As per Health Insurance regulations 2016 General Insurers and Health Insurers may endeavour to provide coverage for one or more systems covered under ‘AYUSH treatment’ provided the treatment has been undergone in a government hospital or in any institute recognized by government and/or accredited by Quality Council of India or National Accreditation Board on Health. Definition 2.d “AYUSH Treatment” refers to the medical and/or hospitalization treatments given under ‘Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems.”

Any hospital, day care centre or other provider that is not part of the network. For the purpose of claim settlement, insurer shall make direct payments to the policyholders by integrating their banking system platform. Provided that, if a claimant opts for payment through a cheque or Demand Draft, the insurer shall not deny such request.

Notification of claim is the process of notifying a claim to the Insurer or TPA by specifying the timeline as well as the address/telephone number to which it should be notified.

OPD treatment is one in which the insured visits a clinic/hospital or associated facility like a consultation room for diagnosis and treatment based on the advice of a Medical Practitioner. The insured is not admitted as a day care or in patient.

Portability means the right accorded to an individual health insurance policy holder (including family cover) to transfer the credit gained by the insured for pre-existing conditions and time bound exclusions if the policyholder chooses to switch from one insurer to another insurer or from one plan to another plan of the same insurer, provided the previous policy has been maintained without any break. As per HIR 2016 Policy is portable from one Insurer to another, 45 days prior to maturity of policy (including cumulative bonus would also be portable), as per Schedule I, Sec(1) & (18) of HIR 2016. One can transfer the policy from one Insurance company to another and the credits (including cumulative bonus) would also be portable.

Medical Expenses incurred for a period up to 60 days from the date of discharge from the hospital, provided that: Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalization was required, andThe In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.Common Clauses Health Insurance : Pre-existing diseases : Any condition, ailment or injury or related condition for which the insured person had signs or symptoms, and/or were diagnosed and/or received medical advice/treatment within 48 months to prior to the first policy issued by the insured. Generally *exclusions and pre-existing diseases* are not covered by a medical insurance policy (as specified in their policy document). Generally these *could be covered after 2-3-4 years of holding the policy*. Consumer must be honest in disclosing pre-existing ailments, if any.

Medical Expenses incurred during the period up to 30 days prior to the date of admission, provided that: Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalization was required, andThe In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.Common Clauses Health Insurance : Pre-insurance Acceptance Health Check up : Any person beyond 45 years of age desiring to take insurance cover has to submit certain medical reports from authorized Network Diagnostic Centre or any other medical reports required by the company in case of fresh proposal and renewal where there is a break in policy period. The cost of any pre-insurance medical examination shall generally form part of the expenses allowed in arriving at the premium. However in case of products with term of one year and less, if such cost is to be incurred by the insured, not less than 50% of such cost shall be borne by the insurer once the proposal is accepted, except in travel insurance policies. (ii) Insurers shall maintain a list of medical examiners and institutions where such pre-insurance medical examination may be conducted whose reports will be accepted by them. Details of fee payable shall be made available to the prospective policyholder at the time of pre-insurance medical examination on demand.

Qualified nurse is a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any state in India.

Reasonable charges means the charges for services or supplies, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the illness/injury involved.

Room rent shall mean the amount charged by a hospital for occupying of a bed and associated medical expenses. Generally *bed charges are 1-2%% of the sum assured, depending on Insurance policy. All other charges like doctor visit etc. are often related proportionately to bed charge (Room Rent). It is as such important and helpful for the insured person undergoing hospitalization to be within these limits.