1 INF Advantage Plan
2 First Health PPO
3 Insurance Enrollment
4 Covered Services
5 Accidental Death Dismemberment
6 Medical Evacuation And Repatriation
7 Assistance Services
8 Exclusions and
Limitations
9 Definitions
10 Cancellation Policy
1 INF Advantage Plan

Visitor Medical Insurance - INF Advantage Plan with $75,000 and $150,000 Program with Pre-Existing Conditions Option limited to Acute Onset



Plan Brochure

   

2 First Health PPO

Provider Network for India Network CHUBB Comprehensive Insurance Plan

Provider Search for PPO Plans Offered by India Network Health Insurance

PLEASE USE THIS SEARCH ONLY FOR NON MEDICAL EMERGENCIES. FOR EMERGENCIES, CALL 911. ELITE Network Plan with and without pre-existing coverage, please use the following link to search for providers in your area. If you go to one of the providers listed, the plan will cover 80 percent of the charges for eligible services.

First Health Network

Network means the First Health Network. When a covered Injury or Sickness requires treatment by a Doctor, the ELITE Network Policy will provide benefits while coverage is in force for the Usual and Customary charges incurred which exceed the deductible per person for each Injury or Sickness. Payment for any covered service will be no more than the Benefit Limit shown for it. In no event will the total combined benefits for a single Injury or Sickness (either in a single Policy year or through continuing year's coverage) exceed the Policy Maximum Benefit.


Plans with First Health Network

  • ELITE Network Coverage Plans (or Comprehensive Plans): Policy holders pay 20% when using providers in the First Health Network. Policy holders pay 40% of when using providers outside the First Health network. For emergencies, policy holders should go to the nearest facility irrespective of network participation.

  • SelectCare Plan, Choice plan with pre-existing conditions coverage and Advantage plan: Policy holders get negotiated prices when using providers in the First Health Network.

Plans Without First Health Network:

Policy holders can choose ANY provider and there is no network linked to these policies.

  • CHUBB Standard Plan

  • CHUBB Premier Coverage Plan

3 Insurance Enrollment

HOW TO ENROLL FOR COVERAGE

Enrollment into this program can be done as follows:
Visit Online Forms at www.kvrao.in and follow step-by-step instructions; or
Visit the Members Area to print out forms at www.kvrao.in and select India Network Printable Forms for Printing Forms.
Complete and submit online Insurance Enrollment Form available under the Members Area link at the above mentioned websites.
On successful completion of online application, ID cards will be produced on the web page for your record and as proof of insurance.

Membership and Advantage Plan Accident and Sickness Insurance forms can also be downloaded from our websites and faxed to (408)-520-4967 with proper credit card authorization for membership and premium. The India Network Services will mail the insurance card and Benefit Information to the member's temporary address in the U.S. for coverage of two months or more. For duration of less than 2 months, India Network Services will email the insurance card and Benefit Information to the member's email provided during the enrollment.

EFFECTIVE AND TERMINATION DATES OF INSURANCE
The India Network Foundation Group Policy Effective date is 12/1/2017. Coverage of Insured Person and any eligible Dependent Child(ren) or Spouse enrolled in this plan will begin at 12:01 AM on the latest of the following dates: the Policy's Effective Date; the departure date from the Insured Person's Home Country; or the date that India Network Services receives the insurance enrollment form and the required premium.
The Company will pay benefits while an Insured Person is traveling:
1. Outside of his or her Home Country in the United States or during a Personal Deviation as listed in the Policy; and 2. up to 300 days.

This Coverage will start on the actual start of the Covered Trip and will end on the first of the following dates to occur: the date the Insured Person returns to his or her Home Country; the date the Insured Person makes a Personal Deviation for more than 2 days; the date the Insured Person is no longer eligible; or the last day of the period for which the required premium is paid. Coverage of an Insured Person's Dependent Child(ren) or Spouse will end when the Insured Person's coverage ends.
4 Covered Services

Covered Medical Expenses include:

  1. Hospital Room (semi private) and Board and Miscellaneous Hospital Expenses. Covered Expenses charged 1) daily semi private room rate when Hospital confined; and 2) general nursing care provided and charged by the Hospital. Miscellaneous Expenses include, while Hospital confined; or 2) for preadmission expenses for being Hospital confined but are not limited to, the cost of the operating room, X-ray examination , laboratory tests, in-hospital physiotherapy, anesthesia; drugs (excluding take home drugs) or medicines, therapeutic services; and supplies, registered nurse services and all necessary charges other than room and board, for services received during a Hospital Stay

  2. Hospital Intensive Care Unit Covered Expenses charged when an Insured Person becomes confined as an Inpatient to a Hospital in an Intensive Care Unit, the Company will pay an additional benefit equal to the Daily Intensive Care Unit Benefit Amount shown in the Rider Schedule of benefits. Only one Daily Intensive Care Unit Benefit is provided for any one day of Intensive Care Unit confinement, regardless of the number of Covered Injuries or Sickness for which the confinement is required.

  3. Surgeon Services (Inpatient) - Covered Expenses charge for performing in-patient surgical procedure. Two or more surgical procedures through the same incision will be considered as one procedure. . However, the Company will pay up to 50% of the benefit for a surgical procedure when more than one surgical procedure through different operating fields is performed during the same surgical session. Covered Expenses will be paid under this inpatient surgery benefit; or under the Out Patient surgery benefit, but not for both.

  4. Anesthetist Services (Inpatient) - Covered Expenses charged by a Physician in connection with inpatient surgery for anesthesia and its administration. . Covered Expenses will be paid under this inpatient surgery benefit; or under the Out Patient surgery benefit, but not for both.

  5. Assistant Surgeon (inpatient) – Covered Expenses charged by a Physician in connection with inpatient surgery. . Covered Expenses will be paid under this inpatient surgery benefit; or under the Out Patient surgery benefit, but not for both

  6. Physician’s (non Surgical Inpatient visit) – Covered Expenses charged by a Physician for other than pre or post operative care, second opinion or consultation: for 1) in Hospital visits and office visits. Benefits are limited to one Physician visit per day. Covered Expenses will be paid under the impatient benefit or outpatient benefit for Physicians Office visits but not both.
  7. Consulting Physician Services- Covered Expenses charges by a Physician for a second surgical opinion or consultation that has been that must be requested by the attending Physician. Physiotherapy Benefits (inpatient) Covered Expenses charges by a Physician for Physiotherapy that must be requested by the attending Physician

  8. Pre – Admission Tests- Covered Expenses charged for pre- admission tests limited to routine test such as complete blood count; urinalyses and chest X ray. If otherwise payable under this Policy, major diagnostic procedures such as Cat-Scans; NMR’s and blood chemistries will be paid under the Hospital Miscellaneous benefit.

  9. Surgeon Services (Outpatient) – Covered Expenses charge for performing outpatient surgical procedure. Two or more surgical procedures through the same incision will be considered as one procedure. However, the Company will pay up to 50% of the benefit for a surgical procedure when more than one surgical procedure through different operating fields is performed during the same surgical session. Covered Expenses will be paid under this inpatient surgery benefit; or under the surgeon services benefit (Outpatient), but not for both.

  10. Day Surgery Miscellaneous Expenses(Outpatient) – Covered Expense related to a major surgery performed at Hospital or licensed Outpatient surgery center including the actual cost of the operating room, laboratory tests and x ray examination anesthesia, drugs, medicines and medical supplies related to the surgery. Does not include non scheduled surgery and surgery performed in a Hospital emergency room; trauma center; Physician’s office; or clinic.

  11. Anesthetist Services (Outpatient) - Covered Expenses charged by a Physician in connection with Anesthetist Services for Outpatient surgery for anesthesia and its administration. . Covered Expenses will be paid under this Outpatient benefit; or under the Inpatient surgery benefit, but not for both Assistant Surgeon (Outpatient) – Covered Expenses charged by a Physician in connection with Outpatient surgery. Covered Expenses will be paid under this Outpatient surgery benefit; or under the Inpatient surgery benefit, but not for both.
  12. Diagnostic X Rays and Lab tests except dental x-rays (Outpatient) – Covered Expenses incurred for the treatment of a Covered Injury or Sickness as prescribed by a Physician.

  13. CAT Scan, PET Scan or MRI tests (Outpatient) -Covered Expenses incurred for the treatment of a Covered Injury or Sickness as prescribed by a Physician

  14. Hospital Emergency Room services – Covered Expenses incurred for the Outpatient emergency room treatment performed in a Hospital. When emergency room treatment is immediately followed by admission to a Hospital, such treatment will be a Hospital Room and Board and Miscellaneous Hospital Covered Medical Service.

  15. Prescriptions (outpatient) – Covered Expenses incurred for the treatment of a Covered Accident or Sickness prescribed by a Physician.

  16. Ambulance Services Covered Expenses incurred for ground or air ambulance service to transport the Insured Person from the place where the Covered Accident or occurs. The Company will pay Covered Expenses incurred for ground or air ambulance transportation from the nearest medical facility to another appropriate medical facility, if a Physician specifies in writing that specialized care not available in the first facility to which the Insured Person was transported is necessary to treat His Covered Injury or Sickness.

  17. Initial Orthopedic Prosthesis or Brace - Covered Expenses incurred for the initial purchase, fitting, and needed adjustment of such appliances or devices, including the components of prosthetic appliances. Orthopedic prosthesis or brace include durable medical equipment which is equipment that 1) is primarily and customarily used to serve a medical purpose; 2) can withstand repeated use; and 3) generally is not useful to a person in the absence of Injury or Sickness. The Orthopedic Prosthesis or Brace must be prescribed by a Physician and a written prescription must accompany the claim when submitted. Replacement prosthesis and braces are not covered and no benefits will be paid for rental charges in excess of the purchase price.

  18. Dental Injury Treatment - Covered Expenses incurred for dental treatment (does not include dental services for the immediate relief of pain), including X-rays, for injury to a tooth: 1) with no fillings or cavities or only fillings or cavities that do not undermine the tooth cusps; and 2.for which pulpal tissues are healthy and intact; and 3. for which periodontal tissue shows little or no signs of active or chronic inflammation. For insurance review purposes, each tooth unit is evaluated under these criteria rather than a blanket rating of the whole mouth. Covered Expenses include examinations, x-rays, restorative treatment, endodontic, oral surgery, initial braces required for treatment of a Covered Injury and treatment of gingivitis resulting from trauma. If there is more than one way to treat a dental problem, The Company will pay based on the least expensive procedure if that procedure meets commonly accepted standards of the American Dental Association. Routine dental care and treatment to the gums are not covered.

  19. Chemotherapy and/or Radiation Services – Covered Expenses incurred for chemotherapy or radiation prescribed by a Physician for the treatment of a Sickness Benefits. Chemotherapy and Radiation means Cobalt Therapy, EX- ray therapy or chemotherapy administered to an Insured Person as treatment of cancer. This includes Injections 1) when administered in the Physician’s office; and 2) charged on the Physician statement. It does not include laboratory and diagnostic tests.

  20. Physical and Occupational Therapy Covered Expenses incurred for Outpatient physical and occupational therapy

  21. Private Duty Nursing Benefit Covered Expenses incurred for services rendered by a
    1) private duty nurse care only;
    2) while Hospital Confined;
    3) ordered by a licensed Physician; and
    4) medically necessary. General nursing care provided by the Hospital is not covered under this benefit.

  22. Maternity Benefit Covered Expenses incurred for the treatment of a pregnancy when conception occurs after the trip begins under this Policy. This does not include any benefits for the unborn child.
5 Accidental Death Dismemberment

ACCIDENTAL DEATH AND DISMEMBERMENT:

If Injury to the Insured Person results, within 365 days of the date of a Covered Accident, in any one of the losses shown below, We will pay the Benefit Amount shown below for that loss. The Principal Sum is $25,000 as shown. If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same Covered Accident.
Covered LossBenefit Amount
Loss of Life 100% of the Principal Sum
Loss of Two or More Hands or Feet 100% of the Principal Sum
Loss of Sight of Both Eyes 100% of the Principal Sum
Loss of One Hand and Foot 100% of the Principal Sum
Loss of One Hand or Foot and Sight in One Eye 100% of the Principal Sum
Loss of One Hand or Foot 50% of the Principal Sum
Loss of Sight in One Eye 50% of the Principal Sum
Exposure and Disappearance Included
6 Medical Evacuation And Repatriation

OTHER BENEFITS - MEDICAL EVACUATION AND REPATRIATION BENEFITS

EMERGENCY MEDICAL EVACUATION AND REPATRIATION: These Benefits will not be payable unless We (or Our authorized travel assistance provider) authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance, and services are rendered by Our a travel assistance provider. Contact Europ Assistance for these services at (877) 243-4134 or call collect from outside the United States at (240) 330-1528 (24 hours a day, 7 days a week). Email: OPS@europassistance-usa.com

EMERGENCY MEDICAL EVACUATION BENEFIT: We will pay Emergency Medical Evacuation Benefits as shown for Covered Expenses incurred for the Emergency Evacuation of a Insured Person. Benefits are payable up to the Benefit Maximum shown, if the Insured Person suffers a Covered Injury or Emergency Sickness during the course of the Covered Trip that requires Emergency Evacuation.

REPATRIATION OF REMAINS BENEFIT: We will pay Repatriation Benefits up to the Benefit Maximum shown for preparation and return of a Insured Persons body to his or her place of primary residence if he or she dies as a result of a Covered Injury or Emergency Sickness while traveling on a Covered Trip.
7 Assistance Services

Europ TRAVEL ASSISTANCE SERVICES

Europ Assistance can help travelers with medical emergencies by:

  • Emergency Medical Evacuation & treatment en-route if necessary
  • Repatriation of remains in the event of Insured Persons death
  • Medical emergencies and many other services (see web)
The Europ Assistance communications network is available 24 hours a day, seven days a week to provide assistance to the Insured Person.
Inside the United States/Canada call (877) 243-4134
Outside United States/Canada call collect 240-330-1528
or email OPS@europassistance-usa.com
8 Exclusions and
Limitations

EXCLUSIONS AND LIMITATIONS

We will not pay benefits for any loss or Injury that is caused by or results from:
  • Intentionally self-inflicted injury, suicide, or any attempt while sane or insane.
  • Commission or attempt to commit a felony or an assault.
  • Commission of or active participation in a riot or insurrection.
  • Declared or undeclared war or act of war or any act of declared or undeclared war unless specifically provided by this Policy.
  • Flight in, boarding or alighting from, an Aircraft or any craft designed to fly above the Earths surface, except as a fare-paying passenger on a regularly scheduled commercial airline.
  • Voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage.
  • The Insured Person's intoxication. The Insured Person is conclusively deemed to be intoxicated if the level in his blood exceeds the amount at which a person is presumed, under the law of the locale in which the Accident occurred, to be under the influence of alcohol if operating a motor vehicle, regardless of whether he is in fact operating a motor vehicle, when the injury occurs. An autopsy report from a licensed medical examiner, law enforcement officers report, or similar items will be considered proof of the Insured Persons intoxication.
  • An Accident if the Insured Person is the operator of a motor vehicle and does not possess a valid motor vehicle operator's license, unless:
    (a) the Insured Person holds a valid learners permit and
    (b) the Insured Person is receiving instruction from a driver's education instructor.
  • Injuries compensable under Workers Compensation law or any similar law.
  • Operating any type of vehicle or Conveyance while under the influence of alcohol or any drug, narcotic or other intoxicant including any prescribed drug for which the Insured Person has been provided a written warning against operating a vehicle or Conveyance while taking it. Under the influence of alcohol, for purposes of this exclusion, means intoxicated, as defined by the motor vehicle laws of the state in which the Covered Loss occurred.
  • Medical or surgical treatment, diagnostic procedure, administration of anesthesia, or medical mishap or negligence, including malpractice, unless it occurs during treatment of injuries sustained in a Covered Injury.
In addition, We will not pay Covered Medical Services for any loss, treatment, or services resulting from:
  • Expenses incurred during travel for the purposes of seeking medical care or treatment, or while on a waiting list for specific treatment or while traveling against the advice of a Physician.
  • Expenses incurred within the Insured Persons Home country or country of regular domicile, Pre-existing Conditions.
  • Routine physical or other examinations where there is not objective indications of impairment for normal health or well-baby care.
  • Dental treatment, except as the result of Covered Injury to sound, natural teeth as stated in the Rider Schedule.
  • Cosmetic or plastic surgery or treatment for congenital abnormalities, except reconstructive surgery as a 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 Sickness
  • Eye refractions or eye examinations for the purpose of prescribing corrective lenses or for the fitting thereof; eyeglasses, contact lenses.
  • Hearing examination 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.
  • Treatment by any Immediate Family member or member of the Insured Person's household. Immediate family member means an Insured Persons spouse, child, brother, sister, grandparents or in laws.
  • Services, supplies, or treatment including any period of Hospital Confinement which is not recommended, approved, and certified as Medically Necessary and reasonable by a Physician, or expenses which are non-medical in nature;
  • In connection with alcoholism and drug addiction, or use of any drug or narcotic agent unless prescribed by a Physician;
  • The commission of a felony offense;
  • Charges for Covered Medical Expenses for which the Insured Person would not be responsible for in the absence of this coverage;
  • Any expense paid or payable by any Other Health Care Plan; Any treatment provided under any mandatory government program or facility set up for treatment without cost to any individual
  • Treatment, services supplies or facilities in:
    a) a Hospital owned or operated by the Veterans 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 Person is required by law to pay)
  • Elective treatment, exams or surgery; elective termination of pregnancy.
  • Expenses for services, treatment or surgery deemed to be experimental and which are not recognized and generally accepted medical practices in the United States.
  • Expenses payable by any automobile insurance policy without regard to fault.
  • Organ or tissue transplants and related services.
  • Expenses incurred for services related to the diagnostic treatment of infertility or other problems related to the inability to conceive a child, including but not limited to, fertility testing and in-vitro fertilization.
  • Birth control including surgical procedures and devices.
  • Expenses incurred in connection with weak, strained or flat feet, corns, calluses or toenails.
  • Birth defects and congenital anomalies, or complications which arise from such conditions.
  • Related Complex (ARC), or Human Immunodeficiency Virus (HIV) infection, or any illness or disease arising from these medical conditions. specific named hazards: piloting any aircraft;
  • Expenses incurred for any treatment if the Insured Person is traveling against the advice of a Physician.
  • Expenses incurred after the date insurance terminates for an Insured Person under this Policy Any mental or nervous disorders or rest cures;
  • Duplicates services actually provided by both a certified nurse- midwife and Physician.
  • Expenses payable under any prior Policy which was in force for the person making the claim.
  • Expenses incurred in a Hospital emergency room visit which is not of an emergency nature.
  • Expenses incurred for chiropractic care-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 sublimation of or in the vertical column.
  • Injury sustained while participating in club, intramural, intercollegiate, interscholastic, professional or semi-professional sports.


Benefits will not be paid for services or treatment rendered by any person who is: Employed or retained by the Policyholder; Living in the Insured Persons household; An Immediate Family Member of either the Insured Person or the Insured Persons Spouse; or The Insured Person.

If We determine the benefits paid under this Policy are eligible benefits under any other benefit plan, We may seek to recover any expenses covered by another plan to the extent that the Insured Person is eligible for reimbursement.

Payment of claims under any policy issued shall only be made in full compliance with all economic or trade and sanction laws or regulations, including but not limited to, laws and regulations administered and enforced by the US Treasury Departments Office of Foreign Assets Control.

This is a brief description of the coverage provided under the policy, and is subject to the terms, conditions, limitations and exclusions of the policy. Please see the policy for details.

This insurance includes limited benefits. Limited benefits plans are insurance products with reduced benefits and are not intended to be an alternative to or integrated with comprehensive coverage. Further, this insurance does not coordinate with any other insurance plan. It does not provide major medical or comprehensive medical coverage and is not designed to replace major medical insurance. Further, this insurance is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act.

General questions about the Insurance Plan should be addressed to India Network Services. Contact India Network Services between 9.00 a.m. and 6.00 p.m. (EST), Monday through Friday. Please provide your Primary ID (Passport Number) when you call India Network Services Office or WebTPA Claims Office.
9 Definitions
DEFINITIONS
Benefit Period as used in this Rider means the maximum period that benefits are payable under this Rider.
Complication(s) of Pregnancy mean(s) conditions which require Hospital Stays before the pregnancy ends and whose diagnoses are distinct from but are caused or affected by pregnancy. These conditions are
  • Acute nephritis or nephrosis; or
  • Pre eclampsia; or
  • Eclampsia puerperal infection; or
  • RH Factor problems; or
  • Severe loss of blood requiring transfusion; or
  • Cardia decomposition or missed abortion; or
  • Similar condition as severe as these above;
  • Non elective cesarean section; and
  • Termination of an ectopic pregnancy; and
  • Spontaneous termination when live birth is not possible (This does not include voluntary or elective abortion)

Delivery by cesarean section is considered a eco of Pregnancy if the cesarean section is non elective. A cesarean section will be considered non elective if the fetus or the mother is determined to be in distress and is in immediate danger of death, Sickness or Covered Injury if the cesarean section is not performed. A cesarean section beyond one performed in any previous pregnancy will also be considered non elective if vaginal delivery is medically inappropriate, or vaginal delivery is attempted but discontinued due to immediate danger of death, Sickness or injury to child or mother.
Not included: (a) false labor, occasional spotting or Physician prescribed rest during the period of pregnancy; (b) morning sickness; (c) hyperemesis gravidarum and (d) similar conditions not medically distinct from a difficult pregnancy.
Covered Expenses as used in this Rider means expenses actually incurred by or on behalf of an Insured Person for treatment, services and supplies covered by this Policy. Coverage under the Policyholders’ Policy must remain continually in force from the date of the Covered Accident or Sickness until the date of treatment, services or supplies are received for them to be a Covered Expense. A Covered Expense is deemed to be incurred on the date treatment, service or supply that gave rise to the expense or the charge, was rendered or obtained.
Covered Injury as used in this Rider means bodily Injury; 1) directly and independently caused by specific accident which is unrelated to any pathological, functional, or structural disorder to Injury; 2) treated by a Physician within 30 days after the Covered Accident; and 3) which caused loss during the term of this Rider.
Covered Trip as used in this Rider, means travel by air, land or sea from the Insured Person’s Home Country.
Deductible as used in this Rider means the amount that must be paid for Covered Medical Services by the Insured Person before benefits will become payable under this Rider. A separate deductible shall apply to each Covered Loss.
Home Country as used in this Rider means a country from which the Insured Person holds a passport or where the Insured Person has primary residency. If the Insured Person holds passports from more than one Country, his or her Home Country will be the country that he has declared to Us in writing as his Home Country
Hospital ‑ as used in this Rider, means a facility that:
  • is operated according to law for the care and treatment of injured people;
  • has organized facilities for diagnosis and surgery on its premises or in facilities available to it on a prearranged basis;
  • has 24 hour nursing service; and
  • is supervised by one or more Physicians.
A Hospital does not include:
  • a nursing, convalescent or geriatric unit of a hospital when a patient is confined mainly to receive nursing care;
  • a facility that is, other than incidentally, a rest home, nursing home, convalescent home or home for the aged; nor does it include any ward, room, wing, or other section of the hospital that is used for such purposes; or
  • any military or veterans hospital or soldiers home or any hospital contracted for or operated by any national government or government agency for the treatment of members or ex-members of the armed forces.
Hospital Confined as used in this Rider means a stay of 48 or more consecutive hours as a registered resident bed-patient in a Hospital.
Intensive Care Unit (ICU) as used in this Rider means specifically designated facility of the Hospital that is designed to provide intensive care services on an interdisciplinary basis to critically ill inpatients. provides the highest level of medical care and that is restricted to those patients who are critically ill or injured and need constant medical care. Such care must be ordered by a Physician. The facility must provide: room and board, registered nursing care, and special equipment and supplies on a standby basis. Such facilities must be separate and apart from the surgical recovery room and from rooms, beds, and wards customarily used for patient confinement.
Medically Necessary ‑ as used in this Rider refers to a Covered Medical Service that:
  • is essential for diagnosis, treatment or care of the Covered Injury or Sickness for which it is prescribed or performed;
  • meets generally accepted standards of medical practice; and
  • is ordered by a Physician and performed under his care, supervision or order
Physiotherapy as used in this Rider means any form of the following: physical or mechanical therapy, diathermy, ultrasonic therapy; heat treatment in any form; manipulation or massage administered by a Physician. It does not include chiropractic care.
Prescription Drugs as used in this Rider 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.
Physician as used in this Rider means a licensed health care provider practicing within the scope of his license and rendering care and treatment to the Insured Person that is appropriate for the condition and locality, and who is not:
  • the Insured Person;
  • an Immediate Family Member of either the Insured Person or the Insured Person's Spouse;
  • a person living in the Insured Person's household; or
  • a person providing homeopathic, aroma-therapeutic, or herbal therapeutic services.
Sickness as used in this Rider means disease or illness, including related conditions and recurrent symptoms, which begin after the effective date of an Insured Person’s coverage and while coverage is in force under this Rider.
Usual and Customary Charge(s) ‑ as used in this Rider means a charge that:
  • is made for a Covered Medical Service;
  • does not exceed the usual level of charges for similar treatment, services or supplies in the locality where the expense is incurred (for a Hospital room and board charge, other than for a Medically Necessary stay in an intensive care unit or a cardiac care unit, does not exceed the Hospital’s most common charge for semi-private room and board); and
  • does not include charges that would not have been made if no insurance existed.
10 Cancellation Policy

CANCELLATION POLICY

Refund of premium, less a $25 processing fee, will be considered only if the Cancellation Form is received by the India Network Services prior to the effective date of coverage. After that date, the premium is considered fully earned and non-refundable. All cancellation requests should be submitted by completing the Cancellation Form found under 'Members Area' section of the web pages. The form can be faxed to 408-520-4967. Policy changes cannot be made under any circumstances once the policy becomes effective.

ADMINISTERED BY:
INDIA NETWORK SERVICES, USA
408-540-3600


CLAIMS OFFICE:
WebTPA
(877) 563-7492, fax (469) 417-1989


Rev. 6/19/18