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.

Medically necessary treatment is defined as any treatment, tests, medication or stay in hospital or part of a stay in hospital which (a) is required for the medical management of the illness or injury suffered by the insured (b) must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration or intensity (c) must have been prescribed by a medical practitioner. (d) Must conform to the professional standards widely accepted in international medical practice or by the medical community in India.

“Network Provider” means network provider as defined in IRDAI (Third Party Administrators-Health Services) Regulations, 2016a. Insurance companies offer policies providing cashless services to the policyholders provided: The services are offered through network providers who have been enlisted to provide medical services under a direct written agreement with the insurer where there is a direct arrangement or by a tripartite agreement amongst health services provider, the TPA and the insurer where it is through a TPA. The Agreements shall cover the tariff applicable with respect to various kinds of healthcare services being provided by the network provider. A clause specifically fixing the onus on the Insurer to deny or repudiate a claim. The insurance company usually endeavour to enter into Agreements with adequate number of both public and private sector network providers across the geographical spread.

Means those babies born to the Insured person during the Policy Period aged between 1 day and 90 days.