Why A Big Travel Insurance Cover Might Not Pay Your Entire Hospital Bill

Buying a travel insurance plan with a $10,000 medical cover seems like a safe protection plan for unforeseen medical emergencies while travelling abroad. But the final amount paid by the insurer often depends on the specific limits put on individual services, including hospital room rent, intensive care unit fees, surgery costs, lab tests, etc.

Such internal caps can raise the maximum payout for certain treatments, even if the total policy cover stays untouched. In case the hospital charges extend above these preset limits, the remaining balance might have to be paid out of pocket.

Sub-Limits Can Restrict Medical Claims

The total sum insured will not necessarily determine the amount an insurer will pay for each medical service. Individual benefits may have separate caps, which can vary across plans.

"A high sum insured does not necessarily mean that every medical expense will be covered up to that amount. Sub-limits place specific caps on benefits such as room rent, ICU charges and surgery costs," said Manas Kapoor, Head of Travel Insurance at Policybazaar.

For instance, some entry-level plans may cap room rent at $1,500 per day, ICU charges at $3,000 per day and surgery expenses at $12,500. Premium plans may offer limits of $2,500 per day for room rent, $4,000 per day for ICU charges and $22,500 for surgery.

Other benefits may also carry caps. Emergency room treatment may be limited to $1,500 under entry-level plans and $2,500 under premium plans. Doctor consultations may be capped at $125 and $350, respectively, while diagnostic tests may have limits of $750 and $2,500. Ambulance expenses may be restricted to $500 and $1,000, respectively.

Medical Expenses Travellers Should Check

Travellers should carefully check sub-limits on room rent, ICU charges, surgery and operation theatre costs, doctor consultations, diagnostic tests and ambulance expenses. "These limits determine the maximum payable amount for specific medical services and can affect out-of-pocket expenses if actual costs exceed the permitted caps," Kapoor stated.

Reviewing these conditions along with the overall sum insured and premium can help travellers choose a coverage suitable for their medical needs and their travel requirements.

Age-Based Limits For Senior Travellers

Sub-limits can also vary by age. Some policies introduce these restrictions from 50 years, while others apply them from 56 years onwards. Some plans can have specific limits for travellers who are 61 and above, including dedicated senior-citizen products.

"Senior travellers should check when age-based sub-limits begin, as these can vary across insurers and policies. Some plans introduce sub-limits from 50 years, while many apply them from 56 years onwards," stated Kapoor.

He also added, "Others reserve specific limits for travellers aged 61 and above, sometimes through dedicated senior-citizen products."

Beyond the overall sum insured and premium, going through these age-specific conditions can help older travellers choose a suitable coverage according to their needs.