Medical insurance terms demystified

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:

• It should have at least 15 in-patient beds.
• Fully equipped operation theatre of its own wherever surgical operations are carried out.
• Fully qualified nursing staff under its employment round the clock.
• Fully qualified doctor(s) should be in charge round the clock.

(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.

• The condition of the patient is such that he/she cannot be removed to the hospital/nursing home or
• The patient cannot be removed to hospital/nursing home for lack of accommodation therein. 

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.