UNITED INDIA INSURANCE COMPANY LTD.

ü  Cashless facility means a facility extended by the insurer to the insured where the payment, of 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-authorisation approved.

ü  Continuous coverage means uninterrupted coverage of the insured person under our Individual Health Insurance Policies or Family Floater Policy from the time the coverage incepted under the policy provided a break in the insurance period not exceeding thirty days being grace period shall not be reckoned as an interruption in coverage for the purposes of this Clause. In case of change in Sum Insured during such uninterrupted coverage, the lowest Sum Insured would be reckoned for determining Continuous Coverage.

ü  Day care treatment - Day Care treatment means the medical treatment and/or surgical procedure which is –

Ø  Undertaken under General or Local Anaesthesia in a hospital/day care centre in less than 24 hours because of technological advancement and

Ø  Which would have otherwise required a hospitalisation of more than 24 hours. Treatment normally taken on an outpatient basis is not included in the scope of this definition.

ü  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 in case of Indemnity policies and for a specified number of days/hours in case of hospital cash policies which will apply before any benefits are payable by the insurer. A deductible does not reduce the sum insured.

ü  Grace period means the specified period of time immediately following the premium due date during which a payment can be made to renew or continue a policy in force without loss of continuity benefits such as waiting periods and coverage of pre-existing diseases. Coverage is not available for the period for which no premium is received.

ü  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.

ü  Acute condition - 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.

ü  Chronic condition - A chronic condition is defined as a disease, illness, or injury that has one or more of the following characteristics:

Ø  It needs ongoing or long-term monitoring through consultations, examinations, check-ups, and /or tests

Ø  It needs ongoing or long-term control or relief of symptoms

Ø  It requires rehabilitation for the patient or for the patient to be specially trained to cope with it

Ø  It continues indefinitely

Ø  It recurs or is likely to recur

ü  In-patient care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.

ü  Network provider means the hospital/nursing home or health care providers enlisted by an insurer or by a TPA and insurer together to provide medical services to an insured on payment by a cashless facility. The list of Network Hospitals is maintained by and available with the TPA and the same is subject to amendment from time to time.

PPN-Preferred Provider Network means a network of hospitals which have agreed to a cashless packaged pricing for certain procedures for the insured person. Updated list of network provider/PPN is available on website of the company (https://uiic.co.in/en/tpa-ppn-network-hospitals) and website of the TPA mentioned in the schedule and is subject to amendment from time to time.

ü  Non-network hospital means any hospital, day care centre or other provider that is not part of the network.

ü  Portability means transfer by an Individual Health Insurance Policyholder (including family cover) of the credit gained for pre-existing conditions and time-bound exclusions if he/she chooses to switch from one insurer to another.

ü  Pre-existing disease means any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and/or were diagnosed, and/or received medical advice/treatment within 48 months prior to the first policy issued by the insurer. Any complication arising from pre-existing disease shall be considered as a part of the pre-existing disease.

ü  Pre hospitalisation medical expenses Relevant medical expenses incurred immediately 30 days before the Insured person is hospitalised provided that;

Ø  Such Medical expenses are incurred for the same condition for which the Insured Person’s Hospitalisation was required; and

Ø  The In-patient Hospitalisation claim for such Hospitalisation is admissible by us.

ü  Post hospitalisation medical expenses Relevant medical expenses incurred immediately 60 days after the Insured person is discharged from the hospital provided that;

Ø  Such Medical expenses are incurred for the same condition for which the Insured Person’s Hospitalisation was required; and

Ø  The In-patient Hospitalisation claim for such Hospitalisation is admissible by us.

ü  Renewal defines the terms on which the contract of insurance can be renewed on mutual consent with a provision of grace period for treating the renewal continuous for the purpose of all waiting periods.

ü  Sum insured is the maximum amount of coverage under this policy opted individually for You and all insured persons shown in the schedule.

ü  Third party administrator (TPA) means any person who is registered under the IRDAI (Third Party Administrators – Health Services) Regulations,2016 notified by the Authority, and is engaged, for a fee or remuneration by an insurance company, for the purposes of providing health services as defined in those.

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