You can purchase visitors medical insurance from companies based in your home country (such as India) or from companies in the U.S. Generally, the cost of medical insurance from an American company is higher, although it is still the preferred insurance to purchase. As demonstrated in the comparisons below, American insurance has many advantages.
The following table provides a detailed comparison of the various issues involving insurance products available from companies in the U.S. and India. Please keep in mind that this is a generic discussion. There may be exceptions to the offerings of products in both countries (and all the products from a given country do not work the same way). You should review all the details of any insurance plan you are considering before purchasing it (i.e., any brochures, policy wording, comparisons between plans and information from your representative).
Most of the information below regarding Indian companies was taken from the Web sites of various companies, as it existed as of writing this, and it may change in the future in case any of the companies revise their products. The information is also based on our personal experiences in dealing with these companies on a trial basis during previous visits to India, professional experience dealing with many customers on a daily basis, and from reading the discussion forums and experiences section on this Web site. The information is not targeted towards any specific company or product.
In order to sell health insurance in the U.S., the person or the company has to be licensed as an insurance agent/agency. The agent goes through training, takes an extensive exam and is regulated by a department of insurance. The agent is generally well aware of how U.S. health care works.
Insubuy®, Inc. is a leading brokerage firm in the U.S. for visitors medical insurance. Each person that answers the phone is a knowledgeable and experienced insurance professional in the U.S. As a broker, we work for the customer (you) and not for any specific insurance company. If you have any problems with claims under policies purchased through us (which generally should not happen), we will work with you to help resolve them. You can contact us and provide us with the relevant information and the authorization to discuss your claim with the insurance company. (We require your authorization because we work for you, not for the insurance company. Pursuant to the HIPAA privacy law, they cannot discuss your medical details with us without authorization.) A team of three people in our company will review the claim, and if we determine that your claim is legitimate, we will present our arguments to the insurance company. We will explain the situation in more detail, clear any confusion, and do our best to help you through the process.
Overseas travel insurance is mostly sold through travel agents when you buy your airline tickets. Travel agents generally do not go through any formal training in selling insurance, are not regulated by government authorities for insurance, and are not aware of how health care works in the U.S. Would you buy home insurance from a builder or car insurance from a car dealer? No. So why would you buy travel insurance from a travel agent?
Travel agents and insurance agents in India are generally not willing or available to help when you have a problem with a claim in the U.S.
Most insurance companies have been around for a long time and have a lot of experience in dealing with the U.S. health care system.
There are reliable companies with proven track records. Companies are rated A-, A, A+ or A++ by A.M. Best Company.
There are many choices to suit your needs based on your budget and the amount of coverage that you wish to purchase.
Even if you have not heard of the insurance company, because they do not sell domestic insurance (e.g., Aetna, Cigna, Blue Cross) or you did not have to deal with them until buying visitors insurance, the providers (doctors/hospitals) will have no problem billing the correct entity. The insurance is connected to a specific PPO network that the providers will recognize and bill. (E.g., no matter which bank or organization issued your credit card, as long as it has a MasterCard or Visa logo on it, stores that accept MasterCard or Visa will accept the credit card.
Private insurance companies are relatively new and have little experience. They may be well-known names in India because they have been around for years in other industries such as automobile and banking, but not because of their insurance experience. More importantly, most providers in the U.S. do not know about them and that is what matters. Even though some of these private companies collaborate with foreign companies, they are still all Indian companies with a presence only in India.
Most products are connected to a PPO network. PPO stands for Preferred Provider Organization. It is a network of doctors, hospitals and other providers who are contracted with the insurance company. When you go to a provider in the network, they recognize the insurance, generally bill the insurance company directly, and charge the company the network-negotiated fees. Most products have a large nationwide network. You can always go outside the network, too. However, in this scenario, the provider may or may not be willing to bill the insurance company directly, and you will not qualify for the discounted network-negotiated fees.
There is no PPO network, and you can go to any doctor. It is easy to say, "Just buy this policy, call this number and everything will be taken care of. There is nothing to worry about." However, the question remains, who is going to accept the insurance? You have to consider what may happen in reality when you really need the insurance. You would first have to ask the hospital or doctor whether they will accept insurance from a company in India, bill the insurance company in India, and deal with claims in India. If they say no, regardless of what the agent/insurance company told you, you will have to pay the provider(s) up front and file for reimbursement from the insurance company later. Also, there are no discounts from network-negotiated fees.
Whenever you go to the doctor or the hospital, the first thing the receptionist asks for is your insurance card. If you buy from a U.S. company, you will get a health insurance card that is imprinted with the insured person's name, certificate (policy) number, PPO network logo, claims filing address in the US, and a phone number in the U.S. to call to verify the coverage. An insurance card is required for providers to consider direct billing.
When you purchase insurance from the U.S. based companies, you will receive a virtual ID card in an e-mail immediately, and the actual ID card will be mailed to you the next business day.
Note: Some products send ID cards only electornically and not by postal mail.
You will not get an insurance card. Therefore, most providers will not be willing to bill the insurance company directly, especially if it is based overseas. In fact, many companies have noted in their claims procedure that you have to first pay the provider directly in the U.S., and then, on your return, provide the company with the proof of return to India and file for reimbursement in rupees.
See the information for PPO networks and insurance cards above. When you go to a participating provider within the network, most doctors and almost all hospitals are willing to bill the insurance company directly.
See the information for PPO networks and insurance cards above. You will have to pay the provider out of pocket first and then file for reimbursement from the insurance company. In fact, many companies may require that you call them first (in places like New Delhi) to get permission to visit a doctor. Otherwise, you may not be covered. There are no network-negotiated fees.
Even if some companies claim they have a toll-free number in the US, it is simply a telecom related technical convenience matter, which just determines who pays the phone bill. Anyone can pay a few dollars and get a toll-free number that rings in India. The hospitals or doctors will be most concerned with the fact that the claims are handled in India and all the paperwork needs to be sent to India.
Some companies may also claim that they have some connection to organizations in the US. It is most likely that these US organizations are simply clerical facilities designed to collect paperwork and forward it to India for claims processing. Again, the hospitals or doctors caring for you in the US will be looking at this detail.
Finally, even if a company indicates that the claims are in fact adjusted in the US, the administrator may not have an actual reserve of money to pay these claims. Therefore, this administrator may have to get the funds from the insurance company in India first and will be unable to pay you or the provider until this money arrives. This process can take time, sometimes even months, during which time collection agencies may already be contacting you.
There are two types of visitors insurance plans available in the US: Fixed coverage plans are cheaper and provide limited coverage. Comprehensive coverage plans are more expensive and provide more extensive coverage.
If a plan is comprehensive, it is comprehensive for all ages. If a plan is fixed, it is fixed for all ages.
Click here to read more information about visitors insurance types.
Most private companies in India offer only fixed coverage plans and only for people age older than 55 years (older than 50 years in some companies). Many times this fact is not even mentioned in the brochure and may not be explained to you. It may be written only in the details of the policy, which most people do not bother to read.
As there is no government mandated universal legal definition of fixed vs comprehensive coverage plans, some companies inaccurately claim that their plans are comprehensive plans. In that case, please ask whether their plans have any sub-limits. If there are any sub-limits, the plan is a fixed coverage plan, and not a comprehensive coverage plan, no matter what they call it.
In fact, fixed coverage plans are so limited that you are really not getting much coverage at all, even for new medical conditions.
Some plans have other severe limits, e.g., if you buy $50,000 worth of insurance, you may be covered only up to $12,000 per sickness. Therefore, it is really a $12,000 policy and not a $50,000 one. Be sure to research the policy details thoroughly and do proper comparisons before making any decisions.
If you extend your stay in the U.S., you can renew the insurance for up to one, two or three years, depending upon the product. Please note that this is a true extension and not a repurchase of the insurance. Therefore, if a covered illness or injury occurs in a previous period, it would be covered during this renewed period as well - as long as you renew your policy before the expiration date.
If you extend your stay, there is no renewal option. Some companies may offer what they call a renewal, but, in reality, it is a repurchase. And, a repurchase will be allowed only if no claims have occurred under a previous policy (i.e., the policy about to expire or expired).
Moreover, if a person is staying or traveling abroad and wants coverage outside of India, IRDA regulations only allow an Indian citizen to purchase an insurance policy from an Indian company for a maximum of 182 days.
If you leave the U.S. earlier than expected, most products - provided no claims have been submitted since the effective date of the policy - will give you a refund for the pro-rated duration of the policy minus a $25 cancellation fee.
Click here to read more information about cancellation/refund rules for visitors insurance.
No refund will be offered.
In the event that an insurance company does not pay appropriately, you can contact the insurance regulatory authorities in the U.S. The insurance industry is one of the most highly regulated industries in the United States and the government rules are very strict. You have a much greater chance of getting the benefits stipulated for in the insurance policy with this support.
Most U.S.-based companies that offer visitors medical insurance are members of the Better Business Bureau (BBB), which can help with any dispute that arises. There are also various organizations that provide arbitration for disputes that may be able to help you.
Insurance regulatory authorities in the U.S. will not be able to help you, because they have no jurisdiction over the insurance companies in India. The Better Business Bureau and other US organizations will be unable to help you either.
If you need assistance at any time, you will be dealing with customer service agents located within a similar time zone as you.
For emergencies, these customer service agents are available 24/7. For other matters, they are available during regular business hours, Monday through Friday.
U.S.-based insurance policies offer faster claim processing with less paperwork and follow-up required.
Because of the significant time zone difference, you may have to get up in the middle of the night to call customer service in India. Even if a company offers a 24-hour call service, the key decision makers may be working only during the day in India.
Although this is an important factor, it should not be a deciding factor in choosing between an American or Indian insurance policy. Often, you get what you pay for.
Both outpatient and inpatient benefits are covered as long as the injury or illness in question is covered by your policy.
If you are told that you need to go to the hospital instead of a doctor, you should check whether the outpatient benefits (e.g., doctor's office visits, outpatient prescription drugs, x-rays) are covered or you are only covered for hospitalization.
You can get instant quotes and make instant purchases with a credit card payment right here on insubuy.com, a secure and McAfee Secure certified Web site. Coverage can start as early as the next day or any future date that you specify.
No membership, paperwork or medical exam is required.
Online purchase is not common for Indian insurance companies. You will have to deal with manual paperwork. A medical exam is also often required with many products, at least for people above a certain age.
There are no clauses regarding delayed treatment. As long as your treatment is medically necessary and not for a pre-existing condition, it will be covered, and you will be treated immediately.
Any medical treatment that can be delayed until you return to India is excluded from coverage. The determination of what treatment(s) can or cannot be delayed will be decided jointly by the treating physician and the Emergency Assistance Service Provider in India . This decision can be very subjective and potentially cause claims problems.