Overseas health insurance
Through the evolution of living creatures ,evolved human race then passed through various improved economic activities called civilization. From the primary economic activity of collection of basic requirements like food materials to store them and then cooking and processing, secondary activity of production, trade and commerce started. With the evolution of jobs in specialized sectors, service the tertiary economic activities evolved. With evolution of trade through sea, marine insurance originated.
Along with civilization it became easy for man to fulfill need up in the Massslows hierarchy. In the pyramid of needs form lower needs, after food, shelter and clothing man needed security as the society evolved. As society evolved human started living in group and while in group they needed some sort of rules to control the social activity. So the age old tested social customs became the law and those natural laws are still prevailing.
As the economic and social activities became varied, then it required new laws. An initial economic law started with maritime commerce was in its full swing. Kings of England made various laws known as codes to control the commerce of maritime in the sixteenth century. Under the leadership of Edward Lloyd commercial community interested in shipping met, marine insurance had its beginning from then. In 1820 Act was passed to throw open Marine Insurance business, in 1871 Lloyds Act was passed and Lloyds of London was incorporated as a society of individual underwriters.
Necessity of Laws in Insurance Sectors:
Laws are generally laid after careful study of market and society, so as to control business from being misused by the organization for their individual needs rather than service. On the following facts generally necessity of laws can be defined:
How to allow insurer in the country
Who to control the business flow of organization
How to issue license to do insurance business
How to regulate the insurance business, premium rating structure, marketing forces, promotional activities
Who else can look into the business of insurance
What are the (non insurance) laws insurance company needs to abide
Do a separate ministry to be formed to overlook after the sector
Necessary laws to ensure individuals to insure
Laws to create different types of insurance products to be launched
How to frame insurance contract
How to protect public, policy holders, claimants against their various types of grievance
Overseas Insurance Policies:
A) Medical treatment cost is very high in western countries hence in almost all cases it is mandatory to have a cover before proceeding to such countries. Oversea Mediclaim Insurance Policy (OMP) provides indemnity for medical expenses necessarily incurred for treatment of illness/diseases first contracted or injury first contracted during the insureds period of overseas travel subject to policy term and conditions.
All Indian citizens who are to take bonafide journey abroad for business or official work or holiday or for employment or for studies are eligible to take this type of policy along with foreign nationals residing in India in the age group of 6 month to 7 years. This policy excludes all expenses incurred relating to existing disease or illness.
Type of OM Policy available:
Business and Holiday Standard cover
Plan A-1- Worldwide travel excluding USA sum insured $50,000
Plan A-2- Worldwide travel excluding USA sum insured $2,50,000
Plan B-1- Worldwide travel including USA sum insured $1,00,000
Plan B-2- Worldwide travel including USA sum insured $5,00,000
Corporate Frequent Traveller
Plan E-1- Corporate frequent raveller for worldwide travel sum insured $1,00,000
Plan E-2- Corporate frequent Traveller for worldwide travel sum insured $5,00,000
Employment & Studies (E&S) Cover
Plan C- E&S excluding USA and Canada sum insured $1,50,000
Plan D- E&S including USA and Canada sum insured $1,50,000
Period of Cover:
Period of Cover for Overseas Mediclaim Policy is defined as the period of travel subject to a maximum of 180 days for any one trip; however extension beyond this subjected to companies approval. This insurance is valid from the first day of insurance and expires on the last day of the number of days specified in the Overseas Mediclaim Policy Schedule or on return to India, whichever is earlier extension of the period of insurance is automatic of the period not exceeding 7 days, without any additional charge or by delay of public transportation services beyond the control of insured person.
This policy covers the injury, illness or accident covered under policy during the policy period and continues to pay beyond expiry date of policy, only emergency expenses would be paid up to forty five 45 days from the date of expiry of Policy provided insured is medically incapable to travel.
Validity of Policy:
This policy is valid if journey commences within 14days of the First day of insurance
Cancellation of policy is accepted if journey is not undertaken and upon production of PASSPORT as proof that journey has not been taken
No refund of premium or part thereof will be provided in case insured person returns to India before expiry of insurance
Risk covered by this policy:
This insurance will pay up to the limit of cover as per policy in total, for the insured in respect of covered medical related expenses, reasonably and necessarily incurred outside the Republic of India.
This insurance will cover the insured person if Claim Settling Agents recommends that continued treatment in India is appropriate.
This policy will pay the limit shown as Schedule if the insured person sustains bodily injury during the covered trip caused solely and directly by accidental violent and visible means.
This policy will pay the limit of cover in the event of insured person suffering due to total loss of checked baggage by an international Airline for an international out-bound flight.
In the event of Loss of PASSPORT insurance will pay up to the limit of cover for the reimbursement of actual expenses necessarily and reasonably incurred by the insured to obtain the emergency travel document in lieu of lost PASSPORT.
This policy pays up to the limit of cover if the insured person in his or her private capacity becomes legally liable to pay accidental bodily injury to Third parties during the trip.
Exclusion in policy:
No claim will be entitled where the insured person travels against the advise of Physician
No claim will be paid arising from suicide, attempted or willfully self infected injury or illness, alcoholism, abuse of drugs, expenses liability attributable to HIV or any HIV related illness including AIDS
No claim will be paid if insured person takes part in naval, military or air operations
No claim will be entitled arising from war, invasions etc
h No claim will be paid when insured engages in Air travel unless as a passenger or on aircraft not properly licensed to carry passengers
No claim will be entitled if insured person indulges in winter sports, mountaineering, riding or driving in races or rallies etc
Claims facilitation and assistance:
In case the insured person suffers serious illness, injury or needs hospitalization the insured or his representative must contact, Claim Settling Agent immediately for emergency advice with as much information as is available concerning the accidents or illness. Name of Doctor, hospital and contact number need to be given to the Claim Agents so as they can coordinate with the authorities.
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