PHP - Definitions

ACCIDENT	shall mean a sudden, unexpected, unusual, and specific event that occurs at an identifiable time and place, which shall, independently of any other cause, be the sole cause of bodily injury.
INJURY	shall mean bodily injury caused solely and directly by Accident.
DISABILITY	shall mean a Sickness, Disease, Illness or the entire Injuries arising out of a single or continuos series of causes.
ANY ONE DISABILITY	shall mean all disabilities arising from the same cause including any and all complications therefrom, except that after thirty (30) days following the latest discharge from Hospital, a subsequent disability arising from the same original cause shall be considered as a new disability.
ILLNESS or DISEASE	shall mean a physical condition marked by a pathological deviation from the normal healthy state.
INSURED PERSON	shall mean the person described in the Policy Schedule including his/her Dependents (if applicable).
CHILDREN	shall mean:- unmarried children over fifteen (15) days old but under nineteen (19) years of age or twenty three (23) years of age if still on full-time higher education, and who are not gainfully employed.
HOSPITAL	shall mean an establishment duly constituted and registered as a Hospital for the care and treatment of sick and injured persons, and which has organised facilities for diagnosis, treatment and major surgery; provides twenty-four (24) hours a day nursing services by registered graduate nurses; is under the supervision of a Physician; and is not primarily a clinic, a place for custodial care for alcoholics or drug addicts, a nursing or rest or convalescent home or a home for the aged and similar establishment.
DOCTOR or PHYSICIAN or SURGEON	shall mean a medical practitioner qualified by a degree and duly licensed or registered to practice western medicine and who, in rendering such treatment, is practicing within the scope of his licensing and training in the geographical area of practice.
HOSPITAL CONFINEMENT	shall mean the Insured Person being duly registered and admitted as an in-patient in a Hospital for more than twelve (12) hours.
INTENSIVE CARE UNIT	shall mean a section within a Hospital which is designated as an Intensive Care Unit by the Hospital, and which is maintained on a twenty-four (24) hour basis solely for treatment of patients in critical condition and is equipped to provide special nursing and medical services not available elsewhere in the Hospital.
DAY	shall mean the definition of a charging day adopted by the Hospital concerned.
DAY SURGERY	A patient who needs the use of a recovery facility on being admitted to Hospital or the Insurer's approved panel of specialist, for a surgical procedure on a pre-planned basis (but not for an overnight stay).
SURGERY	shall mean any of the following medical procedures:- To incise, excise or electro cauterize any organ or body part, except for dental services. To repair, revise, or reconstruct any organ or body part. To reduce by manipulation a fracture or dislocation. Use of endoscopes to remove a stone or object from the larynx, bronchus, trachea, esophagus, stomach, intestine, urinary bladder, or urethra.
PRE-EXISTING ILLNESSES	shall mean any medical conditions, which have been diagnosed or have required treatment prior to the commencement date of this policy irrespective of whether treatment was actually received. Any pre-existing illnesses which has been declared for which an exclusion has not been issued will be covered beginning with the 13th month after original inception.
CONGENITAL CONDITION	shall mean any medical or physical abnormalities existing at the time of birth, as well as neo-natal physical abnormalities developing within 6 months from the time of birth, whether known or unknown to the insured.
SPECIFIC ILLNESSES	means the following disabilities and its related complications, occurring within the first twelve (12) months of this policy, irrespective of whether the insured person was aware of the disability or not: Stones in the Urinary and Biliary systems and cholecystitis Hypertension (High Blood Pressure) and Diabetes Mellitus Cardiovascular (Heart) diseases and Varicose Veins Cataracts and Pterygium All tumours, cancers, cysts, nodules, polyps, growth and lumps of any kind All ears, nose (including sinuses) and throat conditions requiring surgery Hernias, Hemorrhoids, Fistulae, Hydrocele, Varicocele Vertebro-spinal disorders (including disc) and knee conditions; not accompanied by fractures but requiring surgery Systemic Lupus Erythematosus / Discoid Lupus Erythematosus; Epilepsy, Gastritis, and Peptic Ulcer and erosion Endometriosis, Adenomyosis, Prolapsed Uterus and Uterine conditions requiring hysterectomy Prostate conditions requiring surgery
WAITING PERIOD	shall mean the duration of time between the beginning of an Insured Person's disability and the commencement of this Policy and is applied only when the person is first covered. This shall not be applicable after the first year of cover.
REASONABLE and CUSTOMARY CHARGES	shall mean charges for medical care which shall be considered reasonable and customary to the extent that it does not exceed the general level of charges being made by other providers of similar standing in the locality where the charge is incurred, when furnishing like or comparable treatment, services or supplies to individuals of the same sex and of comparable age for a similar sickness, disease or injury and which in accordance with accepted medical standards, could not have been omitted without adversely affecting the Insured Person's medical condition.