In the event of an insured person suffering an insured incident, which necessitates the insured person being confined to hospital and undergoing medical or surgical procedures and/or operations or treatment

“Accident” means bodily injury caused by violent accidental and external physical means.

“Hospital” means any institution in the territory of RSA which in the opinion of the Company meets each of the following criteria:

• Has a diagnostic and therapeutic facility for surgical and medical diagnosis treatment and care of insured and sick persons by or under the supervision of a staff of medical practitioners.
  
• Provides nursing service supervised by registered nurses or nurses with equivalent qualifications.
  
• Is not other than incidentally either a mental institution or a convalescent home.
  
• Is not a place of rest for the aged or a place for drug addicts or alcoholics or a health hydro or natural cure clinic or similar establishment.
  
• Is not an institution providing long-term care for the blind deaf dumb or other handicapped persons.

“Illness” means any one somatic (Definition; relating to or affecting the body, especially the body as considered to be separate from the mind) illness or disease which manifests itself during the period of insurance and includes premature senile degenerative changes, but not an illness which is of such a nature as to be incapable of diagnosis by objective evidence or which though capable of diagnosis by such evidence has not been so diagnosed.

“Incident” means any one accident or illness that causes an insured person to be confined to hospital and to undergo certain medical or surgical procedures and/or operations.

“Medical and surgical procedures and/or operations” means any procedure or operation in the Recommended Scale of Benefits issued as the Reference Price List (RPL). In the event of a procedure and/or operation not being listed the Company will agree an appropriate allocation of units in consultation with an independent medical practitioner.

“Medical practitioner” means a legally qualified registered medical practitioner.

“Treatment” means any form of investigation or examination by or consultation with or treatment by a medical practitioner for the purpose of treating or monitoring an insured person’s medical condition arising out of an insured incident.

“Hospital Confinement” means admission to a hospital ward, limited to General Ward, Maternity Wards, Private Wards and Special Care Units

“Eligible Child” means a child nominated at inception who is factually (by way of natural/ biological child born of or stepchild or legally adopted child placed under the foster care of the Principal Insured Member or financially dependent on the Principal Member and who has not attained the age of twenty one (21) and who is not already insured under this policy or any other insurance issued by the Company providing similar cover. This age may be extended to twenty five (25) in respect of an unmarried child who is a full time student. There will be no age restriction for children who are either mentally or physically incapacitated from maintaining themselves, always provided that the children are wholly dependent on the Principal Insured Member for support and maintenance. A child shall only be accepted for cover if such child is covered in terms of the principal insured member’s medical aid scheme.