Page 385 - Ebook health insurance IC27

Sashi Publications

Health Insurance :
The policy provides for reimbursement of medical expenses incurred in India, in a hospital
as an impatient (and under certain specified circumstances at home) as a direct result of
accident or sickness occurring or contracted anywhere in the world.

Health maintenance organisation (HMO):
An organisation that provides a wide range of healthcare services for a specified group
at a fixed periodic payment (similar to a premium). The main advantage of an HMO is
that it has an inherent interest in keeping costs low.

Hospital/Nursing Home :
Hospital/Nursing Home means any institution in India established for indoor care and
treatment of sickness and injuries and which either: has been registered as a Hospital or
Nursing Home with the local authorities and is under the supervision of a registered and
qualified Medical Practitioner Or

Should comply with minimum criteria as under:
 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.

The term 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 for alcoholics, a hotel or a
similar place.

In-Patient :
An Insured Person who is admitted to Hospital and stays for a minimum period of 24

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