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Medical insurance terms demystified

April 02, 2007 12:29 IST

Important definitions in medical policies that one needs to know. 

"Hospital/nursing home" means any institution in India established for indoor care and treatment of sickness and injuries and which either

1. Has been registered either as a hospital or nursing home with the local authorities and is under the supervision of a registered and qualified medical practitioner, Or

2. Should comply with minimum criteria as under:

(Note: In Class 'C' towns, the condition of number of beds be reduced to 10

"Hospital/nursing home" shall not include an establishment, which is a place of rest, a place for the aged, a place for drug-addicts or place of alcoholics, a hotel or a similar place.

"Surgical operation" means manual and/or operative procedures for correction of deformities and defects, repair of injuries, diagnosis and cure of diseases, relief of suffering and prolongation of life. 

Expenses on hospitalisation for minimum period of 24 hours are admissible. However, this time limit will not apply for specific treatment, that is, dialysis, chemotherapy, radiotherapy, eye surgery, dental surgery, lithotripsy (kidney stone removal), tonsillectomy D&C, taken in the hospital/nursing home and insured is discharged on the same day, the treatment will be considered to be taken under hospitalisation benefit. 

Domiciliary hospitalisation benefit means:

Medical treatment for a period exceeding three days for such illness/disease/injury which in the normal course would require care and treatment at a hospital/nursing home but actually taken whilst confined at home in India under any of the following circumstances namely.

Note: When you undergo treatment such as dialysis, chemotherapy, radiotherapy in the hospital/nursing home and the insured is discharged on the same day, the treatment will be considered to be taken under hospitalisation benefit section.

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