Medical Expenses Cover under Travel Insurance

What Does Medical Expenses Actually Cover?

In simple terms, if you get sick or injured unexpectedly, your travel insurance company pays for your treatment. According to official sources (insurer's policy wording), this generally includes:

• Hospital Stays: Your room rent (usually a standard AC room), ICU charges, and nursing.
• Procedures/Treatments: Fees for the surgeon, anaesthetist, and specialists.
• Diagnostics: X-rays, blood tests, and scans are needed to figure out what's wrong.
• Pharmacy: The cost of medicines prescribed while you're abroad.

Pro-Tip: Another important term to keep in mind is the 'Reasonable and Customary' (R&C) charges. This means your policy won't pay for a USD 10,000 procedure if every other hospital in that city charges USD 2,000. They pay the fair local price.

Is there Coverage for Dental Emergencies and Evacuation?

Yes. Dental emergencies are covered by most insurers. Some insurers even offer extensive coverage, such as for student travellers.

Similarly, evacuating you to a required medical facility is also provided by travel insurance medical coverage. Your travel insurance isn't just for hospital beds; it's for many other situations as well. Here are some important details to keep in mind:

• Dental Pain: You can't get a cleaning or a cosmetic filling. Coverage is strictly for Acute Pain Relief (sudden, unbearable pain) or injury to natural teeth. Limits are usually low, around USD 250 – USD 500.
• Medical Evacuation: If the local clinic/hospital can't handle your condition, or the required treatment is not available locally, your insurance pays for you to be moved (sometimes via air ambulance) to the nearest capable hospital. However, this must be approved by the insurance company's assistance team first.

Coverage for Pre-existing Diseases (PED) under Travel Insurance

This is where most people get confused. Most policies generally exclude pre-existing conditions (such as diabetes or high blood pressure). Unless you buy a specific add-on, you won't be covered for any health emergency arising out of these PEDs. However, there are certain scenarios where you will be covered for declared PEDs:

• Life-saving Emergency Treatment: Even if they don't cover your PED, they will pay to stabilise you if the condition becomes life-threatening.
• The Limit: This emergency stabilisation is usually capped at a small fraction of your total cover (e.g., USD 2,000 to USD 10,000 depending on the total sum insured). Once you are out of danger, the coverage stops.

Medical Coverage for Students & Seniors

Students travelling from India to study at international universities need comprehensive coverage due to their extended stays. The risk of falling sick or injured is higher compared to a short trip. Similarly, senior travellers already face age-related health issues, increasing the risk of becoming ill or injured abroad.

Travel insurers understand these and extend coverage despite the high risk. Here is how they offer medical coverage to student and senior travellers:

• For Students: In addition to medical emergencies, some plans also include mental health coverage if it leads to hospitalisation. Maternity coverage is also offered to students who are abroad for full-time study programs. They also offer compassionate visit cover, which pays for a parent's flight if the student is hospitalised for more than 7 days.
• For Senior Travellers: Senior citizen travel insurance plans include additional benefits such as assistance services and medical coverage. However, these come with high sub-limits. For example, even if you have a USD 50,000 policy, the fine print might say they will only pay USD 15,000 for a single illness or USD 3,000 per day for the ICU.

What is Not Covered under Medical Expenses Benefit?

Reading the exclusions is important to know what will never be covered by your policy. Each insurer has a list of situations that will not be covered, so you must keep these in mind:

• Treatment that can wait: If the doctor says you can safely fly back to India for treatment, the insurer will stop paying for your care abroad.
• Medical Expenses in case of Intoxication: If you have an accident while under the influence of alcohol or drugs, the claim will be rejected 100% of the time.
• Adventure Sports Injuries: Don't assume your policy covers skiing or scuba diving. Most insurers exclude 'High Risk Activities' unless you pay an extra premium for a rider.
• Pregnancy & Childbirth: Maternity expenses, including complications or voluntary abortions, are excluded (except for accidental emergencies in specific plans).
• Medical Tourism: Travelling specifically to seek medical treatment is never covered.
• Alternative Medicine: No coverage for Ayurveda, Homoeopathy, or Naturopathy outside India.

Medical Expenses Nuances at a Glance