What you should know before you opt for a global health insurance cover

Take the case of Religare Health Insurance Co. The company offers global health insurance cover for sum insured of Rs 1-6 crore, for both planned and emergency hospitalisation. However, the plan does not insure you for hospitalisation in the US. You need to pay an additional premium for it. A mandatory co-payment of 10 percent per claim is also applicable. Moreover, the risk coverage period is only 45 continuous days from the date of travel in a single trip and maximum 90 days on a cumulative basis in a policy year. So, in case there is a medical emergency on the 50th day of your trip, the policy will not cover you. The global cover of the policy does not insure you for pre and post hospitalization expenses.

Also, note that the hospitalization expenses borne are limited to inpatient hospitalization treatment only. In case there is no hospital admission required and the treatment is dispensed in an OPD – Out Patient Department -- of the hospital, such expenses would not be covered in the policy benefits, unless the customer opts for an optional cover to include OPD treatments by paying an extra premium. Moreover, overseas maternity benefit is applicable only if the cover opted is a floater cover as per the company terms and conditions. Therefore, if the policy is a standalone policy and not a floater policy then the maternity benefit, which requires an inpatient treatment in a foreign country, would not come under the purview of this coverage.

The ProHealth plan by Cigna TTK Health Insurance Co., offers worldwide cover but only for emergency in-patient treatments. It is applicable only if the policyholder is not in a position to return to India for the treatment. This means that it requires a certification from a medical practitioner at the place of treatment that the case is one of emergency. The claim is admissible only in event of this certification. The insurance claim is paid on reimbursement basis only and no cashless facility is available. This means the expenses have to be incurred by the patient or his accompanies in case of emergency and the same will be reimbursed only in India. The claim is settled in Indian Rupees and only after the patient returns to India.

Max Bupa Health Insurance Company offers international coverage under the platinum version of its Heartbeat Health Insurance plan. The policyholder can avail treatment abroad for 9 specified illnesses. They are covered only if detected in India by a medical practitioner within the policy period on cashless basis. Emergency hospitalization is also covered under the policy and sum insured is upto Rs 1 crore. However, the coverage does not include treatment in USA and Canada. You need to pay extra premium for it. It also has a co-payment clause of up to 20 percent of the sum insured.

Royal Sundaram offers a worldwide emergency hospitalization cover under its Lifeline elite health insurance plan. The sum insured under this plan ranges from Rs 25-150 lakh. However, the policyholder can claim only 50 percent of the base sum insured up to a maximum of Rs 20 lakh under this plan. Plus, there is a clause for deductible of USD 1,000 per hospitalization. The policy also includes international treatment for 11 specified critical illnesses with coverage on hospitalization and reimbursement of return airfares up to Rs 3 lakh. But critical illness needs to be diagnosed in India and customer needs to take pre-authorisation before proceeding for treatment. And there is a co-payment clause of 20 percent of sum insured. The cover does not include treatment in USA and Canada. The policyholder can pay additional premium to include these two countries.

While each policy has different terms and conditions pertaining to the global cover, all policies have a waiting period for pre-existing illness. So, if one has been diagnosed with a critical illness at the time of buying the policy, one will not be paid for the treatment till the waiting period is over. The waiting period ranges from 2-4 years.

Health insurance companies offer global cover only for large sum insured from Rs 50 lakh to Rs 1 crore. Therefore, these plans can also be very expensive. Take the case of Max Bupa heartbeat plan with global cover - the premium for Rs 50 lakh sum insured comes to Rs 48,114 per annum for a 35 year individual with a co-payment option of 20 percent. Whereas, the plan from the same company for domestic cover with sum insured Rs 50 lakh costs only Rs 9,541, almost 1/5th of the cost for global cover.

Along with high cost, the benefits that these policies offer are sharply defined and there are stringent terms and conditions, where the policyholder may not be able to derive the maximum benefit that the plan offers. Sometimes the sum insured available is insufficient for overseas treatment, which along with post-hospitalization expenses, shoots up the out-of-pocket expenses that the policyholder has to bear.

So, while health insurance plans that offer global coverage may look attractive, customers need to read the fine print before they actually buy one.

Here are a few key pointers to keep in mind while purchasing health insurance with global cover

• The plans cover only in-patient hospitalization treatment and exclude all other pre and post hospitalization expenses and OPD treatments.

• Treatments in US and Canada are excluded. To avail insurance in these countries you have to pay extra premium.
• These covers have 10-20 percent co-payment clause, which means the insured has to pay for the entire amount initially, post that once the person comes to India the company will pay 80-90 percent of the total cost.

• There is a waiting period of 2-4 years for all pre-existing diseases and illness.

• The cost of policies with global cover is almost 3-4 times the cost for domestic health insurance policy.

• Insured needs to intimate the health insurance company before travelling abroad for treatment in case of planned hospitalization, and the same needs to be certified by the doctor in India.

• An emergency overseas treatment requires a certification from a medical practitioner at the place of treatment that the case is one of emergency. The claim is admissible only in event of this certification.

• The claims are usually settled on a reimbursement basis as it is difficult for insurers to maintain a global network of associated hospitals. This means the expenses have to be incurred by the patient or his family initially, which will be later reimbursed by the insurer.

• The insured is exposed to the risk of adverse movements in exchange rate as the claim is settled in Indian Rupees and the customer pays for the treatment in foreign currency.

• Overall, the benefits that these policies offer are sharply defined and there are stringent terms and conditions, where the policyholder may not be able to derive the maximum benefit that the plan offers.

(The writer is Founder and CEO of VR Wealth Advisors.)