No. A visiting relative can be sponsored by India Network Member (Citizen/GCard holder/any resident alien) who is in the United States or Canada. They can obtain coverage under one form except when spouses are in different age groups. For example, one spouse is below 70 years (or below 50) old and one is above 70 years old (or above 50), they must file separate enrollment forms.
The Standard and Premier plans are an open network and claims can be made 24x7 through claims processing or travel assistance for emergencies. This is especially convenient for many visitors who have not built established relationships with doctors and other specialists.
The Network based comprehensive plan offers both an open and in network option. The reimbursement for open network providers in the Network based plan is 60/40 and reimbursements is 80/20 when MultiPlan providers are used. When using the Network based plan, it is recommended to use in network providers to maximize your out of pocket expenses at $1,000 should medical expenses exceed $5,000.
Premier Coverage includes all the benefits of Standard Coverage and coverage for pre-existing conditions. This policy when purchased would cover life threatening emergency situations due to any pre existing medical condition.
Premier Plan DOES NOT COVER maintenance 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 Doctor program.
The program is sickness- and injury-based, and for each sickness, or injury, the chosen deductible is to be paid by policy holder. The usual and customary charges are paid by the insurance as outlined in the Schedule of Benefits located on the web page after meeting the deductible.
The pre existing coverage offered by India Network Plan is the highest available in the USA. Pre existing coverage of $25,000 is available for 70 plus members with $100,000 policy and a pre existing deductible of $5,000. Alternatively, if the visitor elects the $1,000 Pre Existing Deductible, the Pre Existing Maximum Coverage is $15,000.
For example, your mom is suddenly sick and rushed to the emergency room. She is 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 for services related to the visit until it reaches $25,000 for this sickness (subject to $5,000 deductible with the $100,000 policy) for the visitor age 70 plus. IT IS NOT TEN PERCENT OF THE BILLS. ALL BILLS WILL BE SETTLED AS PER THE POLICY UNTIL THE AMOUNT REACHES $25,000 in this example.
Keep in mind, if an accident or sickness occurs unrelated to the pre existing condition, the standard deductible and standard maximum coverage applies.
Premier Coverage 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-existing coverage offered by India Network Plan is the highest available in the USA. Premier Coverage is NOT available with $50,000 program. For example, a member purchases the Premier Coverage plan 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).
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, chronic back pain, high cholesterol, kidney stones, skin problems are some examples of pre existing conditions.
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 the Premier policy would be of help. If the visitor wants to see either a specialist or a family physician to checkup blood pressure problem under ordinary circumstances, the doctor visit is not covered by the Premier plan. The India Network Program also offers Medical Evacuation benefit and Repatriation benefit (see program link for details).