If you’re planning to travel to distant shores for a dream vacation, it’s important to understand how your FEHB plan works should you need medical attention when you’re out of the country.
FEHB Coverage When You’re Outside The U.S.
Since each health insurance plan under FEHB is different, it’s important to check Section 7 of your plan’s brochure to find out what’s covered when you’re overseas. For example: if you have an HMO, it usually only covers U.S. territories such as Guam and Puerto Rico.
Other types of FEHB plans might have participating hospitals and preferred providers in certain countries however most international providers will require payment up front. Then you would have to submit a claim to your FEHB plan for reimbursement of your expenses.
“Also keep in mind that some overseas healthcare services may be considered experimental in the U.S. and will not be covered by your FEHB plan.”
Your FEHB Plan May Require A Second Opinion
It’s important to check if your FEHB plan has a 2nd opinion arrangement for certain types of medical treatments when you’re overseas. If it does, you’ll need to have a medical provider based in the U.S. provide a second opinion electronically via the internet to ensure your FEHB plan will cover the cost. Also keep in mind that some overseas healthcare services may be considered experimental in the U.S. and will not be covered by your FEHB plan.
When You Need Prescribed Medication Overseas
Depending on the guidelines for your FEHB plan, you may be able to file a claim for prescription drugs you purchase overseas. The medication will likely need to be prescribed by a physician who is licensed in the U.S. Add to this, the medication must be equivalent to drugs that require a prescription in the U.S. under federal law. You can also check your plan brochure to see if some prescription medications are available through your plan’s Mail Order Pharmacy.
Other Important Facts About FEHB Overseas
- Since some plans pay overseas providers at the Preferred Providers benefit level, you’ll likely need to pay any difference out of pocket.
- Some plans provide you with assistance in locating qualified medical providers overseas or have participating providers and hospitals.
- Most plans do not require pre-certification for inpatient hospitalization and other procedures outside of the U.S. and Puerto Rico (check your plan to confirm).
- Some plans provide benefits for emergency ground transport in an ambulance to the nearest hospital.
In addition to checking your plan’s brochure before you head to the airport, it’s a good idea to call customer service to clarify any questions you may have.
