Frequently Asked Questions definition Questions and Answers Related To definition

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1 What is a chronic condition in health insurance ?

Chronic condition is when you fall sick and it requires a long term treatment. A chronic condition is defined as a disease, illness, or injury that has one or more o f the following characteristics:—it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and /or tests—it needs ongoing or long-term control or relief of symptoms it requires your rehabilitation or for you to be specially trained to cope with it. It continues indefinitely—it comes back or is likely to come back.

2 Who are Senior citizens?

As defined by the Indian Government. people of 60 years of age and above are considered senior citizens.

3 What is an accident?

An accident means sudden, unforeseen and involuntary event caused by external, visible and violent means.

4 What is the meaning of emergency care?

It is any medical assistance required in case of an emergency. Emergency care means management for a severe illness or injury which results in symptoms which occur suddenly and unexpectedly, and requires immediate care by a medical practitioner to prevent death or serious long term impairment of the insured person’s health.

5 What is a Day care centre?

A day care centre means any institution established for day care treatment of sickness and / or injuries or a medical set -up within a hospital and which has been registered with the local authorities, wherever applicable, and is under the supervision of a registered and qualified medical practitioner AND must comply with all minimum criteria as under:- has qualified nursing staff under its employment has qualified medical practitioner (s) in charge 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’s authorized personnel.

6 Who are dependent children?

Dependent children are those who are financially dependent upon their parents. Usually it is upto 25 years of age.

7 What is the meaning of reasonable and customary charges?

Reasonable and Customary 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.

8 What is relapse?

A condition which re-surfaces again.

9 What are Congenital Anomalies?

Congenital Anomaly refers to a condition(s) which is present since birth, and which is abnormal with reference to form, structure or position. Internal Congenital Anomaly is not in the visible and accessible parts of the body. External Congenital Anomaly is in the visible and accessible parts of the body.

10 What is acute condition?

Acute condition is a medical condition that can be cured by treatment.

11 What is Dental Treatment?

Dental treatment is treatment carried out by a dental practitioner including examinations, fillings (where appropriate), crowns, extractions and surgery excluding any form of cosmetic surgery/implants

12 What are birth defects?

Defects at birth are those which are there at the time of birth. They are also known as congenital anomalies.

13 What is inpatient care?

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

14 What is OPD or Out Patient treatment?

OPD treatment means the 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.

15 What is the definition of injury?

Injury means accidental physical bodily harm. To be more specific- 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.

16 What is critical illness?

Critical illnesses are those illnesses that may be life threatening.

17 Who are dependent parents?

Dependent parents are those who are financially dependent upon their children

18 What is Intensive Care Unit or ICU ?

It is a unit in a hospital which gives intensive care in case of serious illnesses that requires continuous monitoring. Intensive care unit 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 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.