my employer's health insurance plan offer ZERO coverage outside of the 50 states
May 9, 2013, 2:33 pm
#1
Original Poster
Join Date: May 2013
Posts: 20
my employer's health insurance plan offer ZERO coverage outside of the 50 states
I've been working for the same large employer for several years now. Never had a problem with the health insurance plan for employees.
However, I recently discovered that it offers ZERO coverage outside of US. Not even for emergencies. It even excludes US territories outside of the 50 states. (such as Guam, Puerto Rico, USVI, Canada, etc) All these exclusions are clearly spelled on on the written policy guide. How can this be legal?
In any case... I travel quite a bit to Europe and Asia on personal trips. I always assumed that I was covered... but guess I should now look for a healthy plan to cover me on these trip. Any recommendations?
However, I recently discovered that it offers ZERO coverage outside of US. Not even for emergencies. It even excludes US territories outside of the 50 states. (such as Guam, Puerto Rico, USVI, Canada, etc) All these exclusions are clearly spelled on on the written policy guide. How can this be legal?
In any case... I travel quite a bit to Europe and Asia on personal trips. I always assumed that I was covered... but guess I should now look for a healthy plan to cover me on these trip. Any recommendations?
May 9, 2013, 2:50 pm
#4
Original Poster
Join Date: May 2013
Posts: 20
My apologies.... I certainly don't mean Canada is currently a U.S. territory. 
That's just how they listed the exclusions in the policy guide.
(as an aside, I do support the merger of the US and Canada into a single country or federation, but that's totally unrelated to this thread
)
That's just how they listed the exclusions in the policy guide. (as an aside, I do support the merger of the US and Canada into a single country or federation, but that's totally unrelated to this thread
)
May 9, 2013, 3:31 pm
#7
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my employer's health insurance plan offer ZERO coverage outside of the 50 states
This seems to be a common clause now for workplaces that don't require international travel. I'd go with a business or leisure year long travel insurance policy. It covers medical emergency and transportation home. I say go with the year Long if you do more than 1 or 2 trips as its not much more expensive to just get the whole year.
May 9, 2013, 3:43 pm
#8
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A significant percentage of large employers self-insure (although contract with a carrier for network administration). Any restrictions like that are certainly not done by the administrator without the employer signing on. One reason for this kind of exclusion is the inability of the administrator to put into place price capitation, when dealing with non-network providers. It's unlikely that a "Blue Cross" kind of administrator is going to have the ability to do so outside of the U.S.
My experience from having been involved in purchasing of self insured programs is that the employer usually will have some provision for foreign emergency coverage. However the patient will have to self-pay for services, and attempt to get a partial reimbursement when back in the U.S. The amount they get back might be subject to a different deductible and/or interpretation of "ordinary & customary" then if you went to an out-of-network provider in the States.
My experience from having been involved in purchasing of self insured programs is that the employer usually will have some provision for foreign emergency coverage. However the patient will have to self-pay for services, and attempt to get a partial reimbursement when back in the U.S. The amount they get back might be subject to a different deductible and/or interpretation of "ordinary & customary" then if you went to an out-of-network provider in the States.
May 9, 2013, 6:13 pm
#10
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As a way to save money, many employers will exclude coverage outside the US and no it's not illegal.
When I moved to my current employer, they had two options: one a PPO that didn't offer coverage outside of the US, and the other a self administered plan that did. The self administered plan was slightly more expensive but worth the $5 more per month for the expanded coverage for me. But for someone who never travels having the option to save $5 per month for something they didn't need was a nice thing. Incidentally this year in order to simplify things, they went to one option only - thankfully the self administered plan - but everyone is paying a lot more as a result.
When I moved to my current employer, they had two options: one a PPO that didn't offer coverage outside of the US, and the other a self administered plan that did. The self administered plan was slightly more expensive but worth the $5 more per month for the expanded coverage for me. But for someone who never travels having the option to save $5 per month for something they didn't need was a nice thing. Incidentally this year in order to simplify things, they went to one option only - thankfully the self administered plan - but everyone is paying a lot more as a result.
May 9, 2013, 11:19 pm
#15
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It's reasonably common for US employer health policies to offer at least emergency coverage. IMO, it's actually kinda uncommon for Americans to buy travel insurance (in the form that kiwis and aussies would recognize) when they travel internationally. I have a pet theory that it's because of their typical destinations - Canada, Mexico, Caribbean islands for the majority of destinations for the vast majority of American international travel.