Not disclosing your medical history? Your foreign travel insurance claim can be rejected

Foreign holidays can be fun, but a sudden sickness abroad can put a dampener. Worse, what if despite having travel insurance, your claims get rejected abroad and you have to shell out precious US dollars?

Delhi-based Shikhar Jha, 53, visited the United States in April 2018 for two months to meet his daughter and son-in-law who recently had a baby. Jha had purchased a travel insurance policy online, but in a hurry, he did not disclose one crucial detail. He had a bypass surgery in the year 2016. The surgery was successful, Jha had recovered and had moved on. And perhaps, forgotten when the time came to pack his bags to fly overseas.

But the ailment came to haunt him. When he reached the US, he got pneumonia. He went to the hospital in New Jersey, and the doctor found something was wrong with his lungs.

When Jha submitted the report to his insurance company back in India, to claim the hospitalisation expenses, the firm rejected his claim. It said that Jha had not disclosed his bypass surgery and his heart condition while buying the policy.

This, despite the fact that the reason for his ailment in the US (pneumonia) had got nothing to do with his heart. " The company further told me that you are obliged to disclose each and every disease that has happened to you and even if that is cured earlier. It was a hard lesson for me," says Jha.

The merits of buying travel insurance are known. But just buying travel insurance doesn’t automatically mean that all your hospitalisation expenses, if any, while travelling abroad get covered.

Although buying travel insurance is easy these days and a policy can be bought online in a matter of seconds, it is important for the policyholder to make the necessary disclosures. Your past health is one such key disclosure.

What we forget is that travel insurance, just like your health insurance in India, can get rejected for a variety of reason. In such times, you are too late to make the right claims, like Jha realized it the hard way.

Foreign travel is very common these days, be it family outing, a solo adventure, honeymoon with your better half or for foreign education. Most travellers buy travel insurance because they think it is necessary and the cost of medical treatment abroad is restrictive. Usually, travel insurance covers financial losses like lost or stolen luggage, cancellation of holiday bookings as well as unexpected medical costs overseas.

Kapil Mehta, co-founder, Securenow.in, a Delhi-based insurance broker told Moneycontrol that it is worthwhile to know how the pre-existing disease coverage will work before you buy one. Whenever you take treatment outside the country, the doctor checks the health history of the patient.

The doctor records everything and gets to know about every pre-existing diseases related to them. “Even if you are making an insurance claim, during overseas travel, against some other ailment which is not related to an ailment or disease for which you had sought treatment in India in the past but did not disclose it while buying your travel insurance, your claims will get rejected,” says Mehta.

For the purpose of buying travel insurance, any disease or ailment that you’ve been treated for, in the past 48 months before you buy a foreign travel policy, is considered to be a pre-existing disease at the time of claim.

If an individual is injured or falls sick while travelling, the cover will include hospitalisation expenses, expenses for prescription drugs and outpatient treatment including doctor and surgery if any.

Tarun Mathur, Chief Business Officer- General Insurance, Policybazaar.com told Moneycontrol that travel Insurance covers almost all medical conditions provided that they have been disclosed by the insured at the time of purchase of travel policy. “The most common, pre-existing conditions like diabetes, blood pressure, cardiovascular diseases are also covered under travel insurance, provided you adequately disclose them at the time of buying the foreign travel policy,” he said.

There is generally a list of permanent exclusions—Acquired Immune Deficiency Syndrome (AIDS), cancer, self-inflicted injury, any sexually transmitted diseases—treatment for these diseases are not covered under most travel insurance plans.

If you get hospitalized in a foreign land for some other ailment, but it gets traced to the exclusionary conditions, even then the claim will get rejected. The doctors dig to find out the root cause of your ailment. Typically, any ailment including accidental death and permanent disability arising out of an accident, if not linked to a pre-existing disease or condition, is covered under your travel policy.

Check the pre-existing diseases coverage before you buy your cover to avoid disappointments later. Also, some insurers have specific exclusions while others don’t cover pre-existing diseases altogether. Do check with the adviser before you get one.

Disclose all past injuries or illnesses or medical condition while buying a policy to avoid any ambiguity during the claims process.

Opt for a cover with an insurance company with a transparent claims management processes and one who provides the list of global network hospitals on their website, thereby helping individuals avail cashless claims facility.

All foreign travel policies are cashless. Once you get admitted into a hospital, the doctor diagnoses and gives you a report. You need to send this report- through an email preferably- to your local insurance company here in India, who would then pay the money directly to your hospital abroad.

It’s best to stick to insurance companies that have a single touch point for all your foreign travel insurance needs, such as a single international toll-free number across the globe.

Only sudden hospitalisation needs (say, you get dengue while travelling abroad) are covered and till the patient is stabilised. Pre-existing diseases not disclosed will be overlooked only in cases where you face a life-threatening situation abroad and get hospitalised.

Any planned hospitalization due to pre-existing diseases will not be covered in your normal foreign travel policy.

Source: Moneycontrol