Policy Terms and Conditions Please check whether the details given by you about the insured 1.8 AYUSH Day Care Centre means and includes persons in the proposal form (a copy of which was provided at the Community Health Centre (CHC), Primary Health time of issuance of cover for the first time) are incorporated Centre (PHC), Dispensary, Clinic, Polyclinic or any such correctly in the policy schedule. If you find any discrepancy, centre which is registered with the local authorities, please inform us within 15 days from the date of receipt of the wherever applicable, and having facilities for carrying policy, failing which the details relating to the person/s covered out treatment procedures and medical or surgical/para- would be taken as correct. surgical interventions or both under the supervision of registered AYUSH Medical Practitioner (s) on day care So also the coverage details may also be gone through and in the basis without in-patient services and must comply with absence of any communication from you within 15 days from the all the following criterion: date of receipt of the policy, it would be construed that the policy issued is correct and the claims if any arise under the policy will be a. Having qualified registered AYUSH Medical dealt with based on proposal /policy details. Practitioner(s) in charge; For the purposes of interpretation and understanding of the product b. Having dedicated AYUSH therapy sections as the Company has defined, herein below some of the important required and/or has equipped operation theatre words used in the product and for the remaining language and the where surgical procedures are to be carried out; words the Company believes to mean the normal meaning of the c. Maintaining daily records of the patients and English language as explained in the standard language making them accessible to the insurance dictionaries. The words and expressions defined in the Insurance company's authorized representative. Act, IRDA Act, regulations notified by the Insurance Regulatory and Development Authority of India (“Authority”) and circulars 1.9 AYUSH Hospital is a healthcare facility wherein and guidelines issued by the Authority shall carry the meanings medical/surgical/para-surgical treatment procedures and described therein. The terms and conditions, insurance coverage interventions are carried out by AYUSH Medical and exclusions, other Benefits, various procedures and conditions Practitioner(s) comprising of any of the following: which have been built-in to the product are to be construed in a Central or State Government AYUSH Hospital or accordance with the applicable provisions contained in the product. b Teaching hospital attached to AYUSH College recognized by the Central Government/Central The terms defined below have the meanings ascribed to them Council of Indian Medicine/Central Council for wherever they appear in this Policy and, where appropriate. Homeopathy; or c AYUSH Hospital, standalone or co-located with 1. Definitions in-patient healthcare facility of any recognized system of medicine, registered with the local 1.1 Accidental / Accident is a sudden, unforeseen and authorities, wherever applicable, and is under the involuntary event caused by external, visible and violent supervision of a qualified registered AYUSH means. Medical Practitioner and must comply with all the 1.2 Age means the completed age of the Insured Person as on following criterion: his last birthday. i. Having at least 5 in-patient beds; 1.3 Alternative treatments are forms of treatments other ii. Having qualified AYUSH Medical than treatment “Allopathy” or “modern medicine” and Practitioner in charge round the clock; include Ayurveda, Unani, Sidha and Homeopathy in the Indian Context. iii. Having dedicated AYUSH therapy sections as required and/or has equipped operation Yoga as a form of treatment is not covered under theatre where surgical procedures are to be Alternative treatments. carried out; 1.4 Ambulance means a vehicle operated by a licensed/ iv. Maintaining daily records of the patients authorized service provider and equipped for the and making them accessible to the transport and paramedical treatment of persons requiring insurance company's authorized medical attention. representative. 1.5 Annexure means the document attached and marked as 1.10 Cashless Facility means a facility extended by the Annexure to this Policy. insurer to the Insured where the payments, of the costs of 1.6 Any One Illness (not applicable for Travel and treatment undergone by the insured in accordance with Personal Accident Insurance) means a continuous the Policy terms and conditions, are directly made to the Period of Illness and includes relapse within 45 days network Provider by the insurer to the extent pre- from the date of last consultation with the authorization is approved. Hospital/Nursing Home where the treatment was taken 1.11 City of Residence means and includes any city, town or 1.7 Assistance Service Provider means the service village in which the Insured Person is currently residing provider specified in the Policy Schedule appointed by in India and as specified in the Insured Person's the Company from time to time. corresponding address in the Policy Schedule. 1.12 Claim means a demand made in accordance with the CARE HEART - UIN: RHIHLIP21371V022021 terms and conditions of the Policy for payment of the liable for a specified rupee amount in case of indemnity specified Benefits in respect of the Insured Person as policies and for a specified number of days/hours in case covered under the Policy. of hospital cash policies which will apply before any benefits are payable by the insurer. A deductible does not 1.13 Claimant means a person who possesses a relevant and reduce the Sum Insured. valid Insurance Policy which is issued by the Company and is eligible to file a Claim in the event of a covered 1.22 Dental Treatment means a treatment related to teeth or loss. structures supporting teeth including examinations, fillings (where appropriate), crowns, extractions and 1.14 Company (also referred as Insurer/We/Us) means surgery. Care Health Insurance Limited. 1.23 Disclosure to Information Norm: The Policy shall be 1.15 Condition Precedent shall mean a Policy term or void and all premium paid thereon shall be forfeited to condition upon which the Insurer's liability under the the Company, in the event of misrepresentation, mis- Policy is conditional upon. description or non-disclosure of any material fact. 1.16 Congenital Anomaly refers to a condition which is 1.24 Domiciliary Hospitalization means medical treatment present since birth, and which is abnormal with reference for an illness/disease/injury which in the normal course to form, structure or position : would require care and treatment at a Hospital but is a. Internal Congenital Anomaly – actually taken while confined at home under any of the following circumstances: Congenital anomaly which is not in the visible and accessible parts of the body a. The condition of the patient is such that he/she is not in a condition to be removed to a Hospital, or b. External Congenital Anomaly – b. The patient takes treatment at home on account of Congenital anomaly which is in the visible and non-availability of room in a Hospital. accessible parts of the body 1.25 Diagnosis means pathological conclusion drawn by a 1.17 Co-payment is a cost-sharing requirement under a registered medical practitioner, supported by acceptable health insurance policy that provides that the Clinical, radiological, histological, histo-pathological policyholder/insured will bear a specified percentage of and laboratory evidence wherever applicable. the admissible claim amount. A co-payment does not reduce the sum insured. 1.26 Emergency Care (Emergency) means management for an illness or injury which results in symptoms which 1.18 Cumulative Bonus shall mean any increase or addition occur suddenly and unexpectedly, and requires in the Sum Insured granted by the insurer without an immediate care by a medical practitioner to prevent associated increase in premium. death or serious long term impairment of the insured 1.19 Day Care Centre means any institution established for Person's health. day care treatment of illness and/or injuries or a medical 1.27 Empanelled Provider means any qualified diagnostic setup within a hospital and which has been registered center, Hospital and Medical Practitioner that has been with the local authorities, wherever applicable, and is empanelled with the Company to provide Services under under the supervision of a registered and qualified Benefit 8:Cardiac Health Check -up and Optional medical practitioner AND must comply with all Benefit 4:Active Health Check-up. minimum criteria as under— 1.28 Grace Period means the specified period of time a. has qualified nursing staff under its employment; immediately following the premium due date during b. has qualified Medical Practitioner/s in-charge; which payment can be made to renew or continue a Policy in force without loss of continuity benefits such as c. has a fully equipped operation theatre of its own, waiting periods and coverage of Pre-existing Diseases. where Day Care Treatment is carried out. Coverage is not available for the period for which no d. maintains daily records of patients and will make premium is received. these accessible to the insurance company's 1.29 Hazardous Activities (or Adventure sports) means any authorized personnel. sport or activity, which is potentially dangerous to the 1.20 Day Care Treatment means medical treatment, and/ or Insured whether he is trained or not. Such sport/activity Surgical Procedure which is: includes (but not limited to) stunt activities of any kind, adventure racing, base jumping, biathlon, big game a. undertaken under general or local anesthesia in a hunting, black water rafting, BMX stunt/ obstacle riding, Hospital/ Day Care Centre in less than 24 bobsleighing/ using skeletons, bouldering, boxing, consecutive hours because of technological canyoning, caving/ pot holing, cave tubing, rock advancement, and climbing/ trekking/ mountaineering, cycle racing, cyclo b.