Overseas Medical Policy (OMP)

Overseas Medical Policy (OMP)

This policy provides for payment of medical expenses in respect of illness suffered or accident sustained by Indian residents during their overseas trips for the specified purpose.

Eligibility

Indian residents undertaking bona fide trips abroad for:

  1. Business and official purposes
  2. Holiday purpose
  3. Employment
  4. Studies
  5. Accompanying spouse and children of the person who is going abroad. They will be treated as going under holiday travel
  6. Foreign nationals working in India for Indian employers or MNCs and getting their salaries in Indian rupees

Age Limit

  1. For adults up to 70 years – Extra premium beyond 70 years
  2. For children above 6 months – Children between 6 months to 5 years, excluding certain specific children diseases such as mumps, measles and so on

Period of Insurance

The insurance is valid from the first day of insurance or date and time of departure from India, whichever is later. The insurance expires on the last day of the number of days specified in the Policy Schedule or on return to India, whichever is earlier.

Extension of the period of insurance is automatic for the period not exceeding 7 days and without extra charge for the delay, which is beyond the control of the insured.

Local Medical Advisors

Name and address of an overseas independent entity, which provides emergency assistance and claims administration services abroad, are specified in the policy. (The same in India are also specified.)

Various Sections under Overseas Medical Policy

There are several sections under this policy.

They are:

Section A – Medical Expenses and Repatriation

Section B – Personal Accident

Section C – Loss of Checked Baggage

Section D – Delayed Checked Baggage

Section E – Loss of Passport

Section F – Personal Liability

Let us understand each of these sections in detail.

Section A – Medical Expenses and Repatriation

This section specifically provides that the policy is not a general health Insurance policy.

Medical expenses coverage is intended for use by the insured person in the event of a sudden and unexpected sickness or accident when the insured person is outside the Republic of India.

Covered Expenses:

  1. Expenses for physician services, hospital and medical services and local emergency medical transportation
  2. Up to USD 225 per occurrence for dental pain
  3. The expense for physician-ordered emergency medical evacuation, including medically appropriate transportation and necessary medical care en route to the nearest hospital when the insured person is critically ill or injured and no suitable local care is available
  4. Expenses for medical evacuation, including transportation and medical care en route to a hospital in India or the insured person’s normal place of residence in India when deemed medically advisable by the medical advisors and the attending physician
  5. If the insured person dies outside India, the expenses for preparing the air transportation of the remains for repatriation to India or up to an equivalent amount for a local burial or cremation in the country, where the death occurred

Examples of specific conditions applicable to this section are:

No claim will be paid in respect of:

  1. Expenses for treatment, which could reasonably be delayed until the insured’s return to India. This decision is taken by the treating physician and local medical advisors
  2. Cosmetic surgery unless necessary as a result of a covered accident
  3. Routine physical examination, where there is no objective indication of impairment of normal health
  4. Pregnancy, miscarriage, abortion

Section B – Personal Accident

If the insured person sustains the bodily injury and such bodily injury within 12 months of the date of the injury is the sole and direct cause of death, permanent total disablement or loss of the eye(s) or limbs.

Not more than USD 2,000 in respect of death if the insured is below 16 years.

Section C – Loss of Checked Baggage

This section covers the total loss of baggage that has been checked by an international airline for an international flight.

No claim will be paid for valuables, such as photographic, audio, computer, telecommunication and electrical equipment, and telescopes, binoculars, spectacles, sunglasses, antiques, jewelry, furs, and articles made of precious stones and metals.

Any recovery from the carrier will become the property of the insurers.

Section D – Delayed Checked Baggage

For emergency purchase of items as replacement in the event that the insured suffers a delay of more than 12 hours from the scheduled arrival time at the destination of delivery of baggage that has been checked by an international airline for an international outbound flight from India.

A non-delivery certificate from the airline and proof of purchase must be submitted in support of any claim under this section.

Section E – Loss of Passport

Reimbursement of actual expenses necessarily and reasonably incurred in connection with obtaining emergency travel documents in lieu of lost passport outside India.

No claim will be paid that is less than the deductible statement in the schedule.

No claim shall be paid for:

  1. Loss or damage to passport due to delay or from confiscation or detention by customs, police or other authorities.
  2. Theft, which is not reported to police authority, and an official report obtained.

Section F – Personal Liability

If the insured person in his or her private capacity becomes legally liable to pay for accidental bodily injury to third parties or accidental damage to third-party property arising from an incident during the covered trip.

No claims shall be paid:

  1. For less than the deductibles. (Deductibles shall not apply to claims for third-party property damage)
  2. Arising out of animals belonging to the insured person or pursuit of a trade, profession, occupation and so on

General Exclusions (All Sections)

  1. No claims will be paid, where the insured person:
    • Is traveling against the advice of the physician or
    • Is on a waiting list for specified medical treatment or
    • Is traveling for the purpose of obtaining medical treatment or
    • Has received a terminal prognosis for a medical condition
  2. Suicide, attempted suicide, venereal disease or abuse of drugs or alcoholic drinks or HIV-related illnesses.
  3. In respect of medical services obtained within India (Unless when specifically provided).
  4. Arising from the insured taking part in naval, military or air force operations.
  5. Arising from aviation except where the insured flies as a passenger in an aircraft properly licensed to carry passengers.
  6. Arising from participation in professional sports events or other hazardous sports.

General conditions applicable to all sections (some examples):

  1. A policy will be valid only if the insured journey has commenced within 14 days of the first day of insurance as indicated in the policy schedule.
  2. Cancellation of the policy may be done ONLY in cases, where a journey is not undertaken, and ONLY on the production of the insured’s PASSPORT as a proof that the journey has not been undertaken. Such cancellation will be subject to deduction of cancellation charge as applicable.
  3. In the event of any occurrence likely to give rise to a claim under this insurance, the insured person, or his representative, must notify local medical advisors immediately.
  4. For non-emergency claims, a local medical advisor should be contacted upon return to India.
  5. The insurance does not operate beyond a period of 180 days continuous absence from India unless specifically agreed by insurers.
  6. Pre-existing exclusion: This policy is not designed to provide an indemnity in respect of medical services the need for which arises out of a pre-existing condition.
  7. The Indian laws shall govern the validity, interpretation and so on of the policy.
  8. Any dispute under the policy shall be subject to arbitration as per provisions of the Indian Arbitration and Conciliation Act 1996.
  9. No sum payable under the policy shall carry interest.