Accidental Hospitalization Clause Samples
Accidental Hospitalization. If an Insured Person suffers an Injury due to an Accident and such Injury requires the Insured Person to be Hospitalized as an In-patient then We will cover the costs incurred on Medical Expenses up to the limit specified in the Policy Schedule or Certificate of Insurance provided that:
a) The Insured Person is Hospitalized in India;
b) The Hospitalization is for Medically Necessary Treatment and is on the written advice of a Medical Practitioner.
c) The Insured Person is admitted to Hospital within 7 days of the occurrence of the Accident. If this benefit is chosen along with section 1.1, then in case of an inpatient hospitalization due to an accident, where the claim is admissible both under section 1.1 and section 10, the admissible claims shall be paid utilizing the limit as specified in the Policy Schedule or Certificate of Insurance under section 10 (Accidental Hospitalization) first and balance if any from available sum Insured under Section 1.1. thereafter up to the limits as specified in the Policy Schedule or Certificate of Insurance.
Accidental Hospitalization. If an Insured Person suffers an Injury due to an Accident during the Policy Period then, We shall reimburse the amount up to the limit specified against this benefit in the Policy Schedule, towards the Medical Expenses incurred in respect of a medical treatment or Surgery for the Injury sustained, provided that: ⚫ The treatment is availed in a Hospital or Day Care Centre in India ⚫ The Insured Person’s Admission to Hospital for Medically Necessary Treatment is within 7 days of the occurrence of the Accident. ⚫ The Medical Expenses incurred are Reasonable and Customary ⚫ A deductible days are as mentioned in the policy schedule is applicable in respect of this cover. The payment under this benefit is over and above the Sum Insured of the opted Benefits under any other Benefit.