2.21 MATERNITY EXPENSES: Maternity expense shall include: a.Medical Treatment Expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during Hospitalization), b.Expenses towards lawful medical termination of pregnancy during the Policy Period. 2.22 MEDICAL ADVICE means any consultation or advice from a Medical Practitioner including the issue of any prescription or repeat prescription. 2.23 MEDICAL EXPENSESmeans those expenses that an Insured Person has necessarily and actually incurred for medical treatment on account of Illness or Injury 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.2.24 MEDICALLY NECESSARY meansany treatment, tests, medication, or stay in Hospital orpart of a stay in Hospital which - Is required for the medical management of the Illness or Injury suffered by the insured; - Must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration, or intensity; - Must have been prescribed by a Medical Practitioner, - Must conform to the professional standards widely accepted in international medical practice or by the medical community in India. 2.25MEDICAL PRACTITIONERmeans a person who holds a valid registration from the Medical Council of any state or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a state Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of his license. The term Medical Practitioner shall not include any Insured Person or any member of his family. 2.26 NETWORK HOSPITAL: All such Hospitals, Day Care centers or other providers that the Company / TPA have mutually agreed with, to provide services like Cashless access to Insured Person. 2.27 NON-NETWORK HOSPITAL: Any Hospital, Day Care centre or other provider that is not part of the Network.
10 2.28 NEW BORN BABY means a baby born during the Period of Insurance to a female Insured Person, who has twenty four months of Continuous Coverage. 2.29 PERIOD OF INSURANCE means theperiod for which this Policy is taken as specified in the Schedule. 2.30 PRE-EXISTING CONDITION / DISEASE means any condition, ailment or Injury or related condition(s) for which You had signs or symptoms, or was diagnosed, or received medical advice / treatment, within 48 months prior to the Date of inception of Your first Policy with Us as mentioned in the Schedule. 2.31 PRE-HOSPITALISATIONMEDICAL EXPENSES means Medical Expenses incurred immediately before the Insured Person is Hospitalised, provided that: i.Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalisation was required, and ii.The Inpatient Hospitalization claim for such Hospitalization is admissible by Us.
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- Fall '16
- Insured Person, Sum Insured