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.

As per sec 16 of HIR, 2016. (i) Cumulative bonuses offered under policies, shall be stated explicitly in the prospectus and the policy document. (ii) . If a claim is made in any particular year, the cumulative bonus accrued may be reduced at the same rate at which it has accrued.

Any Institution established for day care treatment of sickness and/or injuries or a medical set up within a hospital and which has been registered with the local authorities, wherever applicable, and is under the supervision of a registered and qualified medical practitioner and must comply with all minimum criteria as (i) has qualified nursing staff under its employment (ii) has qualified medical practitioner(s) in charge (iii) has a fully equip med operation theatre of its own where surgical procedures are carried out and (iv) maintains daily records of patients and will make these accessible to the insurance company’s authorized personnel.

Refers to medical treatment and/or surgical procedure which is (i) undertaken under General or local anesthesia in a hospital/day care in less than 24 hours because of technological advancement, and (ii) which would have otherwise required a hospitalization of more than 24 hours. Treatment normally taken on an out-patient basis is not included in the scope of this definition. Insurers may restrict coverage to a specified list.

A deductible is a cost sharing requirement under a health insurance policy that provides that the insurer will not be liable for a specified rupee amount of the covered expenses, which will apply before any benefits are payable by the insured. A deductible does not reduce the sum insured. Each policy to define whether the deductible is applicable per year, per life or whether per event and specific deductible limits would be applied.