Insurance Coverage clarification

[surersh]

Hi,

I would like to take travel insurance for my parents who are planning to travel to US ( Indian Citizens ). I need clarification on coverage for emergency admission during their visit. My father is about 70 years old and mother is about 60 years old.

--If there is a sudden fall and bone fracture during their visit, I would like to know your insurance coverage if he gets admitted to hospital under emergency for all tests which are required to investigate the fracture like CT scan etc.
-- My father got operated By pass surgery in 1993 since then he is fine and no complications, I would like to know your insurance coverage during vist if he gets admitted to hospital under emergency for By pass surgery.


Thanks,
Suresh

[insubuy]

1. That depends upon whether you have fixed or comprehensive coverage. Read https://www.insubuy.com/visitors-insurance/ to understand more.

Fixed: It will pay $200, $330 or $550 based on whether you have taken $25,000, $50,000 or $100,000 coverage.

Comprehensive: After the deductible, it pays 80% for first $5,000 and then 100% up to the policy maximum.

2. Most likely, that would be considered as pre-existing condition and not covered by any plan from any company.

If you have any further questions, please feel free to contact us at any time or post them here.

[surersh]

Pre-ex condition clarification

Thanks for the reply, I've one quick question realtes 2nd point, in my father's case, in IMG web site under " Exclusions --> Pre-existing Conditions " says : .... existed at the time of application or at any time during the three years prior to the effective date of the insurance... He got operated By pass surgery almost 14 years back ( in 2003) and he has been doing good till now and visiting US for couple of months, in emergency condition ( like chest pain and consecutive tests/surgery etc ) his medical situation treated as pre-existing condition. I would apprecaite if you can clarify this.

Thanks

[insubuy]

3 years pre-existing condition apply only to the conditions that are NOT chronic, like someone broke their leg 5 years back, completely recovered and if he breaks at the same place again.

Even though your father had bypass surgery 13 years back, he still has heart disease and must be taking medications, even if something like aspirin a day. That means, that the disease still exists today and 3 years look back does not appy. Therefore, it will not be covered most likely.
However, it finally depends upon the insurance company's claims department who will determine based on the medical reports and attending physician's statement whether something is a pre-existing condition or not.

[surersh]

Comprehensive insurance quote

I am looking for Comprehensive Insurance quote with $25000 maximum benefit. I am wondering to know whether IMG ( I am looking at Protection America ) provides this type of Insurance or it starts from $50000 benefit only.
Thanks in advance.
Suresh

[insubuy]

Protection America has $50k, $100k, $500k, $1 million.

If you want $250k, look at Atlas America at https://www.insubuy.com/atlasamerica-insurance/

[surersh]

Insurance Coverage Benefits

Thanks Narendra,

I understood from your reply regarding pre-existing condition. In my parents case ( my father 70+ and about 60 ) both are BP and diabetic patients, I don't see any reason to go with comprehensive plan which is more expensive than fixed plan, this is because in both cases, insurance does not cover treatment for pre-existing conditions and if I claim for any illness, ultimately end up with pre-existing condition.

I am looking at visitor's Care Fixed plan benifits for Plan A $25000. I want to know from that list which do not cover under pre-existing condition. I am sure all of them do not fall under Pre-existing condition like Hospital room & Intensive Care charges, as these charges are not for treatment. Please clarify.

Inpatient Treatment:
Hospital room & board
Intensive Care
Surgical Treatment
Consult physician
Pre-admission tests
Private duty nurse
Physician visits

Outpatient Treatment
Surgical treatment
Diagnostic x-ray & lab
Hospital emergency room
Prescription drugs
Physician visits

Miscellaneous Inpatient & Outpatient Services
Anesthetist
Assistant surgeon

Other Coverages
Ambulance
Dental for accident to sound natural teeth
Physiotherapy

[insubuy]

1. That is not right thinking.
No insurance product covers pre-existing conditions for visitors to US. Insurance is for future protection. And probably of someone getting into completely new medical condition is same for everyone for a given age. When that new condition occurs, what you get covered is what is the difference in fixed vs. comprehensive coverage plans.

Let's say a perfectly healthy person falls down in snow while walking, breaks the hip, needs surgery that costs $40,000. In comprehensive plan, you just pay the deductible and coinsurance (80/20 or 90/10 for first $5,000). In fixed coverage plan with $25k coverage, insurance company pays only $2,000 and you pay the difference. If you have $50k fixed coverage, insurance company pays only $3,300 and you pay the difference.

2. Insurance company will not pay anything for any purpose if it is related to pre-existing condition.

The example you gave regarding Hospital Room/Board,
Person gets admitted into the the hospital and needs room and board. That is obviously because the person needs some treatment and person is going there to just relax over there. If that treatment is related to pre-existing condition, hospital room and board is not covered either. Nothing is covered.

I hope that answers your questions.

If you have any other questions, please feel free to post them here or contact us at any time.

[surersh]

Insurance Plans - Clarifications

Thanks Narendra for clarifications, before making a decision I've couple of more questions.

-- For example: I took Comprehensive Coverage Plan with $100 deductible and coinsurance 80/20 for Max coverage $50000. If I visit doctor's office for check up ( not an emergency ) and if the Doctor's fee $250 then how this coverage works and priscription drugs cost coverage, please clarify.

-- Can I renew my policy by switching to different plans. i.e: First I took fixed coverage plan then after two months can I renew to Comprehensive Coverage Plan. For 70+ age groups I can not take insurance after one month arrival to US.

-- In your last update, you said, " ...if there is sudden fall with healthy person...." I think fall can happen to any person and at any place, like diabtic person may fall in the bath tub or slip during normal walk, this is nothing to do with pre-existing disease, coverage should be normal. Please clarify.

-- Also in your last update, for an example you said for fracture surgical treatment $40000 ( do you have any claims with this much amount ), just I am wondering to know this amount excludes all other fees like:
Hospital room & board, Intensive Care,Consult physician, Pre-admission tests etc. Even if I take Comprehensive Coverage Plan with $50000 max, I need to pay a lot of money from my pocket.

Thanks,
Suresh

[insubuy]

1. You first pay the deductible. Then insurance company will pay 80/20 for first $5,000 (or 90/10 if you chose), and 100% after that.
That means, you pay $100 first. Then out of $150, insurance company will pay $120, you pay $30 (or they will pay $135 and you pay $15, if you choose 90/10).

2. You can't make any changes after the effective date.

3. That should be covered.

4. I have seen many claims with much more amount, ranging from $75,000 to $125,00 and more. $40,000 I was referring to was just for surgery.

You should https://www.insubuy.com/guide/ It would answer many questions like these.

If you have any other questions, please feel free to post them here or contact us at any time.