Sublimits are extra limitations in an insurance policy's coverage of certain losses, primarily Sickness Medical expenses. They are part of the original limit, that is, they do not provide extra coverage, but set a maximum limit to cover a specific loss or for a specific medical expense. Sublimits can be expressed as a dollar amount or as a percentage of the coverage available. Typically they are part of the policy for insureds with advancing age.
For example, in a travel policy which has an Accident & Sickness Expense coverage of $100,000, it might have a sublimit of $10,000 to cover Surgery Expenses in the case of a Sickness. This means that only $10,000 of the total coverage can go toward paying for Surgery Expenses. The insured cannot receive an insurance payout of an amount exceeding the sublimit for the types of loss specified.
It is important to note that most insurance companies have a medical sublimit in place only for Sickness Medical expenses and this means that for any Accident related expenses, the maximum Sum insured is available to the insured for treatment.
The deductible is a cost sharing requirement that the Insurer will not be liable to pay/indemnify/reimburse in case of travel insurance policies for Accident & Sickness and for a specified number of days/hours in case of hospital cash/non medical benefits which will apply before any benefits are payable by the Insurer. A deductible does not reduce the sum insured. The deductible is applicable per event.
For example, the deductible under Accident & Sickness is $100. This means for every medical claim, the insurance company will not settle the first $100 of the claim. So if the medical claim is $250, then the insured will get a reimbursement of $150 (Claim amount $250 – Deductible of $100). Similarly if the claim amount is $90, then the insured will not get any reimbursement since the claim amount is less than the deductible limit of $100.
Another example of a deductible is for a benefit like Trip/Flight Delay. The deductible in this case is 12 hours. This means that if the insured’s Trip/Flight is delayed due to Inclement Weather or Equipment Failure beyond 12 hours, then the insured will get a compensation from the insurance company as per the terms of the policy. However, if the flight is delayed for 8 hours, then there will be no compensation to the traveller since the delay is less than the deductible of 12 hours.
The deductible under the Accident & Sickness is normally USD $100 .The policy deductible is applicable for each instance of sickness/ailment. For continuous treatments relating to the same sickness, the deductible will only be applicable once. The insured is required to quote the Claim reference number when contacting the assistance company while undergoing follow up / re-revisit treatments. The deductible will need to be paid by the insured in each instance of a new/ different ailment / sickness. If the insured is claiming a reimbursement for incurred medical expenses, then the insurance company will reimburse the expenses less the deductible amount.
During discharge of the patient and on preparation of the final bill, the deductible mentioned in the policy schedule is payable by the insured. Apart from this, all expenses that are not payable under the terms and conditions of the policy will also have to be paid by the insured to the hospital / medical facilities. The Assistance/Insurance company will directly pay the allowed expenses to the hospital.
For example assuming that the deductible is $100, and if the medical expense incurred at $8500, then the insurance company will give a guarantee to the hospital to the extent of $8400 and instruct the hospital to collect the $100 directly from the insured at the time of discharge.
A pre existing condition means any condition, ailment or injury or related condition(s) for which the insured had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to commencement of the first Policy issued by the Insurer. This means that if the insured is traveling abroad with a pre existing condition and avails of any treatment abroad, the insurance company will not be liable for paying the claim.
The insurance company normally goes by the guidance of the attending physician in the medical facility abroad while deciding whether a condition is pre existing or not. If the attending physician declares that the cause of the treatment is a pre existing condition carried by the insured, then the treatment costs will not be reimbursed under the policy.
Some insurance companies offer a limited coverage for medical expenses arising due to pre existing conditions, when the situation is Life threatening in nature.
A Life threatening condition is an unforeseen medical emergency, which puts the life of the insured at extreme risk. In such event, measures solely designed to relieve acute pain, provided to the Insured by the Physician for Disease/accident arising out of a pre-existing condition would be reimbursed upto a limit specified in the policy terms and conditions. The treatment for these emergency measures would be paid till the insured becomes medically stable or is relieved from acute pain. All further medical cost to improve or maintain medically stable state or to prevent the onset of acute pain would have borne by the Insured.
It is important to be noted that all plans displayed on the eIndiaInsurance website do not offer coverage for pre existing conditions. Hence the traveller should review the plan prior to purchasing the same, if they are looking for such a cover. If the traveller still has clarifications regarding the same, it is better to speak to our customer service executive.
Single Trip Insurance policies do not have a free look period. However an Annual Multi Trip period has a free look period of 15 days from the date of receipt of the Policy document to review the terms and conditions of this Policy provided no trip has been commenced. If the insured has any objections to any of the terms and conditions, the insured has the option of cancelling the Policy stating the reasons for cancellation and he/she will be refunded the premium paid for the policy, after adjusting the amounts spent on stamp duty charges and proportionate risk premium. The insured can cancel the policy only if the insured has not made any claims under the Policy.
The Insurance Company is committed to extend the best possible services to its customers. But there could be some situation wherein the insured may not be fully satisfied with the level of service or the decision made by an insurance company on a particular claim. If this is the case, then the insured, can lodge a complaint with the insurance company at their 24X7 Toll free number provided on the policy certificate, policy wordings (terms and conditions) or available on the company website. The insured can also choose to send an email to the customer service desk at the email id specified. After investigating the matter internally and subsequent closure, the insurance company will ideally send a response within a period of 10 days from the date of receipt of the complaint by the Company at its Head office or any of the branches. In case the resolution is likely to take longer time, the insurer will inform the insured of the same through an interim reply.
For lack of a response or if the resolution still does not meet the insured’s expectations, they can write to the Head - Customer Services at the insurance company. After examining the matter, they will send their final response within a period of 7 days from the date of receipt of your complaint. Within 30 days of lodging a complaint with the insurance company, if the insured still does not get a satisfactory response from the insurer, they can pursue other avenues for redressal of grievances, as well as directly approach Insurance Ombudsman appointed by IRDA under the Insurance Ombudsman Scheme.
The Insurance Ombudsman operates under Territorial jurisdiction and hence the insured will have to approach the appropriate Ombudsman with the details of grievance. The details are in the link here...
No. Any complainant, whose complaint on the same subject matter is or was before a Court/Consumer Forum or an Arbitrator cannot approach an Insurance Ombudsman.
The Ombudsman will receive and consider complaints or disputes relating to:
Yes. No complaint to the Insurance Ombudsman shall lie unless the complaint is made within one year:
Yes, IRDA has implemented the Integrated Grievance Management System (IGMS). IGMS provides a gateway for policyholders to register complaints with insurance companies first and if need be escalate them to the IRDA Grievance Cells. It uses Web interface to ensure that it is accessible at all places and is on real time. It has also a mechanism to capture complaints received in physical as well as email form or voice calls received by IRDA Grievance Call centre (IGCC).
Also IRDA Grievance Call Centre (IGCC) can be accessed through
Some of the typical exclusions under the Travel policy will include:
The Assistance Company is the partner abroad who is available to assist the insured during any medical or non medical emergency. They are normally referred to as the Third Party Administrator (TPA). Most insureds assume that the Assistance Company is only there for support during medical emergencies, but they do also support in many non medical situations as well. They normally provide the following services:
Some of the unique coverages include:
Some of the insurance company’s Student programs have unique Special Extensions specifically provided in the schedule of benefits:
A traveller must first realise that there are many insurance companies offering Travel Insurance plans in the India market today. They should also understand that in Travel Insurance, one size doesn’t fit all…this means that just buying a Travel Insurance product for the sake of obtaining a visa, or buying a policy because someone suggested it, is not the right way to approach the purchase of Travel Insurance. One must consider the following aspects of the insurance company before choosing a plan:
This is most prevalent in Health Policies, although a few insurers offer this benefit under Travel Insurance. A floater policy is one that is issued with a single sum insured covering number of individuals of a family. The cover can be used by any member of the family any number of times during the policy period. If a person wants a health/travel insurance for himself, his spouse & their children, the Family Floater plan is ideal and offers insurance coverage to the entire family under one premium payment.
LLet’s take an example wherein the person insures himself, his spouse & the two dependent children with the individual insurance plans with a sum insured of Rs 1 lac each, he ends up paying an average premium of Rs X for each family member, which amounts of Rs 4X. If the person opted for the family floater plan with the sum insured of Rs 3 lacs, the total premium would ideally be less than the separate premium payments in individual health insurance plans, ie less than Rs 4X. Moreover the individual plan has coverage of only Rs 1 lac for each member as against Rs 3 lacs in case of the Floater plan( in case the medical treatment exceed Rs 1 lac). This Rs 3 lacs is available for each of the family members individually as well as collectively.
It is recommended that as a general rule, at younger ages of all family members, opting for a floater cover is ideal. As the members grow older, they should go for an individual cover. But ultimately buying an individual cover or a floater cover is an individual’s preference.
The purpose of any Travel Insurance policy is to ensure peace of mind to the traveller when they leave home for a holiday or on business. It is also required to cover any unforeseen expense that may come up due to medical or non medical reasons during the trip. One must realise and acknowledge that such exigencies are as likely to happen abroad as in India. This suggests that every traveller should protect themselves from financial loss even during their travels within India.
The most common excuses for not buying Travel Insurance for trips within India are:
It is important for all travellers to note that the Travel Insurance policies are not just coverage for Medical Expenses, both Accident and Sickness…there are many important non medical covearges, most of which are listed below:
You can buy insurance online by using a credit/debit card, direct funds transfer using NEFT or RTGS or by using a cheque.
Travelers who have already traveled from India and do not have insurance can buy travel medical insurance after approval.
Insurance customers can renew their existing policy online before the exipry date at any time.
In case of a claim or reimbursement of treatment expenses, notify by contacting them.
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