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Tuesday, March 15, 2016

Mediclaim: Condition excluding medical treatment abroad


14 Mar 16, 08:28 PM

subbu: Editor Sir ! A request. Where exactly it is stipulated in the Group Mediclaim or its rules that the policy covers hospitalisation only inside India? In other words, if the retired person goes abroad gets hospitalised and admitted, would it not be possible to claim relief under this Group Mediclaim. I am not asking about cashless benefits. I am asking about the cover per se.

14 Mar 16, 08:52 PM

Ed.: Without referring to policy conditions, it should be presumed that as long as medical expenses incurred abroad are not SPECIFICALLY covered/included, it has to be presumed that such hospitalisation and treatment expenses incurred will not be covered.

On verification of the Policy it is found that as per Policy condition H. (8) (Page 27) "All medical/surgery treatment under this Policy shall have to be taken in India and admissible claims shall be payable in Indian currency." So the provision is very clear.

14 Mar 16, 09:23 PM

JM Aboobucker: Generally the Health Insurance Policies will have a restrictive clause stating that any treatment taken within India only will be covered. These conditions will be shown in the fine prints of policy. Therefore treatments taken outside India will be excluded from the cover.