It is widely known that medical costs are lesser in India as compared to developed nations like USA and Canada, as a result of which families from such countries come to India on what is called “medical tourism” i.e., to get the surgeries, etc. done at a fraction of the cost.
However, the lesser known fact is that back home in India, a desire to get the best medical treatment for severe diseases like cancer and brain tumour have led to a trend whereby Indian families explore options to seek treatment overseas.
Health insurance market in India: The winds of change
In India, most of the health insurance policies require treatment to be taken in India. Some insurers like Max Bupa and Religare have been offering cover for overseas procedures. But if you read the fine print, the cover is restricted to certain specified 9-10 illnesses only. However, things have started changing. Some time back, Cigna launched its operations in India in a joint venture with TTK Healthcare and had policies that provide overseas cover. Similarly, Apollo has launched a rider in its plans for overseas treatments.
Features of select plans offering cover for overseas treatments
Let us look at the specific features and terms & conditions applicable to overseas treatments by the insurers offering these plans:
Max Bupa Heartbeat
Max Bupa’s flagship product “Heartbeat” contains a feature for “International Emergency Medical Evacuation and Hospitalization. This feature is only available in its platinum plan. According to the policy wordings, it will cover Emergency Medical Evacuation and Medical Expenses incurred on Hospitalization outside India. Following medical expenses are proposed to be covered by the overseas treatment clause:
Medicines, drugs, and consumables
Intravenous fluids, blood transfusion, injection administration charges
Operation theatre charges
The cost of prosthetics and other devices or equipment if implanted internally during a Surgical Procedure.
Intensive Care Unit charges
Reasonable Charges for Room Rent for Hospital accommodation
Religare’s “Care” is their flagship and most comprehensive product which offers a “Care Anywhere” cover for a sum insured of Rs. 50 lacs and onwards. The coverage is for five specified illnesses only viz. Cancer, Brain Tumour, Major Organ Transplant, Heart Valve Transplant, and Coronary Artery Bypass Graft. Some other terms and conditions of this cover are as follows:
The cover extends only to the in-patient care or day care treatment undertaken in any hospital
Payment will be made in India, in Indian rupees and on a reimbursement basis only (cashless model is not available)
The insurer will need a written prior seven-day notice to pay this benefit.
Cigna TTK Pro Health
Cigna TTK has a pro-health range of plans whereby a worldwide emergency cover is available without any sub-limits, which means that it is covered up to the full sum insured. Another good thing about this policy is that there is no significant sum insured threshold for this feature, which means that it is available for a pro-protect policy sum assured as low as Rs. 2.5 lacs. Clause II.8 of the policy terms and conditions spells out the following requirements:
The treatment is medically necessary and has been certified as an Emergency by a Medical Practitioner, where such treatment cannot be postponed until the Insured Person has returned to India
The medical expenses payable is limited to Inpatient hospitalisation only.
Payment will only be made in India, in Indian rupees on a reimbursement basis and subject to Sum Insured. Cashless Facility may be arranged on a case to case basis.
Maximum liability under the claim will be the sum insured including cumulative bonus.
The payment of the claim will be based on the rate of exchange as on the date of payment to the Hospital published by RBI and used for conversion of foreign currency into Indian rupees for payment of the claim.
Insured has to give an intimation of such hospitalisation within 48 hours of admission.
It may also be noted that Cigna TTK also has a group product in its portfolio named Global Health Group Policy, which is targeted at Indian companies having a globally mobile workforce and offers an insured level cover of up to Rs. 12 crores. There are four different areas of coverage & the group enrolling in this policy has to choose its area of coverage as follows:
India, Africa, Middle East, Oceania, Asia (excluding China, Hong Kong, Singapore, Japan, Taiwan)
India, Europe, Canada, Latin America, Caribbean
Worldwide Excluding the United States
Worldwide Including United States (minimum Sum Insured is Rs. 2.5 CR)
Apollo Munich Critical Advantage Rider
As compared to the products above which offer worldwide cover, Apollo has launched a “rider” which can be attached to its select products which are Easy Health & Optima Restore plans. The rider offers you freedom to avail specialized and best healthcare services worldwide for listed major illnesses. It offers you hassle-free medical treatment at our network centers with all coverage of travel costs for the insured and accompanying relative; accommodation expenses; second opinion & post hospitalization expenses.
There are two sum insured limits for this rider – USD 250,000 and USD 500,000. For age group 18-34, while the base premium for Apollo Munich Optima Restore is Rs. 8650, the additional cost for rider comes for USD 250,000 and USD 500,000 cover comes to Rs. 7767 and Rs. 8947 respectively. So, the rider effectively increases the premium by around 100%. The Good point is that even the rider premium qualifies for a deduction under Section 80D of the Income Tax Act.
Some other terms & conditions for this rider are as follows:
The sum Insured in the base policy has to be Rs. 10 lacs & above to avail of this rider.
This rider is not available for NRI/ PIO and is allowed only for Indian Citizens.
This rider covers only planned treatment abroad (not emergency treatment) on a cashless model. This rider does not work on the reimbursement benefit model.
The rider only covers some large illnesses like Cancer Treatment, Coronary Artery bypass surgery, Heart Valve replacement or repair, Neurosurgery, Live Donor Organ Transplant, Bone Marrow Transplant, Pulmonary artery graft surgery, Aorta Graft Surgery.
The coverage is as follows: Inpatient treatment, Post hospitalisation, Accommodation expenses, Travelling expenses, Repatriation expenses & Second opinion on critical illness
The Sum Insured of the dependent insured members should be equal to or less than the Sum Insured of the primary insured member. Sum insured of dependent parents and all the children must be the same. Rider will opt on all or none basis for all dependents.
Claim process: You have to notify the claim to Apollo, which will in turn forward it to the authorized service provider & recommend the hospital where insured has to undergo treatment on a cashless basis.
Given the high cost of medical care abroad and also the rise in mobility across geographies, Indian families increasingly prefer an anywhere cover as compared to the one that only covers treatment in India.
There are only a few insurers in India which cover overseas treatments, but the trend is set to change with more insurers coming in and generating more competition. As for the policyholder, it is important to buy the insurance with the right coverage and at the same time, maintain a separate medical fund for such emergencies.