Wednesday, October 29, 2008
Surgical Aid Benefit
SURGICAL AID BENEFIT
This extra benefit is manage by BAI Co(Mtius) Ltd and it will pay to you, for losses due to accidental injury and sickness as outline under this terms and conditions. This surgical aid benefit are subject to exclusions, limitations and conditions. BAI Co (Mtius) Ltd reserve the right to interpret the terms and conditions and to determine the benefits payable hereunder.
Section III-Exclusions and Limitations
The company shall not be liable for expenses incurred of the following exclusions and limitations:-
Exclusions:
1.0 Insured person’s intentional self-injury, disease, suicide or any attempt threat,
insanity or dueling or fighting except in self defense.
2. 0 Routine expenses on physical examinations, regular expenses on any treatment
connected with Diabetes or any other chronic condition and expenses on the
following items will not be payable under the policy (these are intended to be
illustrative only and not intended to be limitative in any manner whatsoever):-
2.1 General:
• Telephone charges
• Registration and admission charges
• Discharge procedure charges
• Administrative charges
• Cashless-processing charges
• Documentation charges
• A/C, TV, and other luxury specificities if carges separately
• Establishment charges
• Laundry charges
• Electricity charges
• Water charges
• Maintenance charges
• Housekeeping charges
• Fax, Photostat and courier charges
• Mineral water
• Carry bags
2.2 Utilities
• Oils, Soaps, Paste and brush
• Dress items, Sanitary pads, diapers and disposable inner wear
• Blades and Disposable razors
• Tissue papers, Toilet papers and Buds
• Measuring jars
• Warming blankets, bed sheet, spread sheet and drapes
• Distilled water
• Gowns, Linen, Cozy sheets and Cozy towels
• Eau de cologne
2.3 External Aids
• Walking aids
• Knee brace, Crepe bandages, Stockings and Leggings
• L.S.Belt, Visco belts, Abdominal belts and Cervical collar
• Band aid
• Alpha bed, Air bed and Water bed
• Hearing aids
• Spectacles, Goggles, Eye pads and Eye shields
2.4 Theatre and ward utilities
• Disponsable Gowns, Masks and Caps and Leggings
• CD, Cassette and camera cover charges
• Alcohol swabs
• Thermometer
• Glucometer, Urometer, Nebulizer, and BIPAP machine
• Oxygen mask, nebulization mask in wards is payable only in respiratory distress cases
• Infuision pump, syringe pump charges are payable only when indicated
• Unsterile gloves
• Boyle apparatus, pulseoxymeter, monitors in OT and ICU should not be charges separately (inclusive in OT, ICU charges) and are payable in room charges if indicated/ required
• ECG electrodes
2.5 Maternity and Baby related:
• Baby charges (unless specified/ indicated)
• Vaccination charges
• Baby utilities
2.6 Personnel related
• Attendant bed, attendant food and attendant pass
• Ayah/ Special attendant charges
• Special nursing charges
2.7 Miscellaneous
• Food charges other than prescribed diet – not forming part of treatment
• Blood grouping and corss matching of donor samples
• Dettol, Glucon D, Horlicks and other supplements
• Screening tests viz., HIV, HbsAG unless surgical intervention is indicated
• Blood reservation charges and Ante Natal booking charges , ward and theatre booking charges.
3.0 Treatment, procedure, diagnosis and surgical procedure linked or related to
sterilization, fertility or infertility and includes tubectomy or vasectomy.
4.0 Epilepsy or any type of fits.
5.0 Treatments for hair loss and therapies for weight reduction or obesity unless
medically necessary.
6.0 Cosmetic and Plastic surgery unless medically requird as a result of accidental bodily
injury sustained during the policy period .
7.0 Bodily injury or sickness as a result of involvement or direct participation in a riot,
felony or any illegal act.
8.0 Expenses related to mental illness.
9.0 Expenses related to the following types of sports activities:
• Mountaineering or scaling of rocks and cliffs
• Water sports
• Winter sports and
• Ice hockey, polo, hunting or racing of all kinds
10.0 Injury as a result of accident under influence of alcohol.
11.0 Treatment for drug addiction, drug abuse or narcotics.
12.0 Expenses on treatment taken at sanatotiums, resting centres for improving general
state of health, convalescence, general debility and spa activities
13.0 Expenses related to sexual dysfunction and Trans sexual surgery
14.0 Transplants of organs are not covered.
15.0 Expenses related to occupational diseases or any other injury or sickness arising
out of employment and required to be covered under Workmen’s compensation
Act or any other statutory legislation.
16.0 Expenses related to HIV/AIDS .
17.0 Injury, diseases or sickness directly related to or attribute to war, war like
operations, act of enemy country and by nuclear weapons/materials.
18.0 Circumcision unless required for treatment.
19.0 Expenses on treatment and medical expenses related yo experiments of research
and development.
20.0 Expenses on treatment and medical expenses not undertaken under the direction
of a medical practitioner.
21.0 Expenses on treatment related to Naturopathy.
Limitations:
1.0 All surgical aid benefit is applicable on renewable of HALO card or a waiting period of 12 months from inception of subscription to HALO Card Extra Benefit. However, this limitation will not be applicable to accidents.
Pre-existing Condition.
Pre-existing condition is a disease or sickness or injury which is known to a subscribers of HALO Card and or diagnosed and in receipt of medical advice, consultation or treatment from a Doctor during the 12 months prior to the effective date of subscription or which in the opinion of a Doctor exhibited or caused symptoms during the 12 months prior to the effective date, warranting to compel an ordinary and prudent person to seek medical assistance or help. No existing diseases or injury is covered under this agreement.
Age Limit.
Age limit 18yrs – 60yrs.
Surgical Aid Limit: Benefit Limit is paid up to a maximum of RS 5,000 any one occurence
CLAIMS
Written notice of an injury or illness under the surgical aid benefit must be sent to HALO Co. Ltd or through Credit Union as soon as possible and in any case with in 14 days after happening of an event which may give rise to a claim.
The Submission of documents include original bills from Provider/s and/or such other relevant documents to substantiate a claim. It will include a duly completed claim from filled in all respects and any investigation reports necessary. The documents shall be furnished to the Company free of expense.
If any claim is fraudulent , the company shall be under no liability in respect of such claim.
At the time of a claim under this policy, if there is another insurance covering the same injury or illness, the insurer shall not be liable to pay or contribute more than its rateable proportion of such claim.
If the Company alleges that by reason of the exclusions and /or conditions of this policy and injury or sickness or disease is not covered bt the policy, the burden of proving such injury or illness is covered shall be upon the insured.
All claim submissions will be treated fairly based on facts surrounding an injury, or illness. It is possible that a claimant might not have submitted vital information while submitting claim papers. Such claims require review. For such cases, claimants can initiate an appeal process for a full and fair review of the claim within 30 days of receipt of a repudiation of a claim.
With the support of Agriterra, ACCU and the Credit Union League of Thailand (CULT) have embarked into a project called E-coop mall (ecommerce). It provides platform for credit unions’ small entrepreneurs who have achieved a level global market acceptance on their products
Six Pravasi Bharatiya Conventions have been held so far. Each PBD has gained from the experience of the previous PBDs and sought to address the concerns and expectations of the Indian overseas community better. It is as a result of these interactions that various initiatives like the Overseas Citizens of India, Know India Programme for Diaspora Youth, Scholarship Programmes for Diaspora Children, Overseas Indian Facilitation Centre (to act as a one-stop-shop for business investments by overseas Indians) and assistance to Indian women deserted by their husbands overseas etc. were launched.
