India Travel insurance for pre-existing conditions

A pre existing condition means any condition, ailment or injury or related condition(s) for which the insured had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to commencement of the first Policy issued by the Insurer. This means that if the insured is traveling abroad with a pre existing condition and avails of any treatment abroad, the insurance company will not be liable for paying the claim.
The insurance company normally goes by the guidance of the attending physician in the medical facility abroad while deciding whether a condition is pre existing or not. If the attending physician declares that the cause of the treatment is a pre existing condition carried by the insured, then the treatment costs will not be reimbursed under the policy.
Some insurance companies offer a limited coverage for medical expenses arising due to pre existing conditions, when the situation is Life threatening in nature.

A Life threatening condition is an unforeseen medical emergency, which puts the life of the insured at extreme risk. In such event, measures solely designed to relieve acute pain, provided to the Insured by the Physician for Disease/accident arising out of a pre-existing condition would be reimbursed upto a limit specified in the policy terms and conditions. The treatment for these emergency measures would be paid till the insured becomes medically stable or is relieved from acute pain. All further medical cost to improve or maintain medically stable state or to prevent the onset of acute pain would have borne by the Insured.
It is important to be noted that all plans displayed on the eIndiaInsurance website do not offer coverage for pre existing conditions. Hence the traveller should review the plan prior to purchasing the same, if they are looking for such a cover. If the traveller still has clarifications regarding the same, it is better to speak to our customer service executive.

A pre-existing condition usually means any medical condition for which medical advice, diagnosis, care or treatment was recommended or received. It is always a good idea to speak to the insurer you are thinking of using to check whether they will include your condition on the policy. For example, If you're pregnant, certain exclusions may apply if you travel after a certain point during the period of your pregnancy. We would advise you to read the policy wording thoroughly, prior to purchasing the plan to see at what exclusions and other conditions may be in place.

Medical costs abroad can be very expensive and without adequate insurance cover you could be left severely out of pocket.

While the policy certificate of most insurance companies may not explicitly state the availability of coverage for pre-existing diseases on the face of the policy certificate, the policy terms and conditions which are shared with your along with the certificate, will state that this coverage is available, subject to prescribed limits, terms and conditions.

A pre existing condition means any condition, ailment or injury or related condition(s) for which the insured had signs or symptoms, which was diagnosed and for which the insured received medical advice/ treatment, within 48 months prior to commencement of the first Policy issued by the Insurer. This means that if the insured is traveling abroad with a pre existing condition and avails of any treatment abroad, the insurance company will not be liable for paying the claim.
The insurance company normally goes by the guidance of the attending physician in the medical facility abroad while deciding whether a condition is pre existing or not. If the attending physician declares that the cause of the treatment is a pre existing condition carried by the insured, then the treatment costs will not be reimbursed under the policy.
Some insurance companies offer a limited coverage for medical expenses arising due to pre existing conditions, when the situation is Life threatening in nature

If you have had the knee replacement surgery within 48 months prior to commencement of your travel/trip, then the same will be treated as a pre existing condition under the policy and any claim/treatment occurring as a result of the surgery, will not be covered under the policy. Some insurance policies have a limited coverage for pre-existing conditions in life threatening conditions, this could provide some coverage subject to other terms and conditions of the policy.

If you have had the bypass surgery within 48 months prior to commencement of your travel/trip, then the same will be treated as a pre-existing condition under the policy and any claim/treatment occurring as a result of the surgery, will not be covered under the policy. Similarly if 48 months have elapsed since the surgery, but you are still under continuous medication for the bypass, the same will be treated as a pre-existing condition and excluded under the policy. Some insurance policies have a limited coverage for pre-existing conditions in life threatening conditions, this could provide some coverage subject to other terms and conditions of the policy.

If you are still under continuous medication for diabetes, the same will be treated as a pre-existing condition and excluded under the policy. Some insurance policies have a limited coverage for pre-existing conditions in life threatening conditions, this could provide some coverage subject to other terms and conditions of the policy, if the life threatening condition is a result of you being a diabetic.

Yes. No complaint to the Insurance Ombudsman shall lie unless the complaint is made within one year:

• From the date of receipt of the order of the insurer rejecting the representation.
• From the date of receipt of decision of the insurer which is not to the satisfaction of the complainant;
• After expiry of a period of one month from the date of sending the written representation to the insurer if the insurer named fails to furnish reply to the complainant.

Yes, IRDA has implemented the Integrated Grievance Management System (IGMS). IGMS provides a gateway for policyholders to register complaints with insurance companies first and if need be escalate them to the IRDA Grievance Cells. It uses Web interface to ensure that it is accessible at all places and is on real time. It has also a mechanism to capture complaints received in physical as well as email form or voice calls received by IRDA Grievance Call centre (IGCC).
Also IRDA Grievance Call Centre (IGCC) can be accessed through

• Call: Toll free number 1800 4254 732
• Email: complaints@irda.gov.in
• Post: Write to
  Insurance Regulatory and Development Authority of India
  Consumer Affairs Department – Grievance Redressal Cell.
  Sy.No.115/1, Financial District, Nanakramguda,
  Gachibowli, Hyderabad – 500 032
  

Some of the typical exclusions under the Travel policy will include:

• any Pre-existing Condition or any complication arising from it (unless specifically covered under certain plans that are purchased by the insured)
• services, supplies, or treatment, including any period of Hospital confinement, which were not recommended or approved, and certified as Medically Necessary by a Physician
• routine physicals or other examinations where there are no objective indications or impairment in normal health, and laboratory diagnostic or X-ray examinations except in the course of a disability established by the prior call or attendance of a Physician (an example could be a person visiting the hospital to check their blood pressure or their cholesterol levels, just for their information)
• elective, cosmetic, or plastic surgery, except as a result of an Injury caused by a covered Accident
• suicide, attempted suicide (whether sane or insane) or intentionally self inflicted Injury or Illness, or sexually transmitted conditions, mental or nervous disorder, anxiety, stress or depression, Acquired Immune Deficiency Syndrome (AIDS), Human Immune deficiency Virus (HIV) infection
• being under the influence of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a Physician and taken as prescribed
• any loss arising out of War, civil war, invasion, insurrection, revolution, act of foreign enemy, hostilities (whether War be declared or not), rebellion, mutiny, use of military power or usurpation of government or military power, Terrorism
• congenital anomalies or any complications or conditions arising therefrom
• participation in winter sports, skydiving/parachuting, hang gliding, bungee jumping, scuba diving, mountain climbing (where ropes or guides are customarily used), riding or driving in races or rallies using a motorized vehicle or bicycle, caving or pot-holing, hunting or equestrian activities, skin diving or other underwater activity, rafting or canoeing involving white water rapids, yachting or boating outside coastal waters (2 miles), participation in any Professional Sports, any bodily contact sport or potentially dangerous sport for which You are untrained (please note that on our eIndiaInsurance website, we offer some insurance plans that cover Adventure sports…so if the insured is likely to participate in any of these activities, it’s best to buy a plan that covers Adventure Sports)
• pregnancy and all related conditions, including services and supplies related to the diagnosis or treatment of infertility or other problems related to inability to conceive a child; birth control, including surgical procedures and devices

Please note that this is not the complete list of exclusions. Please refer to the terms and conditions (policy wordings) that have been shared with the insured along with the policy certificate for the exhaustive list.

The Assistance Company is the partner abroad who is available to assist the insured during any medical or non medical emergency. They are normally referred to as the Third Party Administrator (TPA). Most insureds assume that the Assistance Company is only there for support during medical emergencies, but they do also support in many non medical situations as well. They normally provide the following services:

• Medical Assistance - As soon as the Assistance Company is notified of a medical emergency resulting from an Accident or Sickness, they will contact the medical facility or location where the insured is located, confer with the Physician to determine the best course of action to be taken. If possible and if appropriate, the insured’s family Physician (in India) will be contacted to help arrive at a decision. The Assistance Company will then organize in securing the availability of services of a local Physician and arranging Hospital admission and monitor the insured whilst in hospital.
• Medical Evacuation – When the Assistance Company’s medical panel, judges that it is medically appropriate to shift the insured to another location abroad for treatment or return the insured to India, the Assistance Company will arrange the evacuation, through appropriate mode of transport
• Repatriation – They agree to make the necessary arrangements for the return of the insured’s mortal remains to India in the event of the unfortunate death of the insured whilst abroad and while this policy is in effect.
• Legal Assistance - If the insured is arrested or is in danger of being arrested as the result of any non-criminal action against charges attributed to the insured, the Assistance Company will, if required, provide the insured with the name of an attorney who can represent the insured in any necessary legal matters.
• Lost Luggage or Lost Passport - If the insured, outside India, notifies the Assistance Company that the insured’s luggage or passport has been lost, the Assistance Company will assist the insured by contacting the appropriate authorities involved and provide direction for replacement.
• General Assistance - The Assistance Company will serve as a central point for translation and communication for the insured during emergencies. The Assistance Company agrees to provide the insured advice using services available from consulates, government agencies, translators and other service providers that can help with travel problems.
• Pre-Departure Services - prior to the insured’s departure, the Assistance Company can provide hazard information about foreign locations, information about immunization requirements and passport or visa requirements, general information about weather at locations of travel. The Assistance Company will also arrange for special medical care en-route (i.e. dialysis, wheelchairs, etc.) if required.
• Emergency Travel Agency - the Assistance Company will also provide the insured with 24 hour travel agency service for airline and hotel reservations. The Assistance Company will also arrange payment for the insured’s airline tickets and other travel services, using the insured’s credit cards. Prepaid ticket pickup at airline counters or ticket delivery by mail or courier will also be arranged by the Assistance Company.