Senior Citizen Mediclaim Policy - The New India Assurance Co. Ltd.

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3.8 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 ratable proportion of SumInsured. This clause shall not apply to any benefit offered on fixed benefit basis.3.9 DAY CARE TREATMENT: Day Care treatment refers to medical treatment, and/or surgicalprocedurewhich are:- Undertaken under General or Local Anesthesia in a Hospital / Day Care Centrein less than 24hours because of technological advancement, and- 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.3.10 DEDUCTIBLE: A deductible is a cost-sharing requirement under a health insurance policy thatprovides 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 insurer. A deductible does not reduce thesum insured.3.11 DENTAL TREATMENT: Dental treatment is treatment carried out by a dental practitionerincluding examinations, fillings (where appropriate), crowns, extractions and surgery excludingany form of cosmetic surgery/implants.3.12 DOMICILIARY HOSPITALIZATION: Domiciliary hospitalization means medical treatment for anillness/disease/injury which in the normal course would require care and treatment at a hospitalbut is actually taken while confined at home under any of the following circumstances:- The condition of the patient is such that he/she is not in a condition to be removed to aHospital, or- The patient takes treatment at home on account ofnon-availabilityof room in a hospital.3.13 HOSPITAL: A hospital means any institution established for Inpatient Careand Day CareTreatment of illness and / or injuries and which has been registered as a hospital with the localauthorities under the Clinical Establishment (Registration and Regulation) Act, 2010 or under theenactments specified under the schedule of Section 56(1) of the said act OR complies with allminimum criteria as under:- has at least 10 inpatient beds, in those towns having a population of less than 10,00,000 and 15inpatient beds in all other places;- has qualified nursing staff under its employment round the clock;- has qualified medical practitioner (s) in charge round the clock;- has a fully equipped operation theatre of its own where surgical procedures are carried out- maintains daily records of patients and will make these accessible to the Insurance company’sauthorized personnel.4
3.14.1 HOSPITALISATION:means admission in a Hospital for a minimum period of 24 in patient Careconsecutive hours except for specified procedures/ treatments, where such admission could befor a period of less than 24consecutive hours.The time limit of 24 hours will not be applicable for following surgeries / procedures.Anti-Rabies VaccinationAppendectomyCoronary AngiographyCoronary AngioplastyDental surgery following an accidentDilatation & Curettage (D & C) of CervixEye surgeryFracture / dislocation excluding hairline FractureGastrointestinal Tract systemHaemo-DialysisHydroceleHysterectomyInguinal/Ventral/Umbilical/Femoral HerniaLithotripsy (Kidney Stone Removal)Parenteral ChemotherapyPiles / FistulaProstateRadiotherapySinusitisStone in Gall Bladder, Pancreas, and Bile DuctTonsillectomy,Urinary Tract SystemOR any other Surgeries / Procedures agreed by TPA/Company whichrequire less than 24 hourshospitalization due to advancement in Medical Technology.Note: Procedures/treatments usually done in outpatient department are not payable under the Policyeven if converted as an In-patient in the Hospital for more than 24 hours.3.14.2 Day Care Centre:A day care centre means any institution established for day care treatment ofillness and/or injuries or a medical setup within a hospital and which has been registered with thelocal authorities, wherever applicable, and is under supervision of a registered and qualifiedMedical Practitioner AND must comply with all minimum criteria as under:1) has qualified nursing staff under its employment;2) has qualified medical practitioner/s in charge;3) Has a fully equipped operation theatre of its own where surgical procedures are carried out;Maintains daily records of patients and will make these accessible to the insurance company’sauthorized personnel.3.15 ID CARD means the identity card issued to the insured person by the TPAto avail cashless facilityin network hospitals.3.16 ILLNESS: Illness means a sickness or a disease or pathological condition leading to the impairmentof normal physiological function which manifests itself during the Policy Period and requiresmedical treatment.5
Page 3: India / National Accreditation Boar
Page 7 and 8: Homeopathy set up by the Government
Page 9 and 10: insurance, will not be covered even
Page 11 and 12: 4.4.13 Maternity Expenses, except a
Page 13 and 14: of cancellation. The Insured may at
Page 15 and 16: 8.0 COMPANY’S LIABILITY:The Compa
Page 17 and 18: eginning of the financial year in w
Page 19 and 20: 39 TOOTH PASTE Not Pavable40 TOOTH
Page 21 and 22: 100 TELEVISION & AIR CONDITIONER CH
Page 23 and 24: Payable reasonably169 NOVARAPID Pay
Page 25 and 26: CHENNAINEW DELHIGUWAHATIHYDERABADKO

Senior Citizen Mediclaim Policy - The New India Assurance Co. Ltd.

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