Will a claim be paid for a pre existing condition with visitor medical insurance?

A common question for visitors is “Will a claim be paid for a pre existing condition with visitor medical insurance?”  To answer this question, let’s take as an example a family member that had a heart attack 2 years ago.

Medical insurance for visitors with pre existing coverage of India Network Health Insurance policy would cover heart attack while other policies sold on various web sites would not. Consider the exclusions, requirements and limits. Some policies may have a look back period that might prevent reimbursement of a recurrence while another exclusion may require a precertification.  Some other health insurance plans for visitors have lifetime limits for pre existing condition coverage which could possibly exclude reimbursement for a second heart attack and some policies only cover “recurrence” of conditions.

Consider also that if the family member had high blood pressure but no prior heart attack, then a heart attack would not be covered as it is not a recurrence under all plans sold by various vendors except India Network Health Insurance Plan.

Prior to policies purchased before November 10, 2012, India Network had two guidelines. First, it was advised that the family member have insurance on the day of or day before their arrival in the USA to receive pre existing coverage from the onset of the enrollment. If the visitor is enrolled after arrival  in the United States, the first 7 days covered accidents only. Second, reimbursement for pre existing coverage required an emergency, and benefits would be limited to in-patient benefits.

Effective for policies purchased on or after November 10, 2012 underwritten by ACE American Insurance Company, India Network Health Insurance does not have either of these requirements. Pre existing condition coverage selected with either the Premier Plan or Network based (80/20) plan offers both in-patient and out-patient benefits. The deductible selected determines the maximum coverage available and there is not a 7 day accident only period for those that enroll in insurance after their arrival in the United States.

Administrative Concepts, Inc. (ACI) will provide on-line web portal for claim processor along with an EDI Payor # to facilitate claims processing for both open network plan or the Network based plan from India Network.

Leave Comment

Your email address will not be published. Required fields are marked *