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Ten Important Definitions of Terms in Mediclaim Policies

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Mediclaim or Health Insurance policies have gained enormous significance in the recent past. However, many of the terms and conditions specified in these policies are not quite easy to comprehend for the common man. It’s only after hospitalization that one realize the true definitions of these terms. We have made an effort to bring to you definitions of ten such important terms used in health insurance policies.

1) Acute

It is a disease, illness or injury likely to respond to treatment which will return the insured person to the state of health he was previously in before suffering the disease or illness.

2) Congenital Anomaly

It refers to a condition present since time of birth in the visible and accessible parts of the body and which is abnormal with reference to form, structure or position

3) Co-Payment

It is a cost sharing agreement between the insurer and the insured which implies that the insured must bear a certain amount of hospitalization expenses.

4) Day Care

It is medical treatment and/or surgical procedure which is undertaken under general or local anesthesia in a hospital or day care centre in less than 24 consecutive hours.

5) Emergency Care

It is a medical condition arising out of any illness or injury contracted by the insured suddenly or unexpectedly and required immediate medical attention to prevent death or serious long term impairment of the health of insured.

6) Network Hospitals

They are the hospitals or service providers which the insurer has tied up with in order to provide services as specified in the policy.

7) Pre-Existing Diseases

It is any condition, ailment or injury for which the insured person had signs or symptoms and/or were diagnosed, and/or received medical advice/treatment within 48 months prior to first policy issued by the company.

8) Daily Allowance

The insurer will pay the amount specified against this benefit in the policy certificate for each continuous and completed period of 24 hours of hospitalization of the insured provided that the hospitalization is only for in-patient care for up to 5 consecutive days.

9) No Claims Bonus

At the end of each policy year, insurer will provide 10% of sum insured applicable on the last completed policy year on a cumulative basis for each completed policy year provided there was no claim in the year.

10) Domiciliary Hospitalization

It is a condition where the insured person is not in a condition to be taken to a hospital or he/she receives treatment at home due to non availability of room in a hospital.

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