The Policy : is an insurance agreement  Contract issued by the insurance  Company which includes the coverage, table of benefits , Membership Certificate and all attachments thereto.

Policy holder : The person or organization whose name provided as insured in the Membership Certificate.

Policy Period : The insurance period mentioned in the Membership Certificate from the  coverage commencement date till the expiry date.

The Company : the insurance company mentioned in the Membership Certificate.

The insured Member : The person who has satisfied all pre-requisites and covered under the policy.

Membership Certificate : A document that  provides details on the Policy holder and the insured Member  along with the liability rules of the Policy.

Over Limits : The total benefit which amounts  can be claimed for the member during one year of the policy, projected the table of benefits.

Limits of insurance cover : The company shall pay the cost of the medical treatment for the incidental cases , and the incidental stages of the diseases and other payable illness cases according to the provisions , conditions and exceptions of the Policy .

The Territorial borders : The Geographical borders mentioned in the table of benefits within which the treatment can be provided.

Country of Residence : The territory in which the insured  Members are residing on permanent basis as mentioned in the Membership Certificate/Card.

Excess : the First amount payable by the Member for each initial Compensation Claim ( the excess is mentioned in the table of Benefits) if the costs of treatment is less than the excess amount , the member will be liable to pay all expenses incurred .

Accident : Any sudden and unexpected event  occurred during the effective period of the Policy which causes bodily injury , illness or for any reason  beyond the control of the insured.

The Consultant : is a legally licensed secondary care specialist locally licensed and recognized by the law of the country in which treatment is provided and who in carrying out such treatment , is practicing within scope of his license and training .

The Physician : is a legally licensed medical practitioner recognised by the law of the country in which treatment is provided , and who is carrying out such treatment , is practicing within the scope of his/her license and training .

Treatment : Medical or Surgical procedure , the sole purpose of which is the cure of health case and not sedative of chronic disease.

Illness : any disease not excluded from the Policy occurred during the insurance period and forcing the insured  Member to receive treatment by a Doctor or Consultant.

Physiotherapist : a person qualified to practice physiotherapy and officially registered

Treatment in the day Care Unit : includes any medical or surgical procedures in a hospital or  approved daily Care unit which can issue a discharge permission but the member doesn’t stay there overnight.

Diagnostic Procedures : are tests for diagnosing illness including pathology laboratory tests , X-rays , ECG, medical scanning and imaging techniques and the interpretation of result by a specialist .

Hospital : Any licensed institution as medical or surgical hospital in the Country in which the medical Institution is practicing.

Hospital accommodation and services : are all medically necessary treatment and service provided by or on the order of a physician or consultant to the member when admitted as a registered in-patient to a hospital subject to company pre-approval These include , but are not limited to :
  Room And meal charges
  Nursing care
  Procedures of diagnosis
  Physician’s or Consultant Fees
  Operation theatre charges
  Intensive Care unit charge
  Specialist consultations or visits
  All Drugs , dressing or medication prescribed by the treating  
      physician or consultant for in – patient.
 

In-Patient Treatment : The treatment provided to the Member which led to the Member’s stay at the Hospital overnight which cannot be provided in out patient Clinic without adverse results on the Patient.

Medical Conditions : Any disease or illness or injury not excluded by the policy .

Chronic Condition : ( Chronic Disease) : is a medical condition , which need continuous  periodical   maintenance treatment purely for the control rather than the cure of the condition or where there is less than a 90% probability of a permanent cure , or both.

Pre-existing condition : is any medical condition for which a member has received treatment , or sought medical advice or which has been diagnosed during the 24 months prior to the commencement date of the policy or related condition to such a Pre-existing condition .
        In addition , any Medical Condition of which ( in the opinion of the Company ) the member ought reasonably to have been aware before the commencement of cover will be classified as a Pre-existing condition.

Related Conditions : is any medical condition considered to be either an underlying cause of or directly attributable to another specific medical condition .

Emergency Condition : is a medical condition manifesting itself by acute symptoms of sufficient severity ( including severe pain ) such that the absence of immediate medical attention could reasonably be expected to result in :
   Placing the health of the individual ( or , with respect to    
      pregnant woman , the health of the woman or her unborn
      child) in serious jeopardy , or .
   Serious impairment to bodily function , or
   Serious dysfunction of a bodily organ or part

Nursing at home : means the medical services of a nurse in the members home in the country of residence when prescribed by a physician and related directly to a medical condition for which the members has received in-patient treatment and subject to terms , condition and limitation of the policy

Out-Patient Services : All the necessary Medical treatments and services which do not require overnight stay at the Hospital.

Reasonable and necessary Costs: all such costs must in the opinion of the company be reasonable and necessarily incurred , wholly and exclusively for the purpose of curing the medical condition .

Liability : The company’s maximum liability is limited according to the amounts shown in the table of benefits.

Emergency ambulance transportation : The company will pay the cost of emergency ambulance transportation to the nearest hospital where adequate medical services are available . This includes the transfer from one medical facility to another due to medical necessity if the member chooses to receive treatment at a facility other than the nearest adequate hospital .The company shall only be liable for charges equivalent to the cost of transportation to the adequate hospital .