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Dear Sir/Madam, I am living in India and planning to visit my son who lives in the US for a period of 6 months. I am planning to buy a comprehensive insurance. I was going through the policy wordings of some of the insurance policies like "Patriot America Plus" and "Atlas America" that cover "pre-existing" ailments but I could not understand the legal wordings. My query is - 1) If any pre-existing ailment like DIABETES and HYPERTENSION causes or results any unforeseen medical issue that has never occurred before and that requires hospitalization, will that be covered? 2) If the pre-existing ailment is chronic. If the ailment progresses and causes any acute problems or problems that has not occurred in the history of the patient and the onset of the problem requires hospitalization, will that be covered? 3) If hospitalization occurs as a result of accident, will that be covered? Request you to answer in lay-man terms. thanks and regards
Please see the answers to your questions below.
1. If any pre-existing ailment like DIABETES and HYPERTENSION causes or results any unforeseen medical issue that has never occurred before and that requires hospitalization, will that be covered?
The plans are primarily designed to cover any new illness, injury or accident which occurs after the effective date of the policy. They will not cover pre-existing conditions routine doctors' visits, immunizations or medications in relation to a pre-existing condition. The Atlas America and Patriot America Plus plans provide coverage for an acute onset of a pre-existing condition up to the policy maximum for anyone under the age of 70. An acute onset is defined as a sudden and unexpected recurrence of a pre-existing condition that occurs all of a sudden without any prior symptoms or warnings and treatment must be taken within 24 hours. If something happens to the insured which meets the definition provided the plan would provide coverage. This determination is made by the claims department at the time of the occurrence. The claims department determination whether approval or denial will be made utilizing the attending physicians statement.
2. If the pre-existing ailment is chronic. If the ailment progresses and causes any acute problems or problems that has not occurred in the history of the patient and the onset of the problem requires hospitalization, will that be covered?
Chronic or congenital conditions are excluded under the policy. Any ailments which are caused by the congenital condition would also not be covered under the insurance since the exclusion is listed in the policy certificate wording.
3. If hospitalization occurs as a result of accident, will that be covered?
If the accident is considered an eligible medical expense the plan would provide coverage for the hospitalization. The benefits would be paid according the guidelines of the policy.
You may also obtain assistance by contacting our office at (866) INSUBUY. If you have any additional questions please let us know.
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DISCLAIMER: Information presented in our Questions and Answers section is generic and was deemed to be accurate at the time of response. Please use the answers as a guide and do not make decisions based on the answers. The answers presented may be outdated and altogether inaccurate currently or not relevant as the details provided such as the insurance terms and conditions, plan benefits, eligibility and coverage may have changed. Insubuy assumes no responsibility for relying on such answers. You should review the latest certificate wording of the insurance policy (available on this website) for the product you are considering for the latest and complete details. If there is any conflict between the answers provided here and the certificate wording, the details of the certificate wording will prevail.
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