This special type of Policy has been introduced catering to the medical need of personnel travelling abroad, premium for which is paid in Indian Rupees. However, claims are settled abroad in foreign currency in respect of any emergency treatment. This policy is not general health insurance policy.
Mercury Insurance Pvt. Ltd. London is the authorised agency which should be contacted in the event of any claim of insurance settlement is done through it.
Available schemes under this class of insurance are as detailed hereunder:
Business & Holiday Travellers only – Any Indian Resident taking bonafide trip abroad for Business & Official purpose or Holiday Traveller including spouse/ children of traveller & officials.
Plan ‘A’ – Benefits are available upto a limit of $ 50,000 worldwide excluding U.S.A./Canada.
Plan ‘B’ – Benefits are available upto a limit of $ 1,00,000 worldwide including U.S.A/Canada.
Plan ‘E’ – Benefits are available upto a limit of $ 1,00,000 for Corporate Frequent Traveller only – worldwide including U.S.A/Canada.
Maximum cover available under (i) and (ii) is 180 days only.
Employment and Studies : For all those travelers going abroad in this category separate schemes detailed as under are devised. The Proposal to be forwarded to GIC 15 days advance with necessary documents and reports.
Plan ‘C’ – Benefits are available upto a limit of $ 75,000 – worldwide excluding U.S.A./Canada.
Plan ‘D’ – Benefits are available upto a limit of $ 75,000 – worldwide including U.S.A./Canada.
Under this category (b) the proposer must have regular Visa for non manual job.
This Policy can also be issued to Foreign Nationals working in India with Multi-National Organisations getting their salary in Indian Rupees where they go abroad on behalf of their Indian Employers.
Age Limit : Between 5 to 70 years.
Any proposal above 70 years age has to be referred to GIC 15 days in advance prior to scheduled tour, duly recommended by Divisional Manager together with Medical Examination reports and Proposal Form.
Scope: This policy reimburses medical expenses incurred by the Insured person in the event of sudden sickness or accident during the tour period and consists of two sections.
Section I:
Sub-section A : Medical expenses incurred due to accident and/or sickness contracted / sustained during the Policy Period whilst travelling abroad. Maximum limit being the liability limit under the Policy or 52 weeks after the onset of the injury/ sickness or 12 weeks after expiration date of insurance.
Sub-section B : In case of evacuation of the person to India the company will reimburse the expenses in India as provided under Sub-Section A within overall limit of US $ 75000.
Sub-section C : This sub-section provides for repatriation and alternative expenses. In event of death of the Insured person during the policy period, insurers shall pay actual expenses incurred for preparation / transportation to India, mortal remains of insured or funeral expenses incurred in the country of Posting not to exceed $8000.
Sub-Section D : This sub-section provides for medical emergency reunion expenses upto limit of US$ 5000 in all in event of hospitalization of the insured person due to covered event. Where it is decided to medically evacuate the person the insurers may reimburse on recommendation of claim administrator expenses of travel by either of the parents or guardian or spouse. This would include the following:
Economy air ticket to and fro fare including transportation charges to the place where insured is hospitalised.
Reasonable travel and accommodation expenses incurred due to emergency reunion.
These expenses are reimbursed subject to:
Medical evacuation certified by attending physician within 5 days of commencement of travel by Relative who will return with the patient.
In event of critical condition of patient if medical evacuation is postponed emergency reunion should not exceed 10 days including travel.
Section II:
This section is applicable to sponsored students only. In the event of insured sickness or injury he is unable to complete the studies or in the event of death or Permanent Total Disablement the person is medically evacuated as per Section 1(b) or if any expenses become payable as per Section 1(c) this policy will indemnify nominated sponsor providing financial support to the Insured during the period @ $ 750 Capital Sum for each month of study completed. This sponsor must be declared in the Proposal Form.
In the event of non-completion of studies due to unsatisfactory performance of insured person and duly certified by the educationalist, insured person will not be entitled for any benefits under the policy.
Exclusions:
Pre-existent medical condition for which insured is already treated in India.
Any pre-existent disease at the time of inception of the Policy.
Travelling against medical advise or wait-listed/travelling for specified medical treatment or has terminal prognosis for specified medical condition.
Any expenses which could be delayed till return back to India.
Any cosmetic surgery unless proximately caused by accident.
Self-injury, veneral disease, drug, liquor.
Any expenses pertaining to routine check-up
Any operations related to Naval, Military, Air Force activity
War & Allied Perils
Any Aviation Activity – other than fair Paying Passenger
Inter Scholastic Sports event, including Winter Sports activity
Any existent health Policy except for excess claim not paid under such Plan.
Every Policy shall be subject to excess of $ 50 each claim and therefore, any expense less than $ 50 shall be borne by the insured. This policy can be issued by nominated D.O. only for a proposer upto 70 years for maximum period of 180 days subject to medical selection procedure complied with. Moreover, all the provisos pertaining to specific disease exclusion endorsement are taken care of viz. any expenses incurred pertaining to specific disease stated in medical history/ report in respect of say heart ailment including circulatory disorder. Hypertension, Diabetes, Arthritis, Piles, Cataract etc. These exclusions however, can be deleted provided specific details pertaining to disease are within normal acceptable range viz.
Heart Ailment ECG showing non-specific ST-T changes however, pulse rate ranges between 60 and 90. In case proposer has suffered from heart attack in past and has normal ECG then Treadmill Stress Test Report must be submitted. If report is negative then heart ailment can be covered.
Hypertension: Systolic B.P. not to exceed 140
Diastolic B.P. not below 90
Proposer is not taking any mediclaim to control B.P. then this exclusion can be deleted.
Diabetes Fasting Blood Sugar not to exceed 120 mg.
PP Sugar not to exceed 150 mg.
Proposer is not taking any treatment to control. Unless above reports are complied with these exclusions must be mentioned in the policy schedule.
All original reports and Proposal Form must be attached to the Policy carried by the insured and copies of these documents would be retained by D.O.
Any excluded pre-existing diseased together with Policy details must be forwarded to ‘Mercury’ by Telex on issuance of document.
Medical Selection Procedure: All proposals falling under the following age group category will be required to submit ECG reading with concluding remarks. Fasting Blood / Urine Sugar, Urine Strip Test. Moreover, wherever medical history reveals heart ailment, then computerised Treadmill Test must be obtained and report being negative cover can be granted without exclusion.
In case proposer is unable to submit the reports cover for sickness can be granted upto $ 10000 with accident cover for full Sum Insured.
Medical Tests have to be conducted by M.D. doctor who is also a cardiologist.
For Corporate Clients, reports can be given by Company Doctor.