Think about this for the moment. Spring Break is approaching, and you have an amazing trip planned to another country. You’ve even thought about critical “before you leave” tasks, like contacting your debit/credit card company to let them know you’ll be out of the country, carrying two passport photos with you in case you need to get a new passport, arranging for a multinational calling plan on your mobile phone, etc. Sun and fun is around the corner. But wait…in all of your preparation, there’s a chance you’ve left out a very important step. Have you evaluated your health insurance plan to see what’s covered if something were to happen to you while traveling? It’s a step that many people forget.
The good news is most health insurance providers give members some coverage outside of the United States. The bad news is not all health conditions are covered. It’s impossible to anticipate every scenario; however, with some education and understanding on how your insurance plan works, you can minimize the stress of a challenging situation. Let’s take a look at a few key things you should focus on and/or ask your insurance carrier, consultant, or HR team about.
Emergencies
The standard policy of most providers is to cover emergencies while outside the U.S. Insurance companies use a theory known as the “Prudent Standard.” The Prudent Standard means if a reasonable person would believe a condition could lead to death or permanent damage, the situation would be deemed an emergency, and therefore, could be covered under the terms of the plan.
For example: If a person experiences symptoms associated with a heart attack, an emergency room visit would likely be covered, even if it turns out the symptoms were not due to a heart attack. Other examples of situations that could be covered under the Prudent Standard are altitude sickness, broken bones, animal bites, heat stroke, lacerations requiring stitches, and many others.
Food poisoning, skin rash, mild colds or flu, and other maladies that don’t pose an imminent threat to life are rarely covered abroad. Even if the initial symptoms qualify as an emergency, you’ll most likely have to pay out-of-pocket for follow-up care while outside the U.S.
See what I mean…it gets tricky. Which is why it’s important to take a look at your policy!
Paying Upfront
More than likely, your health insurance ID card will be of no use while outside the U.S. If you seek services from a doctor, pharmacy, or hospital, you’ll likely be required to render payment at the time of service. You shouldn’t anticipate that countries with state-provided health care will extend that privilege to you. This type of care is intended for citizens only, and therefore, providers may charge you for services.
When you receive covered services from a non-network provider, you’re responsible for requesting payment from the insurance carrier. You should submit a request for payment of benefits within 90 days after the date of service. You must file a claim in a format that contains all of the information that the insurance company requires. This may include, but is not limited to: subscriber’s name and address, patient’s name and age, member ID number, name and address of the service provider(s), name and address of any ordering physician, diagnosis from the physician, itemized bill from the provider that includes the CPT codes or a description of each charge, and date the injury or sickness began.
It’s important to note that international and out-of-network claims are complex; the review process may take several weeks to resolve. Your Human Resources team or insurance broker can assist you through this process and provide the necessary international claim forms.
Finding a Credible Doctor Abroad
If you get injured or sick, you don’t want to have to spend significant time trying to locate providers and services you can rely on. Some insurance carriers provide directories of pre-screened doctors and facilities that meet U.S. standards. You may also rely on the U.S. Department of State for assistance and emergency resources, locating doctors and facilities, etc.
Travel Accident Insurance
A separate type of policy covering accidents, injury, and sickness while outside of the U.S. is Travel Accident Insurance. The coverage is specific for situations outside of the U.S., and health insurance companies providing this coverage have networks of doctors and facilities offering care. This type of plan can alleviate upfront costs and the need to file claims for out-of-network benefits with your U.S.-based health insurance provider.
Insurance companies offering travel accident and out-of-country medical coverage typically will provide pre-trip tools and resources as well as 24/7 travel assistance contacts and facilities that are of great benefit if an event occurs. Identification cards, FAQs, and appropriate contact details are provided prior to travel.
Although travel accident coverage can provide coverage and assistance for emergency situations, it can be limited by pre-existing conditions. In many cases, things like heart attack and stroke are specifically not covered under a travel accident policy. Conversely, a travel accident policy can cover more routine and non-emergency situations, such as minor cold and flu, poison ivy, rashes, food poisoning, dental, and vision needs.
We Can Help!
If you’re taking a trip this Spring Break…or really anytime for that matter…and it’s outside of the U.S., be sure you’re thinking about more than just what to pack! If you have questions on your policies with relation to international travel, reach out to me. I can easily get you the information you need to help alleviate any trip bumps.
