Glossary of Insurance Terms
The following words and expressions shall have the following meanings unless the context otherwise requires:
Means an event:
- (a) occurring entirely beyond the Insured Person’s control and is caused by violent, external and visible means; and
- (b) happens while the Insured Person is covered under this Policy.
Act of Terrorism
Means an act whether involving violence or the use of force or not, and/or the threat or the preparation thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in conjunction with any organization(s) or government(s), committed for political, religious, ideological or ethnic purposes or reasons, including the intention to influence any government and/or to put the public or any section of the public in fear.
Means a Physician who specializes in anaesthesiology and is registered to practice anaesthesiology under the relevant laws and regulations of the country in which he practices.
Means the application form signed by the Policyholder and, if the Insured Person is different from the Policyholder, by each Insured Person whereby the Policyholder applied for each Insured Person to be covered under this Policy and which application form forms part of this Policy.
Attending Physician, Physician
“Attending Physician, Physician” means a person qualified by degree and licensed or registered to practice medicine under the relevant laws and regulations of the country in which he practices. The Attending Physician responsible for the medical treatment of an Illness of an Insured Person may not be the Insured Person, an Immediate Family Member, or a travelling companion.
Means the benefits schedule attached to this Policy.
Means a person who specializes in bone-setting and is licensed or registered to practice bone-setting under the relevant laws and regulations of the country in which he practices.
Means a transportation company or transport undertaking whose principal business is the carriage by air, sea or land of passengers and/or cargo for hire or reward and which is duly licensed or certified in all jurisdictions in which such business is carried on for such purposes.
Means a person who is a minor under the laws of his Country of Residence or a full-time student of not more than 23 years of age.
Chinese Medicine PractitionerMeans a person licensed or registered to practice Chinese medicine under the relevant laws and regulations of the country in which he practices.
Close Business Partner
Means a business associate that has a share in the Insured Person’s business.
Means other insurance or other benefits which pay or are payable in respect of any claims hereunder.
Means Pacific Cross Insurance Company Limited.
Means a physical or mental abnormality
(a) existing at the time of birth; or
(b) manifesting within six months from the date of birth.
Means re-constructive surgery or surgery which is not medically necessary or which is performed principally to improve or with the principal objective of improving the appearance of a person or which the person concerned considers or believes will improve his appearance and includes any surgery necessary for psychological reasons, adaptation and personal satisfaction in respect of a Disability covered under this Policy.
Country of Residence
Means the country in which the Insured Person or a Child, as applicable, is resident for not less than 6 months in a Policy Year and which is declared on the Application unless otherwise endorsed in the rider issued by the Company as the Country of Residence.
(a) care provided mainly for personal needs, comfort or convenience that is provided by persons with or
without specialized medical training or skills; or
(b) care provided mainly to maintain, rather than improve the medical condition of a person as a prophylaxis precaution for a physical or mental function or to provide a protected environment.
Means an amount as stipulated in the Benefits Schedule to be deducted from the benefits payable in respect of any Eligible Expenses in each Policy year.
Means a person qualified by degree and licensed or registered to practice dentistry under the relevant laws and regulations of the country in which he practices.
Means an Illness or Injury, and any symptoms, sequelae or complications thereof, and in the case of Injury includes all Injuries arising from the same event or series of contiguous events.
Means medical expenses for treatments and services, which are medically necessary for the treatment of a Disability.
(a) a person who is not a Child; or
(b) a Child who has a parent who is or will become an Insured Person.
Means a bona fide situation where there is a sudden change in an Insured Person’s state of health, which requires urgent medical or surgical intervention to avoid imminent danger to his life or health.
Means the treatment ordered by the Attending Physician of the hospitalization, including follow-up consultation, relevant medicines, diagnostic tests and physiotherapy. Cover is restricted to follow-up treatment of the specific medical condition for which the Insured Person received inpatient treatment covered by the Policy. Follow-up treatment does not include regular outpatient consultation and long-term medication for chronic medical condition.
Means the period of thirty (30) days commencing from the date on which the relevant payment is due.
Means a plant whose leaves are used as a medicine for and are required for the treatment of an Illness or Injury covered under this Policy and which is prescribed by a Herbalist or Chinese Medicine Practitioner for the treatment of such Illness or Injury.
Means a person who grows or sells Herbs and who is licensed, registered or authorized under the relevant laws and regulations in the country in which he carries on such activities to grow or sell such Herbs.
Means nursing care (not personal assistance) provided by a licensed nurse at home immediately after a hospital confinement, and must be certified by the Attending Physician to be medically necessary.
Means an institution which is legally licensed as a medical or surgical Hospital in the country in which it is situated and whose main functions are not those of a spa, hydro-clinic, sanitarium, nursing home, home for the aged, rehabilitation centre, a place for alcoholics or drug addicts. The Hospital must be under the constant supervision of a resident Physician.
Means a sickness or disease marked by a pathological deviation from the normal healthy state:
- (a) beginning or occurring after thirty (30) days from the Policy Effective Date; and
- (b) which requires treatment by a Physician, Specialist or Surgeon; and
- (c) which is covered by this Policy.
Immediate Family Members
Means an Insured Person’s legal spouse, children (natural or adopted), siblings, siblings in law, parents, parents in law, grandparents, grandchildren, legal guardian, stepparents or stepchildren.
Means a bodily injury (which for the avoidance of doubt excludes all psychiatric conditions) arising wholly and exclusively from an Accident which independently of all other causes directly results in loss covered by this Policy.
Means an Insured Person who suffers a Disability and who is admitted to Hospital for the treatment of that Disability and occupies a Hospital bed in connection therewith for a continuous period of not less than 18 hours.
Means anyone of the persons named in the Policy Schedule as an Insured Person.
Medicines and Drugs
Are any medicines or drugs (other than those which are experimental or unproven) prescribed by a Physician which are specifically required for the treatmentof Disability.
Means expenses required for laboratory tests, x-rays, professional fees, medicines and drugs, blood and plasma, wheelchair rentals, outpatient surgery, surgical appliances and devices, and intra-operative standard prosthetic devices.
Normal, Usual and Customary Charges
Means a reasonable charge, which is:
(a) usual and customary when compared with the charges made for similar services and supplies in the
locality of the Insured Person; and
(b) made to persons having similar medical conditions in the locality of the Insured Person.
Means Canada, the United States of America, Mexico and the Caribbean Islands.
Means a benefit included in this Policy which is included at the option of the Policyholder with the agreement of the Company and in respect of which the relevant rider is attached to this Policy and which is described as an affirmed benefit and for which additional premiums are payable to the Company.
Period of Insurance
Means the period stated on the Policy Schedule to be the period of insurance or subsequently any renewal thereof during which the Policy is in effect.
Permanent Total Disablement
Means disablement which entirely prevents the Insured Person from attending to his business or occupation of any and every kind and which lasts 52 consecutive weeks and at the expiry of that period is beyond hope of improvement.
Persistent Vegetative State
a) a severe decrease of consciousness in which an Insured Person with neurologic damage is in a state of
partial arousal rather than true awareness, though superficial signs such as eye opening, swallowing and
spontaneous breathing and the like may persist; and
b) the state must have continued for at least four (4) weeks with no signs of improvement, when all reasonable attempts have been made to alleviate this condition.
Means this policy document and includes the Application, the Policy Schedule, The Benefit Schedule and the Surgical Schedule and any Optional Benefits included in this policy documentwith the relevant rider attached to this policy document and any endorsements, amendments or riders thereto which have been approved by an executive officer of the Company.
Policy Effective Date
Means 12:00 midnight (local time in the Country of Residence) on the first day of the Period of Insurance.
Means the policy schedule attached to this Policy.
Means a calendar year commencing on the Policy Effective Date or any anniversary of that date.
Means the person named in the Policy Schedule as the Policyholder and to whom this Policy has been issued in respect of insurance of the Insured Persons.
Means any Disability:
(a) which existed before the Policy Effective Date in respect of an Insured Person, which presented signs or symptoms of which the Insured Person was aware or should reasonably have been aware; or
(b) for which treatment, or medication, or advice, or diagnosis has been sought or received during the two (2) years prior to the commencement of the Policy by an Insured Person; or
(c) which was known by the Insured Person to exist prior to the commencement of the Policy whether or not treatment, or medication, or advice, or diagnosis was sought or received.
Means the fees payable to licensed medical professionals such as occupational therapist,physiotherapist, and acupuncturist, dietician, Attending Physician (except Surgeon), pathologist and radiologist.
Means all public common Carrier such as multi-engined aircrafts, buses, trains, ships, hovercrafts, ferries, and taxis that are licensed to carry fare-paying passengers and coach being arranged by travel agency and is not a contractor or private Carrier.
Means any publicly accessible location (such as car park, street, park, environmental area, bus station, airport, sports stadium or shopping center) including public transportation of any kind or any other similar place or location.
Means treatment in the form of a combination of therapies aimed at restoring full function after an acute event which was covered under this policy and required inpatient treatment.
Means the date specified in the Policy Schedule to be the renewal date.
Short Period Rate
Means the rate calculated in accordance with the formula below in respect of the period prior to cancellation of this Policy in respect of which this Policy has been in force.
Period prior to cancellation Short Period Rate on annual premium (a) The first month 20% (b) For each successive month after the first month 10% (c) More than eight (8) months 100%
For the avoidance of doubt, the premiums for addition of Insured Persons during the Period of Insurance are not entitled to refund and any indebtedness under this Policy shall be deducted from the premium to be refunded.
Means a Physician who specializes in one particular area of medicine.
Means a person qualified by degree and licensed or registered to practice surgery under the relevant laws and regulations of the country in which he practices surgery.
Means the fee payable to a Surgeon or Surgeons for providing surgery to treat a Disability. The Surgeon’s Fee includes pre-surgical assessment, hospital visits and normal post surgical care and is subject to Normal, Usual and Customary Charges.
Means the surgical schedule attached to this Policy Document which indicates the maximum amount payable by the Company
for a surgical operation.
US$ or US Dollars
Means the lawful currency of the United States of America.