Page 5 - ALC Health

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.
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