering the disease/illness/injury which leads to full recovery.

Any one illness means continuous period of illness and it includes relapse within 456 days from the date of last consultation with the Hospital/Nursing Home where treatment may have been taken.

A chronic condition is defined as a disease, illness, or injury that has one or more of the following characteristics:—it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and/or tests—it needs ongoing or long-term control or relief of symptoms— it requires your rehabilitation or for you to be specially trained to cope with it—it continues indefinitely—it comes back or is likely to come back.

Condition precedent shall mean a policy term or condition upon which the insurer’s liability under the policy is conditional upon.

Congenital Anomaly refers to a condition(s) which is present since birth, and which is abnormal with reference to form, structure or position. External Congenital Anomaly: which is in the visible and accessible parts of the body is called External Congenital Anomaly. Internal Congenital Anomaly: which is not in the visible and accessible parts of the body is called Internal Congenital Anomaly.Common Clauses Health Insurance : Contribution: Contribution is essentially the right of an insurer to call upon other insurers, liable to the same insured, to share the cost of an indemnity claim on a rateable proportion.