Traveling soon? What federal health plans actually cover

It’s the peak tourist season in Florida thanks to our sunny and warm weather and surprisingly low humidity this time of year. Saturday, March 21, was the busiest day of the year at our local Sarasota Bradenton International Airport (SRQ), with up to 16,000 departing passengers — nearly double the daily average of 8,020 — airport officials told the Herald-Tribune — our local newspaper. That would mark the airport’s second-busiest day on record. With so many people traveling, I thought it might be time to review your health insurance coverage and how it works when you are traveling out of town or out of the country. It’s important to know how your insurance plan works should you need care during an emergency when you are traveling overseas. Here are some of the important features to look for:

• Are you responsible for converting the currency to dollars and translating the bills into English? You can find out by reviewing your plan brochure (generally this information is found in Section 7) or by contacting your plan’s customer service.

• Be prepared to pay up front if you need care. Your insurance coverage is likely to reimburse you, but not until after you file the claim.

• Most plans will reimburse at the in-network level of coverage when you travel overseas.

• Note if there is a special number you will need to call if you are traveling outside of the U.S.

• If you are enrolled in a Medicare Advantage option of your FEHB plan, be sure to contact the plan to see how coverage will work overseas.

If you have FEHB coverage, do you still need to purchase travel insurance?

The coverage that is available with commercial travel plans varies from one plan to another, but the best annual travel insurance plans include protection for common mishaps. Your FEHB (and PSHB) plans generally cover medical emergencies while you’re traveling. The one thing that most health plans don’t cover is a medical evacuation back to the U.S. This is sometimes referred to as a “repatriation benefit.” Check for travel plans that cover this benefit.

Travel insurance also covers non-medical problems such as unexpected cancellations and trip interruption benefits. Check your policy for coverage for baggage delays, loss, theft and damage. Travel delay benefits may reimburse you for meals, accommodation and other expenses during a covered delay. If you rent a car, your policy may have car rental protection. Some plans include additional benefits, such as business equipment coverage and change fee coverage.

Let’s look at the nationwide FEHB fee-for-service plans, some of the larger HMOs and Medicare.

APWU:

Outside the U.S.: For covered services you receive by providers and hospitals outside the United States and Puerto Rico, send a completed Claim Form and the itemized bills to the following address. Also, send any written inquiries concerning the processing of overseas claims to:

High Option: APWU Health Plan, P.O. Box 8660, Elkridge, MD 21075

Consumer Driven Option: UnitedHealthcare at the claims address shown on the back of your UnitedHealthcare ID card.

Note: Overseas claims, including emergency claims, will be paid as out-of-network.

Nationwide coverage: You can get care from any “covered provider” or “covered facility.” How much APWU will pay — and you pay — depends on the type of covered provider or facility you use. If you use preferred providers, you will pay less. APWU uses UnitedHealthcare PPO providers. When out of your state of residence, if you do not use a UnitedHealthcare PPO provider or a UnitedHealthcare PPO provider is not available, standard non-PPO benefits apply. For assistance in identifying a provider in the network, call the APWU Health Plan at 800-222-2798.

Blue Cross and Blue Shield Service Benefit Plan:

Outside the U.S.: If you travel or live outside the United States, Puerto Rico and the U.S. Virgin Islands, you are still entitled to the plan benefits. Unless otherwise noted in the plan’s brochure, the same definitions, limitations and exclusions also apply. Costs associated with repatriation from an international location back to the United States are not covered. We may request that you provide complete medical records from your provider to support your claim. If you plan to receive healthcare services in a country sanctioned by the Office of Foreign Assets Control (OFAC) of the U.S. Department of the Treasury, your claim must include documentation of a government exemption under OFAC authorizing care in that country.

Please note that the requirements to obtain precertification for inpatient care and prior approval for those services listed in the plan brochure do not apply when you receive care overseas, except for admissions to residential treatment centers and skilled nursing facilities. Prior approval is required for all non-emergent air ambulance transport services for overseas members. Protections offered under the No Surprises Act do not apply to overseas claims. Members enrolled in the FEP Medicare Prescription Drug Program have no coverage for drugs obtained and/or purchased overseas. Please visit www.fepblue.org/overseas-coverage for additional information.

BC/BS has a network of participating hospitals overseas that will file your claims for inpatient facility care for you — without an advance payment for the covered services you receive. We also have a network of professional providers who have agreed to accept a negotiated amount as payment in full for their services. The Overseas Assistance Center can help you locate a hospital or physician in our network near where you are staying. You may also view a list of our network providers on our website, www.fepblue.org. You will have to file a claim to us for reimbursement for professional services unless you or your provider contacts the Overseas Assistance Center in advance to arrange direct billing and payment to the provider.

Nationwide coverage:

Under Standard Option, you can go to any covered provider you want, but in some circumstances, we must approve your care in advance. How much BC/BS pays — and you pay — depends on the type of covered provider you use. If you use our Preferred, Participating or Member providers, you will pay less.

Under Basic Option, you must use Preferred providers to receive benefits, except under situations listed in Section 4 of the plan brochure. In addition, we must approve certain types of care in advance. Under Basic Option, you must use those “covered professional providers” or “covered facility providers” that are Preferred providers for Basic Option to receive benefits. Please read further in Section 4 of the plan brochure for exceptions to this requirement.

You must use those “covered professional providers” or “covered facility providers” that are Preferred providers for FEP Blue Focus to receive benefits. Benefits are not available for care from non-preferred providers, except in very limited situations.

Compass Rose Health Plan:

Outside the U.S. coverage: When work or travel takes you overseas, the High and Standard Compass Rose Health Plan has you covered. You can see any health care provider or visit any hospital, and you will be reimbursed at the in-network level of benefits. When you use a provider outside the United States, you will pay them up front, then submit the receipt and detailed billing invoice for claims processing and reimbursement. Our overseas customers receive the same PPO benefits and prompt customer service as their stateside counterparts. There may be additional claims processing time for foreign claims. Claims may also be filed online. We will provide translation and currency conversion services for claims overseas and foreign services.

Optional travel insurance for Compass Rose Health Plan members:
UnitedHealthcare Global provides Compass Rose Health Plan members with access to Safe Trip travel insurance plans — an optional layer of protection designed specifically for international travel. These Safe Trip travel plans provide added protection when traveling abroad, covering unexpected trip cancellations, medical emergencies, evacuations and repatriations.

Nationwide coverage: You can get care from any “covered provider” or “covered facility.” How much we pay — and you pay — depends on the type of covered provider or facility you use. On the High Option, if you use our preferred providers, you will pay less. The Compass Rose Health Plan is powered by the UnitedHealthcare Choice Plus network. To help keep out-of-pocket costs low, our contract with UnitedHealthcare limits what doctors, hospitals and other facilities in the network are allowed to charge you. The Standard Compass Rose Health Plan does not provide coverage for out-of-network care.

Foreign Service Benefit Plan:

Who may enroll in this plan: You must be, or become, a member of the American Foreign Service Protective Association. New membership in the FSBP is limited to American Foreign Service personnel and certain Civil Service direct hire employees (i.e., eligible for FEHB insurance) working for the following government organizations: (1) Department of State (Foreign Service and Civil Service); (2) Department of Defense; (3) Department of Homeland Security; (4) USAID (Foreign Service and Civil Service); (5) Foreign Commercial Service (Foreign Service and Civil Service); (6) Foreign Agricultural Service (Foreign Service and Civil Service); (7) CIA, NSA and other intelligence organizations; and (8) Executive Branch civilian employees assigned overseas or to U.S. possessions and territories, and the direct hire domestic employees assigned to support those activities.

Outside the U.S. claims: When you are overseas you have access to a translation service, 24 hours a day, 7 days a week to assist you in discussing your urgent health-related conditions (such as accidents and medical emergencies that require immediate attention) with a foreign healthcare professional. You may call 855-411-9916. The Foreign Service Benefit Plan pays claims for providers outside the 50 United States at the same in-network coinsurance rate as in-network providers in the 50 United States, except in Guam, which is part of the plan’s network and subject to in- and out-of-network benefits. Note: We will provide translation and currency conversion services for claims for overseas (foreign) services. We have direct billing arrangements with providers in many countries, including China, Colombia, France, Germany, Great Britain, Italy, Japan, Korea, Panama, Russia, Switzerland, Thailand and Turkey. In addition, overseas Seventh-day Adventist hospitals and clinics participate in our direct billing arrangement. Please see our website (www.AFSPA.org/FSBP) for the most up-to-date information.

Nationwide coverage: You can get care from any “covered provider” or “covered facility.” We do not require referrals to see a specialist. How much we pay — and you pay — depends on the type of covered provider or facility you use. If you use in-network providers, you will pay less. The out-of-network benefits are the standard benefits of this plan. In-network benefits apply only when you use an in-network provider. Provider networks may be more extensive in some areas than others. In-network benefit levels also apply to providers outside the 50 United States.

GEHA:

Outside the U.S. claims: For covered services you receive by physicians and hospitals outside the United States and Puerto Rico, send a completed Overseas Claim Form and the itemized bills. Eligibility and/or medical necessity review is required when procedures are performed, or you are admitted to a hospital outside of the United States. Covered providers outside the United States will be paid at the in-network level of benefits, subject to the deductible, copays and/or coinsurance. We will provide translation and currency conversion for claims for overseas (foreign) services. The conversion rate will be based on the date services were rendered. You may be required to pay for the services at the time you receive them and then submit a claim to us for reimbursement. Proof of payment is required to be submitted with an overseas claim form. Canceled checks, cash register receipts or balance due statements are not acceptable. All foreign claim payments will be made directly to the enrollee.

Nationwide coverage: If you utilize an out-of-network provider, out-of-network benefits would apply on the Elevate Option. The Elevate Plus Option does not provide benefits for out-of-network providers, except in cases of emergency medical care. This plan uses the UnitedHealthcare network.

MHBP:

Outside the U.S. coverage: Overseas will be paid at the network level of benefits for covered services. Overseas hospitals and physicians are under no obligation to file claims for you. You may be required to pay for the services at the time you receive them and then submit a claim to us for reimbursement. MHBP will provide translation and currency conversion services for claims for overseas (foreign) services. For inpatient hospital services, the exchange rate will be based on the date of admission. For all other services, we will apply the exchange rate for the date the services were rendered. All foreign claim payments will be made directly to the enrollee except for services rendered to beneficiaries of the United States Department of Defense third party collection program. Canceled checks, cash register receipts or balance due statements are not acceptable.

Nationwide coverage: MHBP is a fee-for-service plan that allows you and your covered dependents to choose your health care providers. However, when you use an out-of-network provider, you may incur higher out-of-pocket expenses. The out-of-network benefits are the regular benefits of the plan. Network benefits apply only when you use a network provider. We cannot guarantee the availability of every specialty, or their continued participation in a specialty, in all areas. Out-of-network benefits are based on the plan’s out-of-network allowance. The out-of-network allowance depends on the type of care you receive, whether you receive care in an area that has a fully developed network and other factors. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). A single annual $52 associate membership fee makes all MHBP plans available to you.

SAMBA Health Benefit Plan:

Outside the U.S. coverage: For covered services rendered by a hospital or by a doctor outside of the United States, the plan will pay eligible charges at PPO benefit levels, limited to the plan’s allowance established for the Washington, D.C., metropolitan area. The member is responsible for the difference between the plan’s allowance and the provider’s charge. We will provide translation and currency conversion services for claims for overseas (foreign) services. Charges for overseas (foreign) claims will be converted to U.S. dollars using the exchange rate applicable to the date the service was rendered. For inpatient hospital services, the exchange rate will be based on the date of admission. When you must file a claim — such as for services you received overseas or when another group health plan is primary — submit it on the CMS-1500 or a claim form that includes the information shown in Section 7 of the plan brochure. Bills and receipts should be itemized.

Nationwide coverage: SAMBA’s fee-for-service plan offers services through a PPO. This means that certain hospitals and other healthcare providers are “preferred providers.” We have entered an arrangement with Cigna to offer the Cigna Open Access Plus (OAP) network to serve as the plan’s PPO for SAMBA enrollees in all states. When you use our PPO providers, you will receive covered services at reduced cost. The non-PPO benefits are the regular benefits of this plan. PPO benefits apply only when you use a participating Cigna OAP network provider. We cannot guarantee the availability of every specialty in all areas and continued participation of any specific provider cannot be guaranteed. When you phone for an appointment, please remember to verify that the healthcare provider or facility is still a Cigna OAP network provider. The nature of the services (such as urgent or emergency situations) does not affect whether benefits are paid as PPO or non-PPO. If you reside in the PPO network area and no PPO provider is available, or you do not use a PPO provider, the regular non-PPO benefits apply.

Aetna:

Aetna offers seven unique plan options: Aetna Saver, Open Access Plan, Aetna Value Plan, HDHP w/HAS, CDHP, Aetna Direct and Aetna Advantage.

Aetna Advantage

Outside the U.S. coverage: You should provide an English translation and currency conversion rate at the time of services for claims for overseas (foreign) services. When you must file a claim, such as when you use non-network providers, for services you receive overseas or when another group health plan is primary, submit it on the Aetna claim form.

Nationwide coverage: This plan is a health maintenance organization (HMO). We require you to see specific physicians, hospitals and other providers that contract with us. These plan providers coordinate your health care services. We are solely responsible for the selection of these providers in your area. Contact us for a copy of our most recent provider directory or visit our website at www.AetnaFeds.com. We give you a choice of enrollment in a High, Basic or Saver Option.

If you live or work in our service area, you can go directly to any network specialist for covered services without a referral from your primary care provider. Note: Whether your covered services are provided by your selected primary care provider (for your PCP copay) or by another participating provider in the network (for the specialist copay), you will be responsible for payment, which may be in the form of a copay (flat dollar amount) or coinsurance (a percentage of covered expenses). If you go directly to a specialist, you are responsible for verifying that the specialist is participating in our plan. If your participating specialist refers you to another provider, you are responsible for verifying that the other specialist is participating in our plan.

Aetna Saver, Aetna High Option, Aetna Basic Option

Outside the U.S.:
If you are traveling outside your Aetna service area, including overseas/foreign lands, or if you are a student who is away at school, you are covered for emergency and urgently needed care. For non-emergency services, care may be obtained from a walk-in clinic, an urgent care center or by calling Teladoc. Urgent care may be obtained from a private practice physician, a walk-in clinic or an urgent care center. Certain conditions, such as severe vomiting, earaches or high fever are considered “urgent care” outside your Aetna service area and are covered in any of the above settings. All follow-up care should be coordinated by your PCP or network specialist. Follow-up care with non-participating providers is only covered with a referral from your primary care provider and preapproval from Aetna. Suture removal, cast removal, X-rays and clinic and emergency room revisits are some examples of follow-up care.

Nationwide coverage: Large nationwide Aetna network, 24-hour/7-days-a-week access to doctors with CVS Virtual Care, no referrals to network specialists.

See www.aetnafeds.com for additional plans that Aetna offers, including Aetna Open Access Plan, Aetna HDHP w/HSA, Aetna CDHP and Aetna Direct plans.

Kaiser Permanente:

Outside the U.S.: Most overseas providers are under no obligation to file claims on behalf of our members. You may need to pay for the services at the time you receive them and then submit a claim to us for reimbursement. To file a claim for covered urgent or emergent care received outside the United States, send a completed Overseas Claim Form and itemized bills to: Mid-Atlantic Claims Administration, Kaiser Permanente, P.O. Box 371860, Denver, CO 80237-9998. We will do the translation and currency conversion for you. You may obtain the Overseas Claim Form by calling Member Services toll-free at 877-KP4-FEDS (877-574-3337) or from our website at www.kp.org/feds, Members/Forms and Information.

Nationwide coverage: You must receive your health services at Kaiser Permanente plan facilities, except if you have an emergency, authorized referral or out-of-area urgent care. If you are visiting another Kaiser Permanente or allied plan service area, you may receive healthcare services at those Kaiser Permanente facilities. Under the circumstances specified in this brochure you may receive follow-up or continue care while you travel anywhere. If you have an urgent care claim (i.e., when waiting for the regular time limit for your medical care or treatment could seriously jeopardize your life, health or ability to regain maximum function, or in the opinion of a physician with knowledge of your medical condition would subject you to severe pain that cannot be adequately managed without this care or treatment), we will expedite our review and notify you of our decision within 72 hours.

If your plan is not listed, you can check out all other FEHB and PSHB plans by visiting https://www.opm.gov/healthcare-insurance/healthcare/.

TRICARE:

Outside the U.S. proof of coverage: Learn how to travel. Filling prescriptions overseas: We recommend that you fill all your prescriptions before you travel. If you must fill a prescription while you’re traveling, keep in mind that TRICARE retail network pharmacies are only located in the U.S. and the U.S. territories of Puerto Rico, Guam, the U.S. Virgin Islands and the Northern Mariana Islands. Also, if you’re using home delivery, you must have a prescription from a U.S.-licensed provider and an APO or FPO address. Learn more about filling prescriptions overseas.

Air evacuations: To be medically necessary means it is appropriate, reasonable and adequate for your condition. International SOS will provide cashless, claimless air evacuation services to the closest safe location. This applies only to active-duty service members and their families. For all others, TRICARE will still cover the safest circumstances. However, you should be prepared to pay up front and submit a claim for reimbursement. TRICARE doesn’t cover all air evacuations back to the U.S. Learn more about air evacuation coverage.

Nationwide coverage: TRICARE is the uniformed services health care program for active-duty service members, active-duty family members, National Guard and Reserve members and their family members, retirees and retiree family members, survivors and certain former spouses worldwide.

TRICARE brings together the health care resources of the Military Health System — such as military hospitals and clinics — with a network of civilian health care professionals, institutions, pharmacies and suppliers to foster, protect, sustain and restore health for those entrusted to their care. You can also seek care from a civilian network of TRICARE-authorized providers. This network depends on what region you’re in. Find your region and learn more about network providers. Note: You may be able to see a non-network TRICARE-authorized provider, depending on your TRICARE plan. But you may have higher costs and you may have to file your own claims.

Medicare:

Medicare usually doesn’t cover medical care outside the U.S. and its territories. However, Original Medicare and Medicare Advantage plans must cover care you receive outside the U.S. in some very limited certain circumstances:

• Medicare will pay for emergency services in Canada if you are traveling a direct route, without unreasonable delay, between Alaska and another state and the closest hospital that can treat you is in Canada.

• Medicare will pay for medical care you get on a cruise ship if you get the care while the ship is in U.S. territorial waters. This means the ship is in a U.S. port or within six hours of arrival at or departure from a U.S. port.

• In limited situations, Medicare may pay for non-emergency inpatient services in a foreign hospital (and any connected provider and ambulance costs). Your care is covered if the hospital is closer to your residence than the nearest available U.S. hospital. This might happen if, for example, you live near the border of Mexico or Canada.