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Carrier - Carrier means a civilian or commercial land, air or water conveyance operating under a valid license from transportation of goods or passengers by air, sea, road or rail for a fee.
Certificate of Insurance - Certificate of Insurance means the certificate We issue to an Insured Person to confirm his coverage under the Policy. Coverage in respect of an Insured Person shall commence from the date mentioned therein.
Child - Child - means dependent child/children including adopted and step child/children of the Insured Person between Ages two (2) years and eighteen (18) years (twenty-three (23) years if attending as a full time student in an accredited Institution of Higher Learning) who are unmarried, and receive the majority of maintenance and support from the Insured Person
Claim - Claim - means a demand made by You or on Your behalf for payment of Medical Expenses or any other expenses or benefits, as covered under the Policy
Co-payment - Co-payment - is a cost-sharing requirement under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible claim amount. A co-payment does not reduce the Sum Insured.
Commencement Date - Commencement Date means the commencement date of this Policy as specified in the Schedule.
Condition Precedent - Condition Precedent - shall mean a policy term or condition upon which the Insurer's liability under the policy is conditional upon.
Cover Year - Cover Year - means duration of twelve months beginning from the Cover Period Start Date as specified in the Policy Schedule, and for subsequent Cover Years, it will include any successive durations of twelve months, till the Cover Period End Date, as specified in the Policy Schedule.
Critical Illnesses - Critical Illnesses means diseases/illnesses limited to the following:
- Cancer represented by a malignant tumor characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissue.
- First Heart Attack involving death of a portion of the heart muscle arising from inadequate blood supply to the relevant area.
- Coronary Artery Disease involving narrowing of the lumen of at least one coronary artery by a minimum of 75% and of two others by a minimum of 60%, as proven by coronary arteriography, regardless of whether or not any form of coronary artery surgery has been performed. Coronary arteries herein refer to left main stem, left anterior descending circumflex and right coronary artery.
- Coronary Artery bypass surgery involving the actual undergoing of open-chest surgery to correct the narrowing or blockage of one or more coronary arteries with bypass grafts.
- Heart Valve Surgery involving the actual undergoing of open heart surgery to replace or repair heart valve abnormalities.
- Surgery to Aorta involving actual undergoing of major surgery to repair or correct aneurysm, narrowing, obstruction or dissection of the aorta through surgical opening of the chest or abdomen. For the purpose of this definition aorta shall mean the thoracic and abdominal aorta but not its branches.
- Stroke referring to a cerebrovascular incident including infarction of brain tissue, cerebral and subarachnoid hemorrhage, cerebral embolism, and cerebral thrombosis.
- Kidney Failure involving chronic irreversible failure of both kidneys requiring either permanent renal dialysis or kidney transplantation
- Aplastic Anemia involving Chronic persistent bone marrow failure which results in anemia, neutropenia and thrombocytopenia requiring treatment
- End Stage Lung Disease causing chronic respiratory failure
- End Stage Liver Failure evidenced by Permanent jaundice ascites and Hepatic Encephalopathy.
- Coma that persists for at least 30 days.
- Major Burns representing third degree (full thickness of the skin) burns covering at least 30% of the surface of the Insured / Insured person's body.
- xiv) Major Organ/Bone Marrow Transplantation involving human bone marrow using hematopoietic stem cells preceded by total bone marrow ablation; or any one of the human organs limited to heart, lung, liver, kidney or pancreas, that resulted from irreversible end stage failure of the relevant organ.
- Multiple Sclerosis
- Fulminant Hepatitis involving sub-massive to massive necrosis of the liver by the Hepatitis virus, leading precipitously to liver failure
- Motor Neuron Disease characterized by progressive degeneration of corticospinal tracts and anterior horn cells or bulbar efferent neurons which include spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis and primary lateral sclerosis.
- Primary Pulmonary Hypertension with substantial right ventricular enlargement confirmed by investigations including cardiac catheterization, resulting in permanent physical impairment due to cardiac impairment resulting in not being able to engage in any physical activity without discomfort. Symptoms may be present even at rest
- Terminal Illness involving conclusive diagnosis of an illness that is expected to result in the death of the insured person within 12 months.
- Bacterial Meningitis involving bacterial infection causing in severe inflammation of the membranes of the brain or spinal cord resulting in significant, irreversible and permanent neurological deficit. The neurological deficit must persist for at least 6 weeks.