INDIA NETWORK ACCIDENT AND SICKNESS MEDICAL INSURANCE PROGRAMS 2008-09

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INDIA NETWORK ACCIDENT AND SICKNESS MEDICAL INSURANCE PROGRAMS 2008-09

With Pre-existing Coverage Rider (updated 8/9/08)

 New - Letter from Dr. KV Rao, President on 2008-09 Program

Effective June 12, 2008 - India Network Program offers Pre-existing Condition Coverage For All Age Groups (Rider coverage limited to $3000 for 70 Plus old)

New - India Network Members Share Experiences - May 2008

Accident & Health Privacy Notice (PDF format)

Enhanced Pre-existing Coverage Benefits - 2008-09

Summary of Benefits Brochure 2008-2009 (PDF format)

                                                                                    Online Application Forms

SUMMARY DESCRIPTION OF COVERAGE
bulletPROGRAM ELIGIBILITY
bulletPERIODS OF COVERAGE AND PREMIUM RATES
bullet INSURANCE ENROLLMENT
bulletCOVERAGE
bullet CONTINUOUS COVERAGE
bullet DEFINITIONS
bullet EXCLUSIONS
bulletCLAIMS PROCEDURE
bullet ASSISTANCE SERVICES (Available only to Participants of Health PROGRAM)
bullet SCHEDULE OF BENEFITS  In-Patient,  Out-Patient, and Other
bulletMEDICAL EVACUATION AND REPATRIATION
bulletAccidental Death Dismemberment
bulletPre-Existing Condition Coverage Rider
bulletCancellation Policy

INDIA NETWORK ACCIDENT AND SICKNESS MEDICAL INSURANCE PROGRAM

This is only a brief description of the coverage available under the policy. The policy contains reductions, limitations, exclusions, and termination provisions. If there are any conflicts between this document and the master policy, the policy will govern in all cases. The master policies (GLB 9112772, GLB 9112773 and GLB 9112774) are held by the SunTrust Bank as Trustee of the AIG Group Insurance Trust on behalf of the India Network Foundation. The program is  underwritten by The Insurance Company of the State of Pennsylvania, a Pennsylvania insurance company, has its principal place of business at 70 Pine Street, New York, New York, 10270. It is currently authorized to transact business in all states and the District of Columbia, NAIC No. 19429.

INSURANCE ELIGIBILITY

Only dues-paying Members of India Network and their non-US Citizen relatives, spouses and children are eligible to enroll in this program.

Eligible dependents are any of the following persons: the insured's legal spouse, and their unmarried dependent children under 18 years of age (unless incapable of self-sustaining employment due to physical or mental handicap).

If adoption, birth or marriage occurs while the Insured is covered by this program, the insured will have 31 days within which to pay the required additional premium to enroll any newly eligible dependents for the remainder of the period of coverage.

PERIODS OF COVERAGE & PREMIUM RATES

 Premium Rates in the following table are per month (30 days coverage). Premium for 15 days coverage is 70% of the monthly premium and Single Days premium is calculated as (monthly premium/30)*2.

A. $75 Deductible per sickness and Pre-existing exclusion 6 months.
 

Age at last Birth Day 18-49

Age at Last Birth Day 50-69
Coverage Category $50K Max $100K Max $150K Max 50K Max 100K Max $150K Max

One person

$57

 81 104 83  120 156

Couple

114

 162 208 166 240 312

Couple  and Children

223

 314 400 294 415 527

One Person  and  Children

160

 226 287 195 275 349

B. $250 Deductible per sickness and Pre-existing exclusion limited to 6 months.
 

Age at last birthday 18-49

 Age at last birthday  50-69
 Category $50K Max $100K Max 150K Max 50K Max 100K Max 150K Max

One person

$50

 70 89 70 102 131

Couple

100

 140 178 140 204 262

Couple & Children

189

 267 338 250 353 450

One Person & Children

137

 192 243 166 234 296

Pre-existing Condition Rider Premiums for 18-69 year olds - Pre-existing Condition rider premiums are twenty five percent (25%)more than the base premiums indicated above.

C. $500 Deductible for 70 and Over Age Group and Pre-existing Exclusion of 12 months

Age Last Birthday ==>

 70-79 80+

 Coverage Category

 Policy Max: $50,000
One Person 165 211

Couple

 330 422

Pre-existing Condition Rider Premiums for 70 Plus year olds - Pre-existing Condition rider premiums are sixteen  percent (16%) more than the base premiums indicated above.

A $5 service fee will be charged to each enrollment/renewal.

A premium reminder notice e-mail will be sent  before the period of coverage ends.

One may enroll for coverage, subject to the following rules: Fifteen Days premium is the minimum acceptable premium; twelve months premium is the maximum acceptable premium at a time; and the full premium for requested months is payable at the time of enrollment. Renewal is available for a minimum period of one day and a maximum of 12 months at a time.

INSURANCE ENROLLMENT

To enroll in the India Network Accident & Sickness Medical Insurance Program, the procedure is complete online insurance forms, specifically:

1. Complete India Network Membership Form (1st Form under Online Forms Link)

2. Complete the Insurance Enrollment Form (2nd Form under Online Forms Link)

OR

Fax the membership and enrollment forms (fax versions of the forms are available under download link) with charge authorization to 407-479-3289

or

2.  Mail a check for the exact amount with completed enrollment forms (membership form & insurance form)  to (prepare two checks (i) Membership fee of $10 made payable to India Network; and (ii) Premium amount made payable to 'India Network Services' and mail the package to:

India Network Services
PO Box 22
Windermere, FL 34786

Processing of an insurance enrollment may take up to 2 working days; when processing is complete, India Network office will will mail an insurance ID card and brochure to the USA/Canada address of the member if the insurance coverage duration is more than 1 month. For coverage of less than one month, please print the brochure and keep the ID card generated after online submission form as proof of coverage.

COVERAGE

Coverage of Insured and their eligible dependents who enroll in this program will begin at 12:01 a.m. on the latest of the following dates, whichever is applicable:

1.) The Effective Date of the policy;
2.) The Insured's departure from Home Country or Permanent Residence;
3.) The date the Insured's enrollment form is received by the India Network Services;
4.) The date the Insured's premium is received by the India Network Services; or
5.) The date the Insured requested on the Application.

Subject to the following exception:
If YOU are Hospital confined or disabled, meaning unable to perform the usual and customary daily duties or activities of a person of like age and sex, on the date this insurance would normally become effective, the coverage will take effect seven days after such Hospital confinement or disability terminates, subject to the Pre-existing condition exclusion.

Dependent's Effective Date:
After satisfaction of the Waiting Period (if applicable) insurance under this policy shall become effective on the latest of the following dates:
1) the date the Insured's coverage becomes effective;
2) the date the dependent leaves his Home Country or Permanent Residence; or
3) the date the person becomes a dependent as defined in Item 3 of the Declarations section.

Subject to the following exception:
If Your Dependent is Hospital confined or disabled, meaning unable to perform the usual and customary daily duties or activities of a person of like age and sex, on the date this insurance would normally become
effective, the coverage will take effect seven days after such Hospital confinement or disability terminates, subject to the Pre-existing condition exclusion.

Insured’s Termination Date:

The coverage provided with respect to the Insured shall terminate on the latest of the following dates:

1) The last day of the period for which the premium is paid

2) The date the Insured returns to their home country, but not more than 48 hours after departure from the US or Canada;

3)  The expiration of the maximum period coverage of 36 months or

4)  The date the policy terminates.

Termination of Coverage will not affect a claim for a covered loss that occurred while the Dependent ‘s coverage was in force under this policy.

Dependent’s Termination Date:

The coverage provided with respect to any Dependent shall terminate on the latest of the following dates:

1)  The last day of the period for which the premium is paid;

2)       The date the policy terminates;

3)       The date the Insured’s coverage terminates; or

4)       The date the Dependent eligibility terminates.

This coverage will not duplicate benefits available from other valid and collectible insurance. If an Insured’s injury or sickness is due to act or omission of another, benefits payable by this program are subject to recovery from amounts eventually paid to the Insured by, or on behalf of, the other person.

CONTINUOUS COVERAGE

Coverage for an Insured individual will be considered as continuous during consecutive periods of insurance under this Policy when premium payment is received by the Policyholder or Administrator within the Enrollment Period specified in the Policy Schedule.

This Continuous Coverage provision will not establish a new benefit period, nor affect any lifetime or specifically stipulated benefits shown herein for an incurred loss existing during any preceding coverage period.

DEFINITIONS

ACUTE ONSET OF PRE-EXISTING CONDITION  is a sudden and unexpected outbreak or recurrence of a pre-existing condition which occurs spontaneously and without advance warning wither in the form of Physician recommendation or symptoms which would have caused a prudent person to seek medical attention prior to the outbreak.  Treatment must be obtained within 24 hours of the sudden and unexpected out break or recurrence.

COMPLICATIONS OF PREGNANCY means conditions whose diagnoses are distinct from pregnancy but are adversely affected by or are caused by pregnancy.  Such complications include, but are not limited to: a) acute nephritis; b) Nephrosis, c) Cardiac decompensation; d)-missed abortion; e) hyperemesis gravidarum; f) preeclampsia; and g) similar medical and surgical conditions of comparable severity.  Complications of Pregnancy also includes: a) non-elective Cesarean section; b) ectopic pregnancy which is terminated; and c) spontaneous termination of pregnancy which occurs during a period of gestation which is viable birth is not possible.  Complications of Pregnancy shall not mean: a) false labor; b) occasional spotting; c) Doctor prescribed rest during the period of pregnancy; d) morning sickness; or e) similar conditions associated with the management of difficult pregnancy but not constituting a distinct Complication of Pregnancy. 

COVERED MEDICAL EXPENSES means reasonable charges which are: 1) not in excess of Usual and Customary Charges; 2) not in excess of the maximum benefit amount payable per service as specified in the Schedule of Benefits; 3) made for services and supplies not excluded under the policy; 4) made for services and supplies which are a Medical Necessity; 5) made for services included in the Schedule of Benefits; and 6) in excess of the amount stated as a deductible, if any.  Covered medical expenses will be deemed “incurred” only: 1) when the covered services are provided; and 2) when a charge is made to the Insured Person for such services.

DEDUCTIBLE means the amount stated in the Schedule of Benefits or any endorsement to this policy as a deductible.  Such amount will be subtracted from the amount or amounts otherwise payable as Covered Medical Expenses before payment of any benefit is made.  The deductible will apply per policy year or per occurrence (for each Injury or Sickness) as specified in the Schedule of Benefits.

DEPENDENT means the spouse (husband or wife) of the Named Insured, and their dependent, unmarried children living with the Named Insured.  This includes stepchildren, legally adopted children and children of adopting parents pending adoption procedures.  Children shall cease to be dependent on the first to occur of:

1)       the end of the month in which they marry; or

2)       the end of the month in which they attain the age of nineteen (19) years.

The attainment of the limiting age will not operate to terminate the coverage of such child while the child is and continues to be both:

1)       incapable of self-sustaining employment by reason of mental retardation or physical handicap; and

2)       chiefly dependent upon the Insured Person for support and maintenance.

Proof of such incapacity and dependency shall be furnished to the Company: 1) by the Named Insured; and 2) within 31 days of the child’s attainment of the limiting age.  Subsequently, such proof must be given to the Company upon request following the child’s attainment of the limiting age.

If a claim is denied under the policy because the child has attained the limiting age for dependent children, the burden is on the Insured Person to establish that the child is and continues to be handicapped as defined by subsection (1) and (2).

EXCESS PROVISION means the plan benefits are payable for covered expenses not covered and payable by any other plan providing medical expense benefits. If there is no other valid and collectible benefits available from any other source, this plan will pay the covered expenses up to the limits of the policy.

HOSPITAL means a licensed or properly accredited general hospital which; 1) is open at all times; 2) is operated primarily and continuously for the treatment of and surgery for sick and injured person as inpatients; 3) is under the supervision of a staff of one or more legally qualified Physicians available at all times; 4) continuously provides on the premises 24 hour nursing service by Registered Nurses; 5) provides organized facilities for diagnosis and major surgery on the premises; and 6) is not primarily a clinic, nursing, rest or convalescent home, or an institution specializing in or primarily treating Mental and Nervous Disorders.

HOSPITAL CONFINED/HOSPITAL CONFINEMENT: means confined in a hospital for at least 18 hours by reason of an Injury or Sickness for which benefits are payable.

INJURY means bodily injury: 1) directly and independently caused by specific accident which is unrelated to any pathological, functional, or structural disorder or injury; 2) treated by a Physician within 30 days after the date of accident; and 3) which causes loss during the term of the policy.

INSURED PERSON means: 1) the Named Insured; and 2) Dependents of the Named Insured, if: 1) the Dependent is properly enrolled in the program; and 2) the appropriate dependent premium has been paid.  The term “insured” also means Insured Person.

INTENSIVE CARE means:

1)       a specifically designated facility of the Hospital that provides the highest level of medical care; and

2)       which is restricted to those patients who are critically ill or injured.

Such facility must be separate and a part from the surgical recovery room and from rooms, beds and wards customarily used for patient confinement.

MEDICAL EMERGENCY means the occurrence of a sudden, serious and unexpected sickness or injury.  In the absence of immediate medical attention, a reasonable person could believe this condition would result in:

1)       Death;

2)       Permanent placement of the Insured’s health in jeopardy;

3)       Serious impairment of bodily functions; or

4)       Serious and permanent dysfunction of any body organ or part.

Expenses incurred for “Medical Emergency” will be paid only for sickness or injury which fulfills the above conditions.  These expenses will not be paid for minor injuries or minor sicknesses.

MEDICAL NECESSITY means those services or supplies provided or prescribed by a hospital or physician which are:

1)       Essential for the symptoms and diagnosis or treatment of the Sickness or Injury;

2)       Provided for the diagnosis, or the direct care and treatment of the sickness or injury;

3)       In accordance with the standards of good medical practice;

4)       Not primarily for the convenience of the Insured, or the  Insured’s Physician; and

5)       The most appropriate supply or level of service which can safely be provided to the Insured.

The Medical Necessity of being hospital confined means that: 1) the Insured requires acute care as a bed patient; and 2) the Insured cannot receive safe and adequate care as an outpatient.  This policy only provides payment for services, procedures and supplies which in the judgment of the Company are a Medical Necessity.  No benefits will be paid for expenses which are determined not to be a Medical necessity, including any or all days of Hospital Confinement.

MENTAL AND NERVOUS DISORDER means a Sickness that is a mental, emotional or behavioral disorder.

NAMED INSURED means an eligible, registered or non-registered, student of the Policyholder if : 1) the student is properly enrolled in the program; an d2) the appropriate premium for coverage has been paid.

NEWBORN INFANT means any child born of an Insured while that person is insured under this policy.  Newborn infants will be covered under the policy for the first 31 days after birth.  Coverage for such child will be for Injury or Sickness, including medically diagnosed congenital defects, birth abnormalities, prematurity and nursery care; benefit swill be the same as for the Insured Person who is the child’s parent.

The Insured will have the right to continue such coverage for the child beyond the first 31 days.  To continue coverage the insured must, within the 31 days after the child’s birth: 1) apply to us; and 2) pay the required additional premium for the continued coverage.  If the Insured does not use this right as stated here, all coverage as to that child will terminate at the end of the first 31 days after the child’s birth.

PHYSICIAN means a person, other than the Insured or a member of the Insured’s family, who holds a medical license or medical certificate.

PHYSIOTHERAPY means any form of the following: physical or mechanical therapy; diathermy; ultra-sonic therapy; heat treatment in any form; manipulation or massage administered by a physician.

PRE-EXISTING CONDITION means any Injury or  Sickness that manifested itself, or for which a Physician was consulted, or for which treatment or dedication was prescribed within 6 months (12 months for insureds age 70 and older) prior to the effective date of an Insured  Person's coverage

PRE-EXISTING CONDITION WAIVER - Coverage for  pre-existing conditions will be provided for medical treatment of an  accidental bodily injury or sickness for an Insured who has maintained 6  months of continuous and uninterrupted coverage under this insurance  program. (12 months of continuous and uninterrupted coverage under this insurance program for Insureds age 70 and older)

PRESCRIPTION DRUGS means: 1) prescription legend drugs; 2) compound medications of which at least one ingredient is a prescription legend drug; 3) any other drugs which under the applicable state or federal law may be dispensed only upon written prescription of a physician; and 4) injectable insulin.

SICKNESS means sickness or disease of the Insured Person which causes loss, and originates while the Insured Person is covered under this policy.  All related conditions and recurrent symptoms of the same or similar condition will be considered one sickness.

SOUND, NATURAL TEETH  means natural teeth, the major portion of the individual tooth is present, regardless of fillings or caps; and is not carious, abscessed or defective.

USUAL AND CUSTOMARY CHARGES means a reasonable charge which is : 1) usual and customary when compared with the charges made for similar services and supplies; and 2) made to persons having similar medical conditions in the locality of the Provider.  No payment will be made under this policy for any expenses incurred which in the judgment of the Company are in excess of Usual and Customary Charges.

EXCLUSIONS

No benefits will be paid for loss or expense caused by contributed to, or resulting from:

bulletPre-existing Conditions; except for: a) for individuals who have been continuously insured for 6 months (12 months for persons 70 and older) under the policy issued to the Policyholder and b) as specifically provided for new born infants. (see Rider Override if you have chosen Rider Option)
bulletAny loss that occurs while traveling solely for the purpose of obtaining medical treatment while on a waiting list for a specific treatment, or while traveling against the advice of a physician;
bulletExpense incurred within the Insured Person’s Home Country or country of regular domicile;
bulletRoutine physical or other examinations where there are no objective indications of impairment of normal health, or well baby care;
bulletEye examinations; prescriptions or fitting of eyeglasses and contact lenses; or other treatment for visual defects and problems. "Visual defects: means any physical defect of the eye which does or can impair normal vision;
bulletHearing examinations or hearing aids; or other treatment for hearing defects and problems. "Hearing defects: means any physical defect of the ear which does or can impair normal hearing;
bulletDental treatment, except as the result of injury to sound, natural teeth as stated in the Schedule of Benefits:
bulletProfessional services rendered by a Member of the Insured Person’s immediate family, or anyone who lives with the Insured Person;
bulletServices or supplies not necessary for the medical care of the patient’s injury or sickness;
bulletWeak, strained or flat feet, corns, calluses, or toenails;
bulletCosmetic surgery, or treatment for congenital anomalies, except reconstructive surgery as the result of a covered Injury or Sickness. Correction of a deviated nasal septum is considered cosmetic surgery unless it results from a covered Injury or covered Sickness;
bulletElective Surgery and Elective Treatment;
bulletDiagnostic or surgical procedures in connection with infertility unless infertility is a result of a covered Injury or covered Sickness;
bulletBirth control, including surgical procedures and devices;
bulletRoutine new-born baby care, well-baby nursery and related Physician charges;
bulletInjury or Sickness for which benefits are paid or payable under any Worker’s Compensation or Occupational Disease Law or Act, or similar legislation;
bulletOrgan transplants;
bulletWar or any act of war, declared or undeclared; or while in the armed forces of any country (a pro-rata premium will be refunded upon request for such period not covered);
bulletParticipation in a riot or civil disorder, commission of or attempt to commit a felony in the country in which it was attempted or committed;
bulletSuicide or attempted suicide (including drug overdose), while sane or insane (while sane in Missouri), or intentionally self-inflected Injury;
bulletCharges of an institution, health service, or infirmary for whose service payment is not required in the absence of insurance;
bulletLoss incurred from riding in any aircraft, other than as a passenger in an aircraft licensed for the transportation of passengers;
bulletTreatment services, supplies or facilities in a hospital owned or operated by: a) The Veteran’s Administration; or b) A national government or any of its agencies. (This exclusion does not apply to treatment when a charge is made which the Insured is required by law to pay);
bulletDuplicate services actually provided by both a certified nurse-midwife and Physician;
bulletExpenses payable under any prior policy which was in force for the person making the claim;
bulletExpenses incurred during a hospital emergency room visit which is not of an emergency nature;
bulletExpenses incurred for outpatient treatment in connection with the detection or correction by manual or mechanical means of structural imbalance, distortion or sublimation in the human body for purposes of removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column;
bulletInjury sustained as the result of the Insured operating a motor vehicle while not properly licensed to do so in the jurisdiction the motor vehicle accident occurs;
bulletVoluntary or elective abortion except as specifically provided;
bulletExpense covered by any other valid and collectible medical, health or accident insurance;
bulletExpense incurred after the date insurance terminates for an Insured Person except as may be specifically provided in the Extension of Benefits Provision;
bulletExpenses incurred for injuries resulting from the use of alcohol or intoxicants, or any drugs unless prescribed by a Physician;
bulletSexually transmitted diseases, including AIDS.

CLAIM PROCEDURE

Report at once to the nearest physician or hospital. Generally, claims are submitted by service providers directly to AIG Claims  Service office using the claim form found under print forms section. All claims must be submitted using the Special Claim Form found on the web. First part should be completed by the Policy Holder and section 2 should be completed by the Provider/Hospital.

Completed claim forms must be furnished to the AIG Claims Office within 90 days after the date of such loss. Failure to furnish such proof within the time required will not invalidate or reduce any claim if it was not reasonably possible to furnish proof.

Claims Office

American International Companies
A & H Claims Division
P.O. Box 25987
Shawnee Mission, KS  66225

(800) 551-0824  or  (302) 661-4176

Should it become necessary to check upon the status of your filed claim, or claims related questions you may call the claims office at the above number.

Questions about the brochure or insurance program are answered by India Network. They can be reached by phone at 407-258-8346. Questions are answered from 9:00 AM to 6:00 PM (EST) during week days, Monday through Friday.

ASSISTANCE SERVICES (Available only to Participants of Health Program)

Non-Insurance Services Provided by AIG International Services

AIG International Services, Inc. can help travelers with medical emergencies by:
bulletHelping to obtain local medical care.
bulletMonitoring hospitalizations and maintaining contact between attending physicians and family physicians.
bulletArranging medical evacuations and treatment en-route if necessary.
bulletArranging family, business associates, or friends to join the ill traveler.
bulletArranging repatriation of remains in the event of the insured's death.

Up-to-the-minute information available on:

bulletU.S. State Department and private service warnings about travel to certain locations.
bulletImmunizations requirements.
bulletPassport and Visa requirements.
bulletEmergency transfer of funds;
bulletWeather conditions and hazards particular to certain locations.

AIGAssist provides:

bulletEmergency registry services for vital, confidential, personal, and medical information.
bullet24-hours emergency travel service for airline and hotel reservations.
bulletHelp in replacing lost baggage and lost passports.

AIGAssist can also:

bulletArrange for local legal assistance.
bulletAct as a 24-hour toll free/collect emergency message center.
bulletAssist with emergency cash transfers and credit card advances based on the insured's resources.
bulletCo-ordinate insurance documents and claims submissions.

The AIGAssist communications network is available 24 hours a day, seven days a week to provide assistance to the traveler. In the United States and Canada call 1-800-626-2427. Outside of the United States call 0-713-267-2525 (collect call only).

SCHEDULE OF BENEFITS

PART A

When your covered Injury or Sickness requires treatment by a Physician, the Policy will provide benefits while your coverage is in force for the Usual and Customary (U&C) charges subject to the maximums shown below which exceed a $75 deductible Per Person for each Injury and each Sickness. Payment for any Covered Service will be no more than the Benefit Limit shown for it. The total payable by all Benefits will be no more than the stated policy maximum for each Injury and each Sickness. The $250 deductible and $500 deductible options include the same Covered Services and Benefit Limits as described below in the $50,000 program (For 70+ aged - $50,000 Max with $500 deductible is the only option offered).

COVERED SERVICES INJURY AND SICKNESS BENEFIT LIMITS (U&C Below means Usual and Customary Charges)

I. INPATIENT BENEFITS

 
COVERED SERVICES $50,000 Policy $100,000 Policy $150,000 Policy

Hospital Room (average semi-private) and Board and Miscellaneous   

U&C charges up to $1,300 Max a day, to 30 days

 U&C charges up to $1750 a day max, to 30 days U&C charges up to $1900 a day max, to 30 days

Hospital Intensive Care Unit  

Up to $525 max additional a day, to 8 days

 Up to $750 max additional a day, to 8 days Up to $850 m