Definitions
MEDICATION
Drugs, medicines and corrective devices (including prostheses
when used as an integral part of a surgical procedure) prescribed
by a
medical practitioner
or
specialist
.
ORGAN TRANSPLANT
The surgical procedures to perform a transplant of an organ.
OUT-PATIENT
An
insured person
who receives
treatment
but who is not required
to be admitted to a
hospital
bed.
PALLIATIVE TREATMENT
Treatment
given to an
insured person
, the primary purpose of
which is only to offer temporary relief of symptoms, rather than to
cure the
medical condition
causing the symptoms.
PATHOLOGY
Tests carried out to help determine or assess the nature of disease
and the changes in structure and functions brought about by disease.
PERIOD OF COVER/EACH YEAR
The period of time for which cover is provided. This is specified on
the
Certificate of Insurance
. This will normally be a twelve (12)
month period starting from the
commencement date
or
renewal
date
.
PHYSICIAN
A
medical practitioner
who is registered and legally licensed to
practise medicine in the country where
treatment
is provided.
PHYSIOTHERAPIST
A practising
physiotherapist
who is registered and legally licensed
to practise medicine in the country where
treatment
is provided.
POLICY
The contract whichdetails the level of cover provided. The Application
Form,
Certificate of Insurance
and this Policy Wording incorporating
the
policy
terms and conditions form the contract.
POLICY EXCESS
The specified monetary amount payable by an
insured person
in
respect of expenses incurred before any benefit is paid under this
policy
. The
policy excess
applies per person per
policy
year and is
applied to
in-patient, day-patient
and
out-patient
expenses only.
POLICYHOLDER
The person or company with whom
we
have contracted this
policy
and who is principally responsible for payment of the premiums.
PSYCHIATRIC ILLNESS
Treatment
of a mental disorder carried out by a clinical
psychologist. The disorder must be associated with present distress,
or substantial impairment of the individual’s ability to function
in a major life activity (eg. employment). The aforementioned
condition must be clinically significant and not merely an expected
response to a particular event such as bereavement, relationship
or academic problems and acculturation. The disorder must meet
the criteria for classification under an international classification
system such as Diagnostic and Statistical Manual (DSM-IV) or the
International Classification of Diseases (ICD-10).
QUALIFIED NURSE
A nurse whose name is currently on any register or roll of nurses
maintained by any statutory nursing registration body, within the
country where
treatment
is provided.
REHABILITATION
Treatment
given with the aim of restoring health and mobility
after injury or illness to a state in which an
insured person
can be
self-sufficient.
RENEWAL DATE
12 calendar months from the
commencement date
or from the
previous
renewal date
.
SPECIALIST
A
medical practitioner
who holds a substantive consultant
appointment in the relevant speciality in a National Health Service
hospital
, or has held a substantive consultant appointment
which
we
accept as being of equivalent professional status,
or is recognised as such by the statutory bodies of the relevant
country in which
treatment
is being given. For
treatment
in the
UK, a
medical practitioner
who meets
our
criteria for
specialist
recognition for benefit purposes, and who has been told in writing
that they are currently recognised as a
specialist
for benefit
purposes in his/her field of practice.
TREATMENT
Anymedically necessary surgical procedure or medical intervention
required to cure or provide relief of an
acute medical condition
.
WE/OUR/US
à la carte healthcare limited on behalf of AXA PPP International
who are the underwriters and claims administrators for this
policy
as detailed in the
Certificate of Insurance
.
Exclusions Specific to Each Section of Cover
In-patient & day-patient Treatment
The following exclusions apply to
In-patient
&
day-patient
Treatment
. As well as the General Exclusions on page 10,
we
do
not cover the following:
Applicable to
Prima Premier
and Prima Classic
1
Any costs not incurred as a
day-patient
or
in-patient
in a
hospital
or recognised medical facility.
2
Any costs associated with routine pregnancy & childbirth,
unless Routine Pregnancy & Childbirth has been selected.
3
Any costs associated with any form of dental
treatment
, unless
Dental
Treatment
has been selected.
4
Any costs associated with
evacuation
or
repatriation
unless
Evacuation or Repatriation
has been selected.
5
The
policy excess
specified on the
Certificate of Insurance
for all
eligible expenses incurred for each
insured person
per
policy
year.
6
Any costs incurred in locating a replacement organ, removal of
the organ from the donor, transportation costs and all associated
administration costs in respect of an
organ transplant
.
Applicable to
Prima Premier
only
7
Where
Out-patient Treatment
has been selected, cover
in respect of post-operative
treatment
is deleted from
In-patient
&
day-patient Treatment
.
8