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Home / Health / FAQs

Health FAQs

What is the meaning of "Personal Accident" in legal insurance terminology?

Personal Accident is defined as an accident owing to external, violent and visible means in legal insurance terminology.  

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What does 'External' mean with regards to personal accident insurance policies?

With reference to personal accident insurance policies, 'External' is any impact that is outward and on the exterior. Internal impact like diseases and natural causes of sickness is not covered under this policy.

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What does 'violent' mean with reference to personal accident policies?

The force of the impact that caused injury in relation to the compensation claimed can be termed as 'violent' when referring to personal accident policies

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What does 'visible' signify with reference to personal accident policies?

With respect to personal accident policies, 'visible' is denoted by the result of the impact, which caused the injury. The injury must be either physically or clinically visible.

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What is Permanent Total Disablement?

Permanent Total Disablement refers to the absolute disability of an injured person after which he or she cannot engage in any employment or occupation of any description on a permanent basis.

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What does 'Loss of limbs' mean with reference to Permanent Total Disablement?

An actual loss by physical separation of the hand/s and/or leg/s, clearly discernible as loss of hand up to the wrist and/or foot up to the ankle can be classified as a 'Loss of limbs' while referring to Permanent Total Disablement.

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What does 'Loss of eye/s' mean with reference to Permanent Total Disablement?

An actual loss of sight of eye and/or eyes can be classified as a 'Loss of eye/s' while referring to Permanent Total Disablement.

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What is Temporary Total Disablement?

Any accidental injury that is the sole and/or direct cause of total, yet temporary disablement as long as the injured person is totally and completely unable to engage in any employment or occupation of any description can be termed as Temporary Total Disablement.

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What is "Cumulative Bonus"?

The compensation payable for the death, loss of limb/s or sight or permanent total disablement is normally increased by 5 percent of the Capital Sum Insured for every completed year of insurance.

This compensation payable in event of any of the abovementioned medical contingencies is known as Cumulative Bonus.

However, the cumulative bonus is subject to a amount that can never exceed 50 percent of the Capital Sum Insured.

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What is Mediclaim insurance?

Mediclaim insurance consists of the reimbursement of hospitalisation and/or domiciliary hospitalisation expenses for any illness/diseases or injury sustained by the insured individual.

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What does 'Hospital' mean with regards to mediclaim insurance policies?

Any institution established for the indoor care and treatment of sickness and/or injuries, which is duly registered and supervised actively by a registered medical practitioner

OR

Any establishment

• With at least 15 patient beds
  
  
• With a fully equipped operation theatre of its own if surgical procedures are carried out
  
  
• Employing fully qualified nursing staff around the clock
  
  
• Having fully qualified doctors in charge around the clock

 can be classified as a 'Hospital'.

Note: For Class 'C' towns, the number of beds is relaxed to 10 (ten)

Ayurvedic or institutions practising alternative medicine therapy also qualify as 'Hospitals'

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What is meant by 'Hospitalisation'?

Any instance when and where the insured individual is hospitalised for a minimum period of 24 hours can be termed as 'Hospitalisation'.

However, for specific treatment like dialysis, chemotherapy, radiotherapy, laser eye surgery, dental surgery, etc when the patient is discharged on the same day is also considered as 'Hospitalisation'.

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What is 'Domiciliary Hospitalisation'?

"Domiciliary Hospitalisation' is any instance when and where the insured individual requires medical treatment for more than three days for an illness / disease / injury that in the normal course would require hospitalisation and is conducted at his or her home within India due to

• The condition of the patient being such that he cannot be moved to the hospital
  
  
• Lack of hospital accommodation

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What is 'Any one illness' with reference to mediclaim policies?

'Any one illness' would mean the continuous period of illness, including relapse within 45 days from the last consultation with the hospital where the treatment was taken with respect to any mediclaim policy.

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What is meant by Pre-hospitalisation and Post-hospitalisation expenses?

The relevant medical expenses incurred during 30 days prior to hospitalisation are known as 'Pre-hospitalisation expenses'.

Medical expenses incurred for 60 days after hospitalisation are known as 'Post-hospitalisation expenses'.

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What are the health check-up benefits available under the mediclaim policy?

The Mediclaim policy provides reimbursement of medical expenses for health check-up at the end of every 4 claim-free years at the rate of 0.1 percent of the Capital Sum Insured.

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