Beware of Pre-existing Condition Coverage Mystery – Not all policies are the same..

Many members got confused with finding from various web sites that claim to offer pre-existing conditions coverage maximums upto millions of dollars. On the top of it, these policies offered by foreign companies such as Lloyd of London look too good to be true when read only headlines and not definitions. Many agents selling these policies are clueless as they are bound to honor what they told you as the policy language prevails over whatever the sales person says.

The question is how come India Network policies offer only 20 or 25 thousand dollars of coverage under its flagship program, ACE Network program when others are offering 100K or 200K or even million dollars..

India Network ACE Comprehensive Program with pre-existing condition coverage – This plan provides no nonsense coverage for pre-existing conditions in a straight forward way. Pre-existing medical conditions are covered in the same way like new problems. The only difference is that pre-existing conditions have a separate deductible and policy maximum.  After the deductible is met, the plan will pay 80 percent of your bills till the insurance payments reach the pre-existing policy maximum.

India Network Premium Program – Covers pre-existing conditions in the same way like new problems except subject to special deductible and special policy maximum. After the deductible, the plan will pay fixed amounts irrespective of billing amount as it is a fixed benefit plan.

Platinum Plan by Sirius International (administered by IMG) – This plan sold under various labels by various vendors. It works best with new medical conditions and accidents. But is very weak on pre-existing condition coverage. Its language include several caveats that would nullify the coverage if you miss to follow any one of them.

The Platinum Insurance will pay Usual, Reasonable, and Customer y charges of a sudden and unexpected recurrence of a pre-existing condition. 

The above definition eliminates all out patient care related to pre-existing conditions out of the box. On the top of it, its narrow definition would disqualify most heart related problems, stroke, brain hemorrhage , etc.  that may happen first time and when people do not seek medical assistance within specified time period.

Other Plans sold such as Atlas America etc. have the following defintions

Acute Onset of a Pre-Existing Condition: If you are under age 70, you are covered for an Acute Onset of a Pre-existing Condition. An acute onset of a pre-existing condition is a sudden and unexpected outbreak or recurrence of a pre-existing condition which occurs spontaneously and without advance symptoms. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence.

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What is that means –  Most of the time, the Plan do not pay any bills related to for your pre-existing conditions and outpatient coverage is excluded to start with.

All plans provide medical evacuation and repatriation benefits, and accidental death benefit and they are not really pre-existing condition coverage related though some agents want to sell you on that.

1 Comments

  1. James E. Shouse

    Great and fruitfull information included in your topic. May this will help people to understand about Pre-existing Condition Coverage Mystery. Good work keep it up.

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