• Accident means a sudden, unforeseen and involuntary event caused by external, visible and violent means.
• Age means age of the Insured person on last birthday as on date of commencement of the Policy.
• Any One Illness means continuous period of illness and it includes relapse within forty five days from the date of last consultation with the hospital where the treatment has been taken
• AYUSH Treatment refers to hospitalisation treatments given under Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy systems.
• An AYUSH Hospital is a healthcare facility wherein medical/surgical/para-surgical treatment procedures and interventions are carried out by AYUSH Medical Practitioner(s) comprising any of the following:
  
  1. Central or State Government AYUSH Hospital or
  2. Teaching hospital attached to AYUSH College recognised by the Central Government/Central Council of Indian Medicine/ Central Council for Homeopathy; or
  3. AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any recognised system of medicine, registered with the local authorities, wherever applicable, and is under the supervision of a qualified registered AYUSH Medical Practitioner and must comply with the following criterion:
     
     1. Having at least 5 in-patient beds;
     2. Having qualified AYUSH Medical Practitioner in charge round the clock;
     3. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical procedures are to be carried out;
     4. Maintaining daily records of the patients and making them accessible to the insurance company’s authorized representative.
• Cashless Facility means a facility extended by the insurer to the insured where the payments, of the costs of treatment undergone by the insured person 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.
• Co-payment means a cost sharing requirement under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible claims amount. A co-payment does not reduce the Sum Insured.
• Cumulative Bonus means any increase or addition in the Sum Insured granted by the Insurer without an associated increase in premium.
• Day Care Treatment means medical treatment, and/or surgical procedure which is:
  
  1. undertaken under general or local anesthesia in a hospital/day care centre in less than twenty-four hours because of technological advancement, and
  2. which would have otherwise required a hospitalisation of more than twenty-four hours.

Treatment normally taken on an out-patient basis is not included in the scope of this definition.

• Family means, the Family that consists of the proposer and any one or more of the family members as mentioned below:
  
  1. Legally wedded spouse.
  2. Parents and Parents-in-law.
  3. Dependent Children (i.e. natural or legally adopted) between the age 3 months to 25 years. If the child above 18 years of age is financially independent, he or she shall be ineligible for coverage in the subsequent renewals.
• Grace Period means specified period of time immediately following the premium due date during which a payment can be made to renew or continue the Policy in force without loss of continuity benefits such as waiting period and coverage of pre-existing diseases. Coverage is not available for the period for which no premium is received.
• Hospital means any institution established for in-patient care and day care treatment of disease/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 Schedule of Section 56(1) of the said Act, OR complies with all minimum criteria as under:
  
  1. has qualified nursing staff under its employment round the clock;
  2. has at least ten inpatient beds, in those towns having a population of less than ten lakhs and fifteen inpatient beds in all other places;
  3. has qualified medical practitioner(s) in charge round the clock;
  4. has a fully equipped operation theatre of its own where surgical procedures are carried out
  5. maintains daily records of patients and shall make these accessible to the Company’s authorized personnel.
• Hospitalisation means admission in a hospital for a minimum period of twenty four (24) consecutive ‘In-patient care’ hours except for specified procedures/treatments, where such admission could be for a period of less than twenty four (24) consecutive hours.
• 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.
  
  1. Acute Condition means 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.
  2. Chronic Condition means a disease, illness, or injury that has one or more of the following characteristics
     
     1. it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and/or tests
     2. it needs ongoing or long-term control or relief of symptoms
     3. it requires rehabilitation for the patient or for the patient to be special trained to cope with it
     4. it continues indefinitely
     5. it recurs or is likely to recur
• 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.
• Medical Expenses means those expenses 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.
• Medically Necessary Treatment means any treatment, tests, medication, or stay in hospital or part of a stay in hospital which
  
  1. Is required for the medical management of illness or injury suffered by the insured;
  2. must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration, or intensity;
  3. must have been prescribed by a medical practitioner;
  4. must conform to the professional standards widely accepted in international media medical practice or the medical community in India.
• Migration means, the right accorded to health insurance policyholders (including all members under family cover and members of group Health insurance policy), to transfer the credit gained for pre-existing conditions and time bound exclusions, with the same insurer.
• Network Provider means hospitals enlisted by insurer, TPA or jointly by an insurer and TPA to provide medical services to an insured by cashless facility.
• Notification of Claim means the process of intimating a claim to the Insurer or TPA through any of the recognised modes of communication.
• Pre-Existing Disease (PED): Pre-existing disease means any condition, ailment or injury or disease:
  
  1. That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or
  2. For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy or its reinstatement.

• Pre-Hospitalisation Medical Expenses means medical expenses incurred during the period of 30 days preceding the hospitalisation of the Insured Person, provided that:
  
  1. Such medical expenses are incurred for the same condition for which the Insured Person’s Hospitalisation was required, and
  2. The In-Patient Hospitalisation claim for such Hospitalisation is admissible by the Insurance Company.
• Post-Hospitalisation Medical Expenses means medical expenses incurred during the period of 60 days immediately after insured person is discharged from the hospital, provided that:
  
  1. Such medical expenses are for the same condition for which the insured person’s hospitalisation was required, and
  2. The in-patient hospitalisation claim for such hospitalisation is admissible by the Insurance Company.
• Portability means the right accorded to an individual health insurance policyholder (including all members under family cover), to transfer the credit gained for pre-existing conditions and time bound exclusions, from one insurer to another insurer.
• Room Rent means the amount charged by a hospital towards Room and Boarding expenses and shall include the associated medical expenses.
• Sub-limit means a cost sharing requirement under a health insurance policy in which an insurer would not be liable to pay any amount in excess of the pre-defined limit.
• Sum Insured means the pre-defined limit specified in the Policy Schedule. Sum Insured and Cumulative Bonus represents the maximum, total and cumulative liability for any and all claims made under the Policy, in respect of that Insured Person (on Individual basis) or all Insured Persons (on Floater basis) during the Policy Year.
• Third Party Administrator (TPA) means a company registered with the Authority, and engaged by an insurer, for a fee or by whatever name called and as may be mentioned in the health services agreement, for providing health services.
• Waiting Period means a period from the inception of this Policy during which specified diseases/treatments are not covered. On completion of the period, diseases/treatments shall be covered provided the Policy has been continuously renewed without any break.