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Claim means a demand made by You for payment of any benefit under the Policy in respect of an Insured Person. Condition Precedent shall mean a policy term or condition upon which the Insurer's liability under the policy is conditional upon. Congenital Anomaly refers to a condition(s) which is present since birth, and which is abnormal with reference to form, structure or position. a) Internal Congenital Anomaly -Congenital anomaly which is not in the visible and accessible parts of the body b) External Congenital Anomaly- Congenital anomaly which is in the visible and accessible parts of the body. Contribution is essentially the right of an insurer to call upon other insurers, liable to the same insured, to share the cost of an indemnity claim on a ratable proportion of Base Annual Sum Insured. This clause shall not apply to any Benefit offered on fixed benefit basis. Cumulative Bonus shall mean any increase in the Base Annual Sum Insured granted by the insurer without an associated increase in premium. Day care center means any institution established for day care treatment of Illness and / or injuries or a medical set -up within a hospital and which has been registered with the local authorities, wherever applicable, and is under the supervision of a registered and qualified medical practitioner and must comply with all minimum criteria as under:- 1) Has qualified nursing staff under its employment; 2) Has qualified medical practitioner (s) in charge; 3) Has a fully equipped operation theatre of its own where surgical procedures are carried out 4) Maintains daily records of patients and will make these accessible to the Insurance company's authorized personnel. Day Care Treatment refers to medical treatment, and/or Surgical Procedure which is: i) Undertaken under General or Local Anesthesia in a Hospital/Day care centre in less than 24 hrs because of technological advancement, and ii) Which would have otherwise required a Hospitalisation of more than 24 hours. Treatment normally taken on an out-patient basis is not included in the scope of this definition. Dental treatment is treatment carried out by a dental practitioner including examinations, fillings (where appropriate), crowns, extractions and surgery excluding any form of cosmetic surgery/implants. Dependants means Your legally married spouse, Your natural or adopted dependent children and Your dependent parents. 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approved.", "<strong>Cashless facility</strong> means a facility extended by the insurer to the insured where the payments, of the costs of treatment undergone by the insured in accordance with the policy terms and conditions, are directly made to the network provider by the insurer to the extent pre-authorisation approved.", "The Insured Person can avail <strong>Cashless facility</strong> at the time of admission into any Network Hospital, by presenting the health card as provided by Us with this Policy, along with a valid photo identification proof (Voter ID card / Driving License / Passport / PAN Card / any other identity proof as approved by Us).", "<strong>Cashless facility</strong> for hospitalisation will not be available for treatment in non-Network Hospital / Nursing Home and may be declined even for treatment at Network Hospital / Nursing Home where the information available does not conclusively establish that a claim in respect of the treatment would be admissible.", "The card is issued to the Insured Person by the TPA to avail <strong>Cashless facility</strong> in the Network Hospital only.", "Note: <strong>Cashless facility</strong> for Hospitalization Expenses shall be limited exclusively to Medical Expenses incurred for treatment undertaken in a Network Hospital for Illness or Injury which are covered under the Policy and shall not be available to the Insured Person for coverage under Worldwide Emergency Cover (Section II.8) For all Cashless authorisations, You will, in any event, be required to settle all non-admissible expenses, Co-payment and / or Deductibles (if applicable), directly with the Hospital.", "<strong>Cashless facility</strong> \u201cmeans a facility extended by the insurer to the insured where the payments, of the cost of treatment undergone by the employee and the dependent family members of the insured in accordance with the policy terms and conditions, or directly made to the network provider by the insurer to the extent pre-authorization approved.", "If claim for treatment appears admissible, TPA shall issue pre-authorisation to the Hospital / Nursing Home concerned for <strong>Cashless facility</strong> whereby Hospitalisation expenses shall be paid directly by the Company through the TPA as confirmed in the pre-authorisation.", "For the purpose of considering pre-authorisation and <strong>Cashless facility</strong>, the Insured / Insured Person shall submit to the TPA complete information of the disease, illness or injury requiring treatment along with necessary certification from the Medical Practitioner and / or Hospital / Nursing Home.", "<strong>Cashless facility</strong> for Hospitalisation benefit shall be limited exclusively to Hospitalisation Expenses incurred for treatment at a Network Hospital / Nursing Home for disease, illness or injury which are covered under the Policy and shall not extend to any other Value Added Benefits."], "related": [["wireless-facility", "Wireless facility", "Wireless facility"], ["qualified-facility", "Qualified facility", "Qualified facility"], ["increased-facility-activation-notice", "Increased Facility Activation Notice", "Increased Facility Activation Notice"], ["designated-facility", "Designated facility", "Designated facility"], ["micro-wireless-facility", "Micro wireless facility", "Micro wireless facility"]], "related_snippets": [], "updated": "2025-07-23T06:14:10+00:00"}, "json": true, "cursor": ""}}