Traveling With An Hmo: What You Need To Know

Before travelling, it is important to check whether your health insurance covers you in your destination. This is because, depending on the type of health insurance plan, your benefits may be limited when you are out of state or the country. For example, local HMOs might not have out-of-state coverage, and most US-based health plans do not cover international travel. Therefore, it is recommended to contact your health insurer and ask specific questions about your coverage while travelling.

Check if your HMO covers you in your travel destination

Before travelling, it is important to check whether your HMO covers you at your destination. HMOs, PPOs, POS, and EPOs have varying levels of healthcare access, especially when travelling. Understanding your insurance policy's provisions, especially concerning emergencies and out-of-network costs, is crucial for managing healthcare while travelling.

Firstly, determine if your plan covers emergency care at your destination. Then decide if buying supplemental coverage is a smart decision based on factors like your itinerary and any pre-existing health conditions. Ask your provider whether there are any local service providers at your destination that will cover you under your plan, and whether any states or countries are restricted.

Your health insurance plan might cover emergencies, but not all insurers share a definition of "emergency". Ask your insurer for the exact definition. It will help you decide whether you need to buy supplemental coverage, like health or medical travel insurance. Ask whether urgent care facilities are covered or only emergency rooms. You don't want a claim denied for going to the wrong place.

Ask what additional coverage is included in the emergency medical care for you and your family. For instance, if you are going to a remote spot, you may want to know about services like air ambulances.

If you are travelling internationally or for an extended period domestically, consider additional health coverage options, or purchase travel insurance that covers emergency medical needs and potential trip disruptions.

Ask your HMO about emergency and urgent care coverage

Before travelling, it's important to ask your HMO about emergency and urgent care coverage. While emergency care is often covered by HMOs, urgent care may be more restricted.

For example, Blue Cross Blue Shield of Michigan covers emergency care anywhere in the world, but for urgent care, you need to be within the US and have your Blue Care Network ID card on you.

Kaiser Permanente also offers urgent and emergency care worldwide, but you will need to pay the full cost upfront and file a claim for reimbursement later.

HMOs often have specific networks of healthcare providers that they work with, so going "out of network" can result in higher out-of-pocket costs or a claim denial. Therefore, it's important to ask your HMO about their specific policies and what they define as an emergency.

Additionally, if you are travelling internationally, you may need to provide proof of medical insurance to enter certain countries. About 60 countries require tourists to have a minimum level of travel insurance. In such cases, you may need to purchase additional travel medical insurance, which is widely available, inexpensive, and easy to obtain.

Find out if you need to pay upfront and claim later

Whether or not you need to pay upfront and claim later depends on your health insurance provider and your specific policy. Before planning a trip, it is always a good idea to contact your health insurer and ask specific questions about your coverage while travelling. Ask them to refer you to written documents that clarify exactly what is and isn't covered when you travel.

If you are a Harvard University Group Health Plan member, you are covered for urgent and emergency care when travelling within the United States and abroad. However, for planned or foreseen care outside of Massachusetts and the United States, HMO members are not covered. POS and POS Plus members are covered, but they will be subject to higher out-of-pocket costs.

If you are a Kaiser Permanente member, you can visit any Kaiser Permanente facility and pay your normal copay, coinsurance, or deductible for care and prescriptions—there is no need to file a claim for reimbursement later. Outside of Kaiser Permanente areas, your care options and payment experience may vary. In the US, you will often pay your normal copay, coinsurance, or deductible for 24/7 virtual care, urgent care from select providers, and prescriptions from an urgent or emergency care visit. For other urgent and emergency care and prescriptions, you may need to pay the full cost upfront and file a claim for reimbursement later. All other Kaiser Permanente plans cover urgent and emergency care anywhere in the world, but you will need to pay the full cost of care upfront and file a claim for reimbursement later.

If you have travel insurance, the procedure is similar. If it's an emergency situation where hospital admission and/or medical evacuation is required, your coverage can coordinate payment with the hospital directly as long as the event is covered under your policy. If it's not urgent and you visit the local doctor, you may have to pay upfront and claim later.

Check if you need to buy travel insurance

Before travelling, it is important to check whether your health insurance covers you in your destination. Depending on the type of health insurance plan, your benefits may be limited when you're out of state or the country.

• Are there any local service providers at your destination that will cover you under your plan, and are there any restricted states or countries?
• What counts as an emergency? It is important to ask this because your health insurance plan might cover emergencies, but not all insurers share a definition of "emergency".
• Is urgent care covered, or only emergency room care?
• What is covered under emergency care? For example, if you are going to a remote spot, you may want to know about services like air ambulances.
• How do you file a claim? Find out how claims payment works, which documents you will need, whether you will have to pay in advance and request reimbursement, and whether there are forms for out-of-network physicians' claims.

If your plan does not cover you in your destination, you may need to buy travel insurance. Travel insurance can be purchased up until the very last minute—most insurance companies will allow you to buy a policy until the day before your departure. However, your options will be limited, and some benefits such as trip cancellation and interruption may no longer be available.

Ask about prescription medication coverage

If you are travelling with prescription medication, it is important to plan ahead. Many countries allow a 30-day supply of certain medicines, but some require a prescription or a medical certificate from your healthcare provider. If you are travelling for longer than 30 days, you should talk to your healthcare provider about how you can obtain enough medicine for your trip. Some insurance companies will only pay for a 30-day supply at a time.

If you are travelling within the US, you may pay more to refill a prescription if the pharmacy is out of your plan's network. If you are travelling internationally, it is important to stock up on your medication before you leave. Some insurance plans offer a "vacation override" that allows you to refill a prescription early. If you are travelling for longer than 30 days, you may be able to get a 90-day refill. It is important to note that Medicare drug plans do not cover prescription drugs bought outside the US.

When travelling with prescription medication, it is recommended that you keep it with you to avoid loss or theft. The CDC recommends storing medication in your carry-on bag, along with copies of your prescriptions. You should also keep medicines in their original, labelled containers to avoid questions or delays at customs.

Before travelling, it is important to check the laws and regulations of your destination country regarding prescription medication. Many countries have different laws and regulations regarding medicines that are commonly prescribed or available over the counter in the US. Violating these laws can have serious consequences, including authorities taking away your medicine and penalties such as jail time. You can check with your destination's embassy to ensure that your medications are permitted.

Frequently asked questions