Overseas Mediclaim Process

Scope of Cover and Documents required for Claims

The salient features of the policy are:

  • Policy covers the medical expenses while the beneficiary is outside the Republic of India.
  • It covers medical expenses both as inpatient as well as outpatient while in a foreign country.
  • It provides for Medical Repatriation to India.
  • Cashless settlement is provided through Overseas Services Provider .
  • Personal Accident Cover.
  • Loss of Checked Baggage.
  • Delay of Checked Baggage.
  • Loss of Passport.
  • Personal Liability.
  • Hijack Cover.
  • Trip Cancellation.
  • Missed Departure Up to the specific limits mentioned in the said policy.

The Standard Exclusions of the Policy are:

  • Any medical condition or complication arising from it which existed before the commencement of the policy period, or for which care, treatment or advice was sought, recommended by or received from a physician.
  • Routine physical or other examination where there is no objective indication of impairment of normal health.
  • Medical expenses beyond the expiry of the policy period.
  • Suicide, attempted suicide or willfully self-inflicted injury or illness, mental disorder, anxiety/stress/depression/nervousness having no underlying physical illness as a cause; venereal disease, alcoholism, drunkenness or the abuse of drugs.
  • Manual work or hazardous occupation, self-exposure to needless peril (except in an attempt to save human life), engaging in any criminal or illegal act.
  • Pregnancy, resulting in childbirth, miscarriage, abortion, or complication arising out of any of the foregoing.
  • Experimental, unproven or non-standard treatment.
  • Treatment by any other system other than modern medicine (also known as Allopathy).
  • The cost of spectacles, contact lenses, hearing aids, crutches and all other external appliances and/or devices whether for diagnosis or treatment.
  • Delay of baggag e when the intended destination is in India.
  • Loss or damage to the insured`s passport as a result of the confiscation or detention by customs, police or any other authority.
  • Loss which is not reported to the appropriate police authority within 24 hours of the discovery of the loss, and in respect of which an official report has not been obtained.
  • Loss caused by the insured`s failure to take reasonable steps to guard against the loss of passport.

Documents Required for Health Claims:

  • The Overseas Provider should be intimated for Medical Emergencies and other claims.
  • The Overseas provider should be given the copy of the Policy together with a copy of the Passport for Identification details.
  • The Hospital where the Insured is admitted has to send the Pre authorization to the Service Provider who in turn will process the Claim and accord sanction.
  • In cases where the treatment is of outpatient nature and the Insured has intimated but not claimed whilst abroad can be claimed after return to India by submitting all the required documents to the service providers office in India.
  • In cases where the claims are rejected by the Overseas service providers the Insured can lodge the claim in India for treatment taken through the Insurance Company.

Documents Required for Personal Accident Claims Death Claims:

  • Intimation to overseas claim providers.
  • Completion of claim form.
  • Report of the Police Authorities regarding circumstances of Death.
  • Death Certificate issued by the Authorities.
  • Inquest certificate issued by the Police authorities.

Documents Required for Personal Accident Injury Claims:

  • Intimation to overseas claim providers.
  • Completion of claim form.
  • Report of the Police Authorities regarding circumstances of Injury.
  • In cases of disability due to Injury then the percentage of such disablement duly supported by the report of the Medical Practioner.
  • Copies of Medical Reports for treatment taken.

In the event of Claims being repudiated by the Insurance Company the following options are available as a recourse:

  • Make a representation to the Insurance Company/TPA.
  • If no reply is received within 15 days on making such representation make a representation to the Grievance Cell of the Insurance Company.
  • If No Reply is received or if the reply is not satisfactory then make a representation to the Insurance Ombudsman who has Quasi Judicial powers to hear the case and make adjudication.
  • If still not satisfied the next option is to go to court.