INDIA NETWORK FREQUENTLY ASKED QUESTIONS AND
ANSWERS
Pre-existing Condition Rider -
Rev. 5/07/2010
New Higher Limits for Pre-existing
Conditions
Members when choose pre-existing
condition coverage along with the policy, the following benefit for offered for
acute Onset of Pre-Existing Condition for any pre-existing condition, effective
May 1, 2010.
| Age Group |
Policy Max |
Pre-ex Deductible |
Pre-ex Amount |
Additional Premium |
| 2-69 years |
100K |
$1,000 |
$20,000 |
25% |
| 2-69 Years |
100K |
$5,000 |
$40,000 |
23% |
| 2-69 years |
150K |
$1,000 |
$25,000 |
25% |
|
2-69 years |
150K |
$5,000 |
$50,000 |
23% |
| 70 Plus |
50K |
$1,000 |
$10,000 |
25% |
| 70 Plus |
50K |
$5,000 |
$20,000 |
23% |
| 70 Plus |
100k |
$1,000 |
$15,000 |
25% |
|
70 Plus |
100K |
$5,000 |
$25,000 |
23% |
1. Does the program cover doctor visits related to pre-existing
problems?
No. However, every policy holder with pre-existing coverage can
use the physician consultation service (on Phone) offered by India Network
Foundation during their stay in the United States for a small fee of $35 per
consultation. The consultation can be requested by completing the
Consult A Doctor Form. The Physician consultation can be used for
prescription refills, discussion of current medications, seeking second
opinions, or non-emergency illnesses. All participating physicians are USA Board
Certified and practicing physicians in USA.
2. What are pre-existing conditions? Can you
provide some examples?
A health or medical
condition is categorized as pre-existing condition if that condition is known to
the insured,
a Physician was consulted, or for which treatment or
medication was prescribed prior to the effective date of an Insured Person's
coverage. Diabetes, Blood Pressure (BP),
chronic back pain, high cholesterol, kidney stones, skin problems are some
examples of pre-existing conditions.
3 .
Why pre-existing conditions are excluded from coverage?
No insurance company can
afford to cover these sure losses with few premium dollars. The insurance
premiums are determined on the basis of probabilities, and not the sure or near
certain probabilities obtained from pre-existing conditions. Hence there
is no insurance company that would cover the pre-existing conditions. Many
insurance companies in the US will not even underwrite coverage if pre-existing
conditions are found in medical reports. The Consult a Doc
Program of India Network Foundation is designed to help visitors with
non-emergency nature problems arising out of pre-existing medical conditions.
President Obama's health care reform, when enacted, may help people with
pre-existing conditions, who currently can not obtain private medical insurance.
4 .
What is this "Pre-existing Condition Rider?" How does work?
Pre-existing condition
rider is an add-on option to India Network members who wish to insure
their visitors or themselves. This rider when purchased would cover life
threatening emergency situations due to any pre-existing medical condition.
The Rider DOES NOT COVER maintainence of pre-existing problems such as
prescriptions, lab tests, x-rays or doctor consultations or any outpatient
services. If you have non-emergency nature of sickness, you may
make use of India Network Foundation
Consult a Doc program.
5. Can you give some examples of when rider
would be of help?
For example, say someone
has blood pressure problem which is under control with medication. Suddenly the
insured become sick with brain hemorrhage and rushed to hospital. This would be
a scenario where rider would be of help. If the visitor want to see either a
specialist or a family physician to checkup blood pressure problem in ordinary
circumstances, the doctor visit is not covered either by the rider program or
the medical insurance. The India Network Program also offers Medical Evacuation
benefit and Repatriation benefit (see program link
for details).
6. How much does it cost? How much does it pay in case of emergency?
Please see the table at the top of this faq.
The rider provides
a maximum of $50,000 coverage with $150K policy and with a deductible of $5,000
for 2-69 Year old and $25,000 to 70 Plus members with $100K policy and with a
deductible of $5,000. The pre-ex coverage offered by
India Network Plan is the highest available in the USA.
The Rider is NOT available
with $50,000 program for 2-69 years old. For example, a member purchases the
pre-existing condition rider with $150,000 policy for parents. Mom got suddenly
sick and rushed to emergency room. She was treated and stabilized. The emergency
visit is related to pre-existing high blood pressure problem. The insurance will
pay U&C charges as given in benefits schedule.
The Insurance will pay to services related to the visit until it reaches $50,000
for this sickness (subject to $5,000 deductible) . IT IS NOT TEN PERCENT OF THE BILLS. ALL BILLS WILL BE
SETTLED AS PER THE POLICY UNTIL THE AMOUNT REACHES $50,000 (with 150K policy).
7. We have used all our rider amount; is there anything else that would help
with pre-existing problems?
India Network program
offers up to $25,000 for medical evacuation (with $150K policy). This amount
would still be available to the family should the family and attending
physicians decide to shift the care to home country.
8. I am browsing various sites on internet and
they authoritatively say that pre-existing conditions are not covered by any
insurance company. Is that correct?
Unfortunately, there are many health
insurance programs sold by insurance agents that do not serve consumer needs.
These agents are contracted with various General Agents and operate various web
sites and forums to promote products that does not serve consumer interest. No agent is allowed to sell or market India
Network Health Insurance in the US or elsewhere. There is no insurance program
other than India Network Health Insurance that is designed based on member
feedback and member welfare as the core of its program. India Network Program
is the ONLY ONE that covers pre-existing conditions in case of life threatening
emergencies for the elderly including 80 plus.
9. Are there any other companies that provide
some coverage for pre-existing conditions for shorter durations ie less than 3
months?
Multinational Underwriters (HCC Medical Insurance) provide limited coverage for pre-existing
conditions. The India Network Rider Program is much broader and provides blanket
coverage for pre-existing condition related emergencies. Please read the following clarification
provided by HCC Medical Insurance (formerly Multinational Underwriters):
"Please keep in mind that in order for the Acute Onset of a pre-Existing
Condition provision to take effect, the insured client must not have had any
treatment for that pre-existing condition during the 2 years preceding the
policy’s effective date, which is also known as the look-back period. If
treatment has been had within the 2 years preceding the policy’s effective
date, then there is no coverage for the Acute Onset of the Pre-Existing
Condition. Otherwise, said provision applies at the coverage limit maximums
described above" (Email dated April 20, 2010 from Multinational
Representative to Dr. Rao).
The above statement does not apply to INDIA
NETWORK PLAN.
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