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Any accident caused by the vehicle, or as a result of its use, or anything falling from it, or its explosion, being on fire or stolen, even when it is not moving.
The date the person causing the accident doing the following:
1. Pay the prescribed excess amouont.
2. Insurer receives the vehicle.
3. Insurer supplied copy of vehile registration certificate and driving license.
4. Minor accident from in case of minor accident.
5. ROP technical inspection repot in case of gross accident or minor accident where necessary.
6. Letter from financier or morgagee (if any).
7. Any documents the insurer requuires provided request is made on reporting the accident.
The requirements apply on the person who incur damage except payment of excess amount.
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The insurance on the body of the motor vehicle, insurance in favour of third party, natural calamities and personal accidents.
Insurance which covers all that has occurred to the third party, such as death, bodily injuries, material damage and medical expenses.
A damaged vehicle is considered as a total loss if the actual cost of repairs exceeds seventy five percent of its value at the time of accident.
Consequential loss is indirect loss not directly resulting from the insured accident and occuring later
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The percentage on the cost of new genuine spare parts in the event of partial loss to be contributed by the Insured or the person who incur damage at the time of an accident UNIFIED MOTOR VEHICLES INSURANCE POLICY 6 in accordance with the depreciation scale mentioned in the Policy. In case of total loss, the percentage to be deducted from the cash value of the vehicle in line with the depreciation scale mentioned in the Policy.
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The fixed amount specified in the Policy Schedule to be borne by the Insured for each accident.
A vehicle used for construction works and is not designed to carry any load.
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The period stated in the insurance Policy during which the Policy shall be valid, or any other renewal period agreed by both parties.
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Apersonalized card issued by the insurer in the name of each Insured member, identifying him as an Insured member and facilitating his access to the benefits covered under this Policy and provided by the Designated providers.
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Deduction of certain amount from the premium of the polciy inconsideration of no claim paid or payable for the previous insurance term.
Floods, wadis, cyclones, hurricanes storms and hail.
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The application to be completed by the Insured with the specified details, which includes the required insurance, additional benefits and the desired coverage.
The Schedule specified in the insurance Policy which is an integral part of it and states the details of the Insured, the insured vehicle and the insurance cover granted.
Covering death or bodily injuries as a result of a road traffic accident to the vehicle owner, the driver, and their family members, within the limits specified in the Addendum.
Disability caused by an injury and resulting in the total and permanent loss of earning power or ability to work or ability to use the affected organ; or if the compensation percentage to the affected organ for one injury or total of more than one permanent injury is one hundred per cent or more.
Disability caused by an injury to an organ or organs which results in a permanent decrease in the injured person’s earning power or his ability to work or his ability to use the affected organ or organs.
A vehicle connected or able to be connected to a trailer or more and together form one unit.
The period of this Policy stated in the Policy schedule and the Membership card from the Commencement Date to the Expiry date subject to remittance of premium in full.
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Schedule/Certificate of Insurance means the Schedule/Certificate issued by Insurer and if more than one, the latest in time and shall always form part of this policy document.
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The Unified Motor Vehicle Insurance Policy and its appendices.
Any vehicle used for the transport of passengers or goods, or a motorcycle, a carriage or trailer, whether mechanically propelled or otherwise (other than those pulled by animals), used or to be used on the road within the borders of Oman.
Any land passages available for vehicles traffic anywhere within the borders of Oman.
Any person inside the vehicle within the authorized seating capacity or getting into or dismounting from the vehicle.
The insurance company licensed to operate in Oman.
The owner of the vehicle whose accidents on the road are covered by the Insurer, and anyone driving the insured vehicle is considered as the Insured.
Any person, other than the Insured or anyone who is in his position and their family members, even if he is an employee of the Insured.
Disability caused by an injury which results in a loss of a temporary nature of the injured person’s earning power or his ability to work or his ability to use the affected organ or organs.
A vehicle without engine designed to be hauled or tracted by a motor vehicle.
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a
Accident or Accidental mean an injury which is the result of a sudden, unexpected, fortuitous, visible and external event independent of the will of the insured and which may arise from a cause outside the individual's control. The cause and symptoms must be medically and objectively definable.
Age or Aged means completed years as at the Commencement Date.
Accommodation charges is the charges for the insured member made by a hospital/clinic for inpatient or day care treatment including charges for beds, routine nursing and care services, house keeping, drugs, dressing and Medications etc. Any costs towards sundry expenses such as food (other than to the Insured), telephone charges, news paper etc... will not be covered.
Administrator means the person or organization, who has been appointed by the Insurer to provide administrative services on its behalf and at its direction.
Alternative medicines are the types of medical care that are alternative to the conventional allopathic medicine covered under this policy. Such medicines include but not limited to chiropractic, osteopathy, acupuncture, Chinese medicines, herbal medicines and massages...etc.
Annual maximum limit/Sum assured is the total amount that may be claimed in any one (1) Policy period by an insured member. These limits are shown in the Table of benefits and represents the maximum liability of the Insurer for each Insured person for any and all eligible benefits claimed for during the Policy Period.
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Bodily injury is an identifiable physical injury on the body of the insured, caused by an accident requiring immediate treatment by a Physician, which occurred during the Policy period as specified in the Schedule and Table of Benefits.
Birth defect is any deformity arising during the antenatal stages of pregnancy or caused by/or during childbirth.
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Chronic Condition is defined as a sickness, illness or injury which has one or more of the following characteristics:
1. Is recurrent in nature
2. Is without a known, generally recognized cure
3. Is not generally deemed to respond well to treatment
4. Requires prolonged supervision or monitoring
5. Requires palliative treatment
6. Leads to permanent disability
Commencement Date means the commencement date of this policy as specified in the table of benefits and /or Certificate of Insurance/Schedule
Congenital conditions are the conditions existing from the birth that constitutes a significant deviation from the common form or normal and for the purpose of this policy will include visible and latent structural deviations as well as chromosomal abnormalities. It shall also include abnormal external conditions which is present since birth in the visible and accessible parts of the body or conditions which is present since birth whether inherited or not, but is internal and not visible.
Cosmetic surgeries are any operative procedure, or portion of a procedure, performed to improve the physical appearance and/treat a mental condition through change in bodily form.
Coinsurance/Co Pay is the specific percentage of admissible costs which the insured member must pay as cost sharing requirement under this policy.
Country of residence is the country where the insured lives for the greater part of the policy period.
Claim is an application to the Insurer for payment of expenses incurred under the benefits of the policy.
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Day care treatment is the treatment received by the insured member in a hospital or day care facility during the stay, including a hospital room and nursing that does not medically require the patient to stay overnight and where a discharge note is issued.
Deductible/Excess is the cost sharing requirement under the policy and is first amount of a claim which has to be borne by the insured before the relevant benefits are payable under the policy. Deductible/Excess shall be specifically mentioned in the Table of Benefits and/or Certificate of Insurance/Schedule. In the event that the total cost of treatment is lower than the deductible/excess amount the insured will be liable to pay all the expenses incurred.
Dependant Primary insured's legally married spouse and she/he continues to be married to primary insured, children and legally adopted children.
Designated Medical providers is the Hospitals or medical centers or Pharmacies or Diagnostic centers specified in insurer's applicable network or health care providers with whom the insurers or its designated representatives have contracted to enable the insured to receive the treatment in accordance with the policy. It shall also include one or more medical provider from the Designated Medical Provider list chosen under this policy by the Insured with whom the Insured shall avail the medical services this policy. Designated Medical Provider applicable to the Insured under this policy shall be as specified in the Table of Benefits or Certificate of Insurance/Schedule. The list is available with the company and is subject to amendment from time to time.
Diagnostic procedures Any Investigation or tests for diagnosing Illness, including pathology, laboratory, x-ray, ECG, medical scanning and imaging techniques and interpretation of the results by a Physician or Consultant.
Doctor/Medical Practioner/Medical Examiner is a person who holds a valid registration/licence issued from the appropriate authority and is thereby entitled to practice medicine within its jurisdiction and is acting within the scope and jurisdiction of his licence. It shall include the specialist doctor holding specialized qualification in the field of or expertise in, the treatment of the illness or injury being treated and shall exclude any person who is part of the insured persons immediate family. Immediate Family would comprise of the Insured persons spouse, dependent children, brother(s), sister(s) and parent(s).
Due date for remittance of premium by the insured to the insurer shall be the commencement date as specified in schedule of premium and its anniversaries or other alternate date agreed in writing between insurer and insured.
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Eligible medical expenses covered under the policy and is net of specific deductible/excess and /or coinsurances and/or any other deductions within the limits of liability of the insurer as defined in the table of benefits.
The actual expenses incurred by an insured member that are reasonable and customary for the medically necessary treatment/care and services, administered by or ordered by a qualified physician licensed to practice medicine.
Emergency can be affirmed in case of an accident, a disaster or any sudden beginning or worsening of a severe illness resulting in a medical condition that presents an immediate threat to the insured member and therefore requires urgent medical measures. Only medical treatment through a physician, medical practitioner, or specialist and hospitalization that commences within 24 hours of the emergency event will be covered.
The date shown in the Policy schedule and the Membership card (if provided by the insurer) on which cover under this Policy ceases.
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Excluded Illnesses, items, Treatments, procedures and their related or consequential expenses, which are not covered under this Policy. These exclusions are shown in the General exclusions list.
Grace Period means the specified period of time immediately following the premium due date during which a payment can be made to renew or continue a policy in force without loss of cointinuity benefits such as waiting period and coverage of pre existing conditions. Coverage is not available for the period for which no premium is received.
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An establishment, which is legally licensed in the country of Treatment, as a medical or surgical Hospital and provides Allopathic medicines
Hospitalisation/Hospitalised means the Insured persons admission into a Hospital or other medical service provider for a medically necessary treatment for a covered ailment under this policy as an Inpatient for a continuous period of 24 hours following an illness or accident occurring during the policy period.
All Medically necessary treatments and services provided by or on the order of a Physician or Consultant to the Insured member when admitted as a registered Inpatient or for a Daycare Treatment to a Hospital.
Hospital Cost Band means one or more Designated Medical Provider grouped by the Insurer or its administrator based on including but not limited to medical facilities available, claim cost etc., The Hospital Cost Band shall be specified in the Table of Benefits under the policy and insured is eligible to avail medical services eligible under the policy only with such Designated Medical Providers.
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Any kind of health condition not otherwise excluded by the Policy which is sustained by an Insured member during the Policy period and occasions the necessity for the Insured member to receive care and attendance from a Physician or Consultant or specialist or surgeon.
Injury means any physical bodily harm sustained because of an accident occurring during the policy period for which medical treatment by a Medical Practioner is required, but does not include any illness.
Insurer/We/Our/Us/Insurance Company/Company means National Life and General Insurance Company, SAOG.
Any Primary insured or his Dependants (if insured) who has fulfilled the Eligibility conditions and is named in the Policy schedule and Membership card (if provided by the insurance company).
Intensive Care Unit means an identified section, ward or wing of hospital which is under the constant supervision of a dedicated Doctors, and which is specifically equipped for the continuous monitoring and treatment of patients who are in a critical condition, or require life support facilities and where the level of care and supervision is considerably more sophisticated and intensive than in the ordinary and other wards/room.
Where the Insured person requires hospitalization for a minimum of one (1) night, for specialized medical attention and care, before, during and after the treatment. Such Treatments cannot be performed on an Outpatient basis.
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Any medical, surgical or other services that an Insured member requires provided such services are:
1. Essential and related to the Illness presented.
2. Rendered in accordance with generally accepted medical practice and professionally recognized standards.
3. Treatments that are not generally considered as experimental or unproven.
4. Not in excess of the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration or intensity.
The period an Insured member has to wait before he becomes eligible for a benefit. The Moratorium period is measured from the Insured member's first Join date.
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Hospitals, clinics, laboratories, diagnostic centers and pharmacies with whom insurer have no agreement to provide covered benefits, in accordance with the terms and conditions of this Policy, to the Insured members and/or are not included under the list of Designated providers in Your Policy schedule. Benefits Received at such Providers will be on reimbursement basis and subject to coinsurance as mentioned in the Table.
Rendering the medical services of a nurse in the Insured member's home in the Country of residence when prescribed by a Consultant and related directly to an Illness for which the Insured member has received Inpatient treatment in accordance with the terms and conditions of this Policy. This benefit is provided in lieu of a Hospital admission where a skilled nurse, under the supervision of the treating Consultant, can provide the necessary care at home for the remaining length of stay of a particular admission or procedure.
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All Medically necessary treatments and services that do not require hospitalization during the day or overnight for Inpatient treatment nor necessitate specialized medical attention or admitted for Day care procedures.
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A registered medical practitioner who is legally licensed to practice Allopathic medicine in the country in which Treatment is provided and who in carrying out such Treatment is practicing within the scope of his licensing and training.
Policy Year means a period of twelve months beginning from the Commencement Date and ending on the last day of such twelve month period. For the subsequent years subject to the receipt of premium, "Policy year" shall mean a period of twelve months beginning from the end of the previous Policy Year and lapsing on the last day of such twelve month period and as specified in the table of benefit and/or Certificate of Insurance/schedule.
Any bodily injury or Illness or its related conditions, ailments, that is medically existing prior to the Commencement date of the Insured member, whether it is known or not known to him, and necessitates the Insured Member to receive care and Treatment.
A pre-printed Claim form used for Inpatient and Emergency Treatments. It is also used for Pre-authorization of Treatment requests, as required under the terms and conditions of this Policy.
An individual who has fulfilled the Eligibility conditions and is named in the Certificate of Insurance/schedule and Membership card.
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The amount insurance company recognize for payment for a particular Medical procedure/treatment/medications. It is based on what is considered "reasonable" (as illustrated under cost of medical expense in General terms and Conditions) for that procedure/treatment/medications in accordance with the market price, in the country where the Treatment (if eligible as per table of benefits) was provided or in the Applicable Hospital Cost band of designated providers (as specified in the table of benefits) in the Country of residence, whichever is less.
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Schedule/Certificate of Insurance means the Schedule/Certificate issued by Insurer and if more than one, the latest in time and shall always form part of this policy document.
Treatment delivered by a Consultant following referral for further Treatment from a Physician.
Maximum Annual maximum limits that may be claimed in respect of any one (1) benefit. If the Sub-limit is stated to be full refund, then maximum liability for the benefit shall be the Policy's Overall limit.
Surgery/Surgical Procedure means an operative procedure for the correction of deformities and defects, repair of injuries, cure of diseases, relief of suffering and prolongation of life.
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A schedule issued by Insurer showing the extent and nature of benefits, Deductible amount and percentages of Coinsurance applicable under this Policy and annexures thereto.
Advanced or rapidly progressing incurable illness incurred within the insurance period, where, in the opinion of the attending physician/specialist and chief medical officer of the insurer, the life expectancy is no greater than 12 months.
The geographical limits within which Treatment may be received and are stated in the Certificate of Insurance/schedule and/or Table of benefits.
A medical or surgical procedure, the sole purpose of which is to cure an Illness and not to alleviate long-term Chronic condition.
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Visiting Consultant shall be a Registered Medical Practioner not on regular employment for a salary with the Designated Medical provider or does not reside within the Sultanate of Oman for a greater part of a calendar or not a resident of sultanate of Oman or is a Medical Practioner visiting from foreign country.