For many Californian’s foreign travel is a fact of life for business or to visit relatives. The question always arises as to whether California individual and family plans cover health care services outside of the United States. To get a definitive answer, it is necessary to scour the health plan’s Evidence of Coverage or Member Agreement for language regarding foreign travel coverage.
All Emergency Services Covered In U.S.
All individual and family health plans, purchased either through Covered California or off-exchange, cover emergency care treatment anywhere in the United States. It doesn’t matter if the plan is an EPO, HSP, HMO or PPO network type. This coverage will often extend to Urgent Care services. However, most plans will not automatically cover non-emergency services without prior authorization. For instance, your allergies flare up on a trip to Texas. You visit a local doctor to get an allergy shot or prescription for your allergy medication. Don’t assume this visit or the prescription medication will be covered by your insurance when you file a claim for reimbursement for the costs.
Some health plans like Blue Shield and Blue Cross participate in the BlueCard Program. The BlueCard Program allows you to find local doctors or providers and to receive health care services at reciprocal costs to your California plan. In the event of an allergy attack, you can contact the BlueCard program, find a doctor, and receive treatment. Other health plans such as Western Health Advantage and Sharp Health Plan use Assist American which is similar to the BlueCard program for non-emergency health care services outside of the service area.
Foreign Travel Health Insurance Coverage With California Health Plans
But once you cross the border, some plans can be a little coy in whether they will cover any health care services. For both travel in the United States and abroad, you really need to study the health plan’s member agreement also referred to the Evidence of Coverage (EOC). The EOCs are those big documents that tell you have the plan works, what’s included, and what’s excluded. Some EOCs are specific about foreign travel coverage while others that I have studied make no mention of coverage outside the U.S.
As of November 12, 2017, not all of the health plans have released their EOCs for 2018. Consequently, I pulled information from 2017 EOCs. The language in the EOCs can change every year. Always refer to your most recent and applicable EOC before determining you will have emergency health care coverage when traveling outside of the U.S.
2018 Kaiser California Member Agreement
When you have an Emergency Medical condition, we cover Emergency Services you receive from Plan Providers or Non-Plan providers anywhere in the world.
Kaiser is the most explicit in their language about coverage outside of the U.S. In reality, it is probably cheaper for them pay the costs for emergency care in Canada or the U.K. than it is from Stanford Hospital right here in California. The U.S. and California have some of the most expensive health care costs in the world.
2017 Sutter Out of Area Care EOC MI03 Silver
OUT-OF-AREA URGENT CARE
If you are temporarily outside our Service Area and have an urgent care need due to an unforeseen illness or injury, we cover the Medically Necessary services you receive from a non–Participating Provider if we find that the services were necessary to prevent serious deterioration of your health (or your unborn Child’s health) and they could not be delayed until you returned to SHP’s Service Area. You do not need prior authorization for Out-of-Area Urgent Care. SHP covers Out-of-Area Urgent Care you receive from non-Participating Providers as long as the services would have been covered under the Your Benefits chapter (subject to the Exclusions and Limitations chapter) if you had received them from Participating Providers.
Coverage for the following Covered Services is described in other sections of this Evidence of Coverage:
Follow-up care and other Covered Services that are not Urgent Care or Out-of-Area Urgent Care described in this “Urgent Care” section (refer to the “Your Benefits” chapter for coverage, subject to the “Exclusions and Limitations” chapter)
The Sutter EOC is not specific as to whether emergency services in another country are covered. I called Sutter and they said it is. But you will never know if ANY out-of-network claim will be honored until you submit it for reimbursement. Health plans have a way of finding loopholes for denying claims.
2018 Blue Shield Bronze Evidence of Coverage Bronze HDHP PPO
Care for Covered Urgent Care and Emergency Services Outside the United States
Benefits will also be provided for Covered Services received while temporarily traveling outside of the United States, Puerto Rico and U.S. Virgin Islands for emergency care of an illness or injury. If you need urgent care while out of the country, contact the Blue Cross Blue Shield Global™ (BCBS Global™) Service Center through the toll-free BlueCard Access number at 1-800- 810-2583 or call collect at 1-804-673-1177, 24 hours a day, and seven days a week. In an emergency, go directly to the nearest hospital. If your coverage requires pre-certification or prior authorization, you should also call Blue Shield of California at the Customer Service telephone number indicated on the back of the Member’s identification card. For inpatient hospital care, contact the Blue Cross Blue Shield Global™ (BCBS Global™) Service Center to arrange cashless access. If cashless access is arranged, you are responsible for the usual out-of-pocket expenses (non-covered charges, Deductibles, and copayments). If cashless access is not arranged, you will have to pay the entire bill for your medical care and submit a claim.
When you receive services from a physician, you will have to pay the doctor and then submit a claim. Before traveling abroad, call your local Customer Service office for the most current listing of providers or you can go on-line at www.bcbs.com and select “Find a Doctor or Hospital” and “Blue Cross Blue Shield Global™ (BCBS Global™) Service Cente[r]”
2017 Anthem Blue Cross Bronze 60 EPO 2EUU
BlueCard Worldwide® Program
If You plan to travel outside the United States, call Member Services to find out Your BlueCard Worldwide benefits. Benefits for services received outside of the United States may be different from services received in the United States. The Plan only covers Emergency, including ambulance, outside of the United States. Remember to take an up-to-date health identification card with You.
When You are traveling abroad and need medical care, You can call the BlueCard Worldwide Service Center any time. They are available twenty-four (24) hours a day, seven (7) days a week. The toll free number is 1-800-810-2583. Or You can call them collect at 1-804-673-1177.
Keep in mind, if You need Emergency medical care, go to the nearest hospital. There is no need to call before You receive care. Please refer to the “Requesting Approval for Benefits” section.
2017 Health Net Silver 70 EPO
Emergency Care is available and accessible to all Covered Persons through the EPO Network 24 hours a day, seven days a week. Emergency Care is also covered when provided by providers who are outside of the EPO network or outside California, including outside the United States.
Western Health Advantage 2018
Emergency assistance when you travel
When you travel 100 or more miles from home you are eligible for assistance with medical consultations and referrals, care of a minor child, lost luggage and more. Assist America > mywha.org/travel
With services such as the BlueCard Program or Assist America, it is incumbent upon the plan member to contact those programs prior to or directly after receiving health care services. Don’t expect the health plan to necessarily offer any assistance for health care services while traveling. Before you leave on a trip read through your EOC to find out exactly how the plan covers health care and emergency care while you are travelling.
If you are not a current health plan, but are investigating your options, the health plans won’t give you much information over the phone. Because there are so many health plan types and structures, customer service representatives will usually only give detailed answers to current health plan members where they can determine specifically which plan the member has.
If the EOC is vague on foreign travel coverage, and the customer service representatives are less than helpful, you may want to consider purchasing a separate travel insurance plan that will cover emergency health care services outside of the United States.