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Get cover for overseas medical treatment

Specific health insurance plans offer this facility. Regular travel insurance does not pay for ailments related to pre-existing diseases

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At a recent seminar of the association of insurance brokers, one member requested the Insurance Regulatory and Development Authority of India’s (Irdai) chairman to consider allowing coverage of pre-existing diseases as part of travel insurance policies. Today, if an individual travelling abroad and suffering from an ailment has to be admitted to the hospital, he/she would not be covered under regular travel insurance policies. For this, the individual would require a health insurance policy that specifically covers overseas medical treatment. Let us see what the coverage of such policies include and what are the conditions to keep in mind while buying such policies. 

How do the policies work: According to Vaidyanathan Ramani, head product and innovation, policybazaar.com, broadly there are three kinds of international health insurance plans. One is which works like travel insurance plans. They help you get stabilised and come back to home country. The second kind is which offers coverage only for named critical illnesses and that too listed ones. Only with prior permission can you fly out to another country, get treatment and get it reimbursed up to the sum insured. The third type is which again offers treatment only for critical illness. It is a cashless policy and the company will tell you which hospital you can fly to and get treatment. This has no India coverage. Currently, only New India Assurance offers this kind of policy.

“Buying a policy offering international coverage is a personal choice. If you think you have a better chance of getting treated by going to the US or Singapore, and you can afford it, then definitely buy it. But remember that only named critical illness are covered and you can fly out at only at defined stages. For all these plans you have to take permission before you fly out. There is some check and balance. Since these are technically critical illness covers, the companies will look at what stage you are eligible. The insurer will give you cover to fly out only when nothing in India can cure you,’’ he explains.

Cigna TTK Health Insurance offers coverage for international treatment as part of the base cover in two policies. The company’s ProHealth Insurance provides coverage up to the policy sum insured for emergency medical treatment worldwide on a reimbursement basis. “Such treatment received outside India should be medically necessary and has to be certified as an emergency by a medical practitioner and intimation of such hospitalisation has to be made within 48 hours of such admission. The medical expenses payable shall be limited to inpatient hospitalisation and shall be made in India and in Indian rupees,’’ says Prasun Sikdar, MD and CEO, Cigna TTK Health Insurance. 

The minimum sum insured under ProHealth Insurance is Rs 2.5 lakh and maximum is Rs 1 crore.

The company also offers international treatment for group policies, which is designed for globally mobile population and their families whilst working/ travelling overseas. The coverage is available as per the areas of coverage selected while taking the policy. For ‘Worldwide Including US’, a minimum sum insured of Rs 2,50,00000 must be selected. The maximum coverage for Cigna TTK’s Global Group Health Policy is Rs 12 crore. 

“For customers who are frequent travellers, worldwide coverage as part of health insurance works as a back-up plan for emergency care. This is like Plan B in addition to the travel insurance. Few health players are offering worldwide coverage as there are customers who want a worldwide risk cover for a complete health protection, however, the segment is small in size,’’ Sikdar adds.

Nikhil Apte, chief product officer, Royal Sundaram General Insurance agrees that there is a misconception that an overseas travel policy will cover you for PED. “It will, of course, cover you for an emergency treatment abroad, for example, for you have a sudden heart attack then you can avail treatment abroad under travel insurance. However, if the heart attack is associated with any pre-existing disease, then it will not be payable. Travel policies either do not cover PED or if they do then it is for a specific sum insured in case of a life-threatening situation,” Apte says.

Royal Sundaram has two policies, namely Travel Secure which is an overseas treatment policy and Lifeline Elite under which overseas treatment is possible. The latter covers treatment for 11 critical illnesses in any country on cashless basis and offers sum insured from Rs 25 lakh to Rs 1.5 crore. 

Religare Health Insurance offers access to healthcare overseas under its product ‘Care’. It offers high sum insured options from Rs 1 crore to Rs 6 crore. It is the only product in India to offer global coverage on a cashless basis for all illnesses and is not just limited to some specific illnesses, says Anuj Gulati, MD & CEO.

Conditions to keep in mind: It is prudent to check if the health plan covers planned hospitalisation, emergency care or listed medical conditions/ illnesses under worldwide benefit, if there any sub-limit, co-pay applicable and the waiting period clause. Also check if the benefit is available within the network or outside network hospital and is there any negative list of countries where the coverage is not available. Further enquire if the claim will be cashless or on reimbursement, says Sikdar. 

For Royal Sundaram’s Lifeline Elite, the main condition is that the diagnosis has to be done in India, pre-authorisation has to be taken from the company and there is a 20% co-pay. Customer can get treated in a country of his choice.

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