Total Health Plan 5

Def. 12.
Day Care treatments means those medical cured by treatment

treatment, and/or surgical procedure listed in Appendix 1
which is b) Chronic Condition means a disease, illness, or injury that
has one or more o f the following characteristics: - it needs
i) undertaken under General or Local Anaesthesia in a ongoing or long-term monitoring through consultations,
Hospital/day care centre in less than 24 hours because of examinations, check-ups, and / or tests—it needs ongoing
technological advancement, and or long-term control or relief o f symptoms— it requires your
rehabilitation or for you to be specially trained to cope with
ii) which would have otherwise required a Hospitalisation of it—it continues indefinitely—it comes back or is likely to
more than 24 hours, come back.
Treatment normally taken on an Out-patient basis is not Def. 17. Injury means accidental physical bodily harm
included in the scope of this definition. excluding illness or disease solely and directly caused by
external, violent and visible and evident means which is
Def. 13. Dental Treatment means treatment carried out by verified and certified by a Medical Practitioner.
a dental practitioner including examinations, fillings (where
appropriate), crowns, extractions and surgery excluding any Def. 19. In-patient Care means treatment for which the
form of cosmetic surgery / implants Insured Person has to stay in a Hospital for more than 24
hours for a covered event.
Def. 14. Grace Period means the specified period of time
immediately following the premium due date during which a Def. 20. Intensive Care Unit means an identified section,
payment can be made to renew or continue a Policy in force ward or wing of a Hospital which is under the constant
without loss of continuity benefits such as waiting periods supervision of a dedicated Medical Practitioner(s), and
and coverage of Pre-Existing diseases. Coverage is not which is specially equipped for the continuous monitoring
available for the period for which no premium is received. and treatment of patients who are in a critical condition,
or require life support facilities and where the level of care
Def. 15. Hospital means any institution established for in- and supervision is considerably more sophisticated and
patient care and day care treatment of illness and/or injuries intensive than in the ordinary and other wards.
and which has been registered as a hospital with the local
authorities under the Clinical Establishments (Registration Def. 21. Maternity Expense / Treatment means the
and Regulation) Act, 2010 or under the enactments specified expense / treatment that include the following Medical
under the Schedule of Section 56(1) of the said Act OR treatment Expenses:
complies with all minimum criteria as under:
i. Medical Expenses for a delivery (including complicated
• has at least 10 in-patient beds, in those towns having a deliveries and cesarian sections) incurred during
population of less than 10,00,000 and 15 in-patient beds in hospitalisation
all other places,
ii. The lawful medical termination of pregnancy during the
• has qualified nursing staff under its employment round the policy period limited to 2 deliveries or terminations or either
clock, during the lifetime of the Insured Person
• has qualified Medical Practitioner(s) in charge round the iii. Pre-natal and Post-natal Medical Expenses for delivery
clock, or termination.
• has a fully equipped operation theatre of its own where Def. 22. Medical Advise means any consultation or advise
surgical procedures are carried out, from a Medical Practitioner including the issue of any
prescription or repeat prescription
• maintains daily records of patients and will make these
accessible to the insurance company’s authorized personnel. Def. 23. Medical Expenses means those expenses that
an Insured Person has necessarily and actually incurred
Def. 16. Hospitalisation or Hospitalised means admission for medical treatment on account of Illness or Accident on
ina Hospital for a minimum of 24 In patient care consecutive the advice of a Medical Practitioner as long as these are no
hours except for specified procedures / treatments, where more than would have been payable if the Insured Person
such admission could be for a period of less than 24 had not been insured and no more than other Hospitals or
consecutive hours. doctors in the same locality would have charged for the
same medical treatment.
Def. 17. Illness means a sickness or a disease or i) Pre-hospitalisation Medical Expensesmeans the Medical
pathological condition leading to the impairment of normal Expenses incurred immediately before the Insured Person
physiological function which manifests itself during the Policy is Hospitalised, provided that:
Period and requires medical treatment.
i. Such Medical Expenses are incurred for the same
a) Acute Condition means the medical condition that can be condition for which the Insured Person’s Hospitalisation was
HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to 4
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: Total Health Plan - HDHHLIP21317V032021.

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Def. 12.

Day Care treatments means those medical cured by treatment

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