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If my father, who has known heart problems, visits the US and experiences a heart attack requiring hospitalization and surgery, will your insurance cover the costs? If my deductible is 100 and I have 90/10 coverage up to 60,000 with PPO option, and I receive a 20,000 bill from hospital, how much will the insurance pay?
Please keep in mind that Visitors Insurance plans are primarily designed to cover someone for new illnesses, injuries or accidents that either exist in the body or occur after the policy effective date. They are not designed to cover pre-existing conditions, routine doctors visits, or preventative treatment.
Many plans will include coverage for what is called acute onset of pre-existing conditions, which is a sudden and unexpected outbreak or recurrence of a pre-existing condition that occurs spontaneously, without advance warning, and that generally requires to seek immediate medical treatment within 24 hours.
The final determination on whether or not the situation would meet the acute onset definition will be made by the plans claims department and they will use the medical records and attending physicians statement to determine if the situation is an eligible expense or not.
If your father is still in his home country, and you'd like a plan that provides coverage for pre-existing conditions, you may consider the Visitors Protect.
In the example you have provided, if the $20,000 is considered an eligible medical expense the plan would pay $19,400 and your responsibility would be a total of $600. You would pay your $100 deductible, and $500 which is 10% of the first $5,000. This is how most plans will work.
If you have any additional questions, please feel free to contact our office at 1+ (866) INSUBUY 467-8289.
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DISCLAIMER: Information presented in our Questions and Answers section is generic and was deemed to be accurate at the time of response. Please use the answers as a guide and do not make decisions based on the answers. The answers presented may be outdated and altogether inaccurate currently or not relevant as the details provided such as the insurance terms and conditions, plan benefits, eligibility and coverage may have changed. Insubuy assumes no responsibility for relying on such answers. You should review the latest certificate wording of the insurance policy (available on this website) for the product you are considering for the latest and complete details. If there is any conflict between the answers provided here and the certificate wording, the details of the certificate wording will prevail.
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