What You Need to Know About Your Coverage While On Vacation
Posted on June 16, 2015
Going on vacation? Health New England will cover you for emergency and urgent care services when you are out of the service area. Here are some things to keep in mind:
If you go to a walk-in urgent care facility or a doctor’s office, you must contact HNE following the visit for the services to be authorized.
You do not need to notify HNE if you receive services in an emergency room. Emergency room services are covered worldwide. You will be responsible for paying your ER cost sharing (copay and/or deductible). If you are admitted into the hospital from the emergency room, then your ER cost sharing is waived and you will instead be responsible for your inpatient cost sharing.
If a follow-up appointment is needed after your urgent care or ER visit and you are unable to wait until you return to the HNE service area, authorization is required prior to the visit. You should contact your Primary Care Provider (PCP) to submit an authorization request for review.
For services outside of the country, you may be required to pay out of pocket for urgent medical services and pharmacy costs. HNE will reimburse you for these expenses minus any applicable copay or deductible. You will need to submit your itemized bill and proof of payment, translated into English and U.S. dollars, and allow 4-6 weeks for reimbursement. If you require follow up services while out of the country, prior authorization is not required, but will be reviewed for medical necessity.
As a reminder, routine care such as physical exams, laboratory tests and screenings are not covered out of the service area, so be sure to book any necessary appointments with your PCP before leaving for vacation.
We hope you have a happy and safe vacation!
Comments are currently closed.