Cross-Border Terminal Illness & Advance Care Checklist: United States & India

1. 1

   Coordinate specialist palliative care, hospice services, and cross-border coverage

   Start with the treating oncology or specialist team where your family member currently receives care to establish pain management and home or inpatient palliative support:

   • United States: Hospital and outpatient palliative care teams provide symptom relief alongside active treatment, or the person can elect the Medicare Hospice Benefit under Medicare Part A (administered by the Centers for Medicare & Medicaid Services) once a hospice physician and the attending physician certify a life expectancy of 6 months or less [1]. Medicare hospice covers home nursing care, medical equipment, symptom-control medications, respite care, and family bereavement support; directories and planning guides are also provided through CaringInfo (an initiative of the National Hospice and Palliative Care Organization) [1].
   • India: If care takes place in India or the person plans to relocate there, specialist services are coordinated through public hospital palliative care units under the National Programme for Palliative Care (implemented by the Ministry of Health and Family Welfare) as well as accredited centers listed by the Indian Association of Palliative Care [4][5]. Because US Medicare does not cover treatment in India and domestic Indian schemes (such as Ayushman Bharat PM-JAY or private Indian health policies) apply domestic network rules, any international medical transfer requires advance clinical coordination, fit-to-fly medical clearance, and continuity plans for opioid pain medications.
2. 2

   Execute written Advance Directives in both the United States and India

   Advance care documents are governed by the law of the jurisdiction where medical care is delivered, so separate written directives should be executed while the person has full mental capacity [1][5]:

   • United States: Complete a state-specific Advance Directive (Living Will) stating preferences regarding cardiopulmonary resuscitation, mechanical ventilation, and artificial nutrition or hydration in accordance with the witnessing or notarization rules of the relevant US state [1]. Ask the attending physician or advanced practice clinician to sign Physician Orders for Life-Sustaining Treatment (POLST or MOLST), which convert those preferences into standing medical orders for emergency personnel.
   • India: Under the Supreme Court of India judgment in Common Cause v. Union of India (2018, as streamlined by the January 2023 modification order), a competent adult can execute an Advance Medical Directive (Living Will) specifying when life-sustaining treatment should be withheld or withdrawn in an irreversible terminal condition [5]. Under the updated 2023 rules, the directive is signed by the executor in the presence of two attesting witnesses and attested before a Notary Public or a Gazetted Officer (without requiring countersignature by a Judicial Magistrate), with copies provided to the appointed healthcare surrogate, the family physician, and the local municipal authority or panchayat; explanatory guides are published by the Indian Association of Palliative Care [5].
3. 3

   Establish separate financial and healthcare Powers of Attorney in both jurisdictions

   Indian banks, property registries, and hospitals generally do not operate on a standard US domestic Power of Attorney without specific Indian attestation and stamping, and US institutions require state-specific documents. Execute separate mandates while full legal capacity remains [3][6]:

   • United States: Execute a state-specific Durable Power of Attorney for Health Care (Health Care Proxy) and a Durable Financial Power of Attorney, and register Payable-on-Death (POD) or Transfer-on-Death (TOD) beneficiaries on US bank and brokerage accounts so funds remain accessible without court probate.
   • India: For property, banking, and administrative representation in India, execute a General or Special Power of Attorney [6]. If the person is in India, it is registered before the local Sub-Registrar of Assurances. If the person is in the United States, the Power of Attorney must be signed before two witnesses, notarized, and attested through the Embassy of India or the regional Consulate General of India (processed via VFS Global), then sent to India for adjudication/stamping within the statutory period (typically 3 months of receipt in India) [6]. Simultaneously, verify that statutory nominations (Form DA-1 for bank accounts and demat account nominations) are recorded with Indian financial institutions.
4. 4

   Claim fast-track terminal illness benefits and statutory caregiver leave

   Both countries offer financial and workplace entitlements during serious illness:

   • United States: Apply to the Social Security Administration (phone 1-800-772-1213) for expedited processing of Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) under the Compassionate Allowances (CAL) and Terminal Illness (TERI) programs [2]. Eligible family caregivers employed in the US can request up to 12 workweeks of unpaid, job-protected leave under the federal Family and Medical Leave Act administered by the U.S. Department of Labor, alongside paid family leave benefits in participating US states [3].
   • India: If the person is an insured worker in India, they can claim cash Sickness Benefit (and Extended Sickness Benefit for specified long-term conditions) through the Employees' State Insurance Corporation (ESIC), or apply for non-refundable medical advances for life-threatening illness from their provident fund account via the Unified Portal of the Employees' Provident Fund Organisation using the Composite Claim Form [7].
5. 5

   Align cross-border wills, beneficiary nominations, vital documents, and funeral wishes

   While capacity is intact, review or execute separate wills tailored to US assets and Indian assets (ensuring neither will inadvertently revokes the other), verify beneficiary nominations on US retirement accounts (401(k)/IRA) and Indian provident fund or insurance accounts, and assemble civil certificates, passports, OCI card, Social Security Number, Aadhaar, and PAN card in a single accessible folder [2][7]. Discuss whether the person wishes to be buried or cremated locally or whether remains or ashes should be transported between the United States and India (which requires Consular No Objection Certificates through the Consulate General of India) [6].

   For post-death administration in the United States, survivors notify the Social Security Administration (at 1-800-772-1213 or via the Federal Benefits Unit abroad), contact the Department of Veterans Affairs if applicable, file the final federal tax return (IRS Form 1040) with the Internal Revenue Service, and complete state Probate Court filings where required [2]. In India, survivors submit the death certificate and Composite Claim Form to the Employees' Provident Fund Organisation (for Provident Fund settlement, Employees' Deposit Linked Insurance, and EPS survivor pension), notify ESIC or Pravasi Bharatiya Bima Yojana (PBBY) insurers where applicable, and obtain a Legal Heir Certificate (from the local Tehsildar/revenue office) or a court Succession Certificate if required to release un-nominated Indian assets [7].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Medicare Hospice Benefits and Coverage (Medicare Part A) — Centers for Medicare & Medicaid Services (Medicare.gov)
2. [2]
   Compassionate Allowances and Expedited Disability Claims — Social Security Administration (SSA)
3. [3]
   Family and Medical Leave Act (FMLA) Caregiver Leave — U.S. Department of Labor (DOL)
4. [4]
   Operational Guidelines for National Programme for Palliative Care (NPPC) — Ministry of Health and Family Welfare / NHSRC
5. [5]
   Advance Medical Directive (Living Will) and Supreme Court of India Guidelines — Indian Association of Palliative Care (IAPC)
6. [6]
   Power of Attorney and Miscellaneous Consular Attestation Services in the USA — Consulate General of India, Chicago
7. [7]
   EPFO Single Page Composite Claim Form for Advances and Final Settlement — Press Information Bureau / Ministry of Labour & Employment