Are travel insurance directly billed or is it reimbursement basis, is there a hospital network

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All travel insurance companies do offer direct/cashless settlement to hospitals for inpatient treatment for Accident of Sickness expenses incurred by the insured traveler. Direct settlement is more often referred to as cashless settlement or payment and is the process where the insurance company issues a Guarantee of Payment (GOP) letter to the medical institution (Hospital) confirming coverage for the insured against the treatment being availed by the insured. This GOP is issued to the hospital after the insurance company/its TPA confirms that the insured does have a valid policy and the treatment/ailment is actually covered under the scope of the policy terms and conditions

Procedure to file a Claim under India travel insurance while overseas

It is important for the insured / family member of the insured to inform the Assistance Company/TPA as soon as the insured is admitted to the hospital for treatment to ensure they don’t end up spending any money from their pocket except the deductible payable for every claim. The Assistance Company/TPA Toll Free contact numbers/email ids are printed on the insurance certificate and they can be reached for any Assistance. Kindly note that it is important to also have the Policy Certificate number handy to inform the Assistance company regarding a claim.

There are two types of claims that an insured can file under a Travel Insurance policy. The first is a Cashless/Direct Settlement claim which is typically for Inpatient treatment for Accident & Sickness Medical expense claims.

The process for Direct / Cashless Settlement is as follows:

Insured needs to be admitted to the hospital for treatment for accident/sickness
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Insured's family member informs the Assistance Company (TPA) at the earliest
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Assistance Company reaches out to the hospital to ascertain details of the case - pre existing conditions etc
 
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Assistance Company checks coverage and sum insured limits with the insurance company
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Post all verifications and post approval from the insurance company, Assistance Company provides GOP to Hospital
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Hospital starts treatment and then claims a reimbursement for the expenses incurred against the GOP from the Assistance company/Insurer

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The other type of claims are Reimbursement claims where the upfront expenses are incurred by the insured and then a reimbursement is sought from the Insurance company. Reimbursement claim are usually for Outpatient Medical Expense claims and for Non Medical claims like Passport Loss, Baggage Delay/Loss, Trip Delay, Missed Connection, Personal Accident etc. They can also be for any minor treatment like a fever/cold/cough etc where the expenses incurred are not very high. Here the insured is required to retain bills, receipts, documents pertaining to the expenses incurred and then submit the same to the insurance company on their return to India. The documents are submitted along with a claim form which narrates the type of loss incurred and other information including bank details, policy details etc. All insurance companies reimburse these claims against the documents submitted in a standard outer timeframe of 14 working days subject to policy terms and conditions.

Just a short recap in the chart below on the types of claims:
types of claims

Each Assistance Company has their own network of hospitals throughout the world and the insured can reach out to these hospitals/medical facilities through the Assistance company. The recommended process is as follows:
  • For any support, call the Assistance Company/TPA and explain the nature of support required – medical, / non-medical…Keep the policy certificate number handy when calling them
  • Inform them about the exact location of the insured and what treatment is required.
    • For example, if the insured requires treatment for a routine illness (fever, cold, cough, hypertension etc) they would refer the insured to a General Practitioner (GP) who is located closest to the insured. They may also taken into consideration language challenges and could refer the insured to a local language speaking doctor (Hindi, Tamil, Punjabi etc)
    • If however there is a more serious condition that requires more sophisticated treatment, they could refer the insured to the nearest multi speciality hospital for treatment
    • If the treatment required is specialised in nature, like physiotherapy, psychiatric treatment etc they may opt to refer the insured to a specialist near by
  • They will inform the Medical facility prior to your arrival that will ensure better quality treatment
Hence it is important that the insured traveller uses the presence of the Assistance Company/TPA abroad and their network of hospitals for the best quality medical care.

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How are Claims settled?

Are travel insurance directly billed or is it reimbursement basis, is there a hospital network.

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