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Learn More About Your Employer Group Insurance Part 2

Here is part two of our series on how to use your international employer group medical insurance while in the U.S. and throughout our wonderful globe!

Ask Doug – About International Employer Group Insurance is a series of videos created by Good Neighbor Insurance, here in Gilbert, Arizona – https://www.gninsurance.com.  Almost every week, we get great phone calls and emails from our clients around the world about their international employer insurance coverage – https://www.gninsurance.com/group-health.

Good Neighbor Insurance (GNI) provides international and U.S. group health insurance and comprehensive insurance options for employers, for profit, non-profits, international small businesses, social good organizations and agencies, NGOs, and mission organizations and agencies. We provide insurance solutions for social entrepreneurs and international businesses both large and small.

We offer International Group Health insurance (for paid overseas staff, 1099 workers, volunteers, foreign nationals, short-term projects/teams) from a variety of top-rated carriers.

We feel these videos will provide you valuable information.  However, our international insurance agents are here anytime to connect with them via email or phone for more detailed information on your international employer group medical insurance.

  1. The Difference Between Annual Wellness and Preventative Benefits versus Sick Benefits on your International Group Employer Medical Insurance
  2. Who should you call in a medical emergency on your international employer group medical insurance?
  3. Where can I get the most out of my international employer group medical insurance? Outside the U.S. or in the U.S. – Utilization of your international employer group health insurance internationally and in the U.S.

Joey and Sally called in to our Good Neighbor Insurance office here in Gilbert Arizona last month.  Joey could not understand why the ultrasound his wife, Sally, had for her breast was not covered as her annual preventative check, which has no out of pocket (100% paid for by their international insurance policy), but rather was being applied to their family deductible.

It turns out that the mammogram, taken a week earlier, showed that Sally had a lump and her doctor requested an ultrasound to be performed at her earliest opportunity.  The subsequent ultrasound was then ordered to determine whether this lump was something to be concerned about or not.  Because there was a symptom, this lump, it was no longer in the preventative category and thus was coded by the medical facility as a non-annual preventative check-up procedure or also called a diagnostic test.

Even for myself, Joey and Sally, when I went for my annual wellness and preventative checkup, I had to pay an office co-pay for a prescription that is filled annually.  Why did I have to pay my office visit co-pay during my annual wellness and preventative checkup?  Because I was doing two things during one office visit.  I was getting my annual preventative and wellness checkup which cost me nothing out-of-pocket for that visit.  However, my second reason I was seeing my doctor to write another annual prescription out for this certain Rx.  That second reason caused me to have to pay, my office visit copay.

Joey and Sally, this follow up test with the ultrasound has now moved from being coded as an annual wellness and preventative checkup to now being a diagnostic test. Therefore, this and any other diagnostic test will be subject to your deductible and co-insurance (once the deductible has been met).

Now let’s chat about in-network and out-of-network just for a second, Joey and Sally. When you are going in for your annual wellness and preventative checkup, and nothing comes up that needs to be investigated more, than your office visit is covered at 100% and not subject to a deductible.  However, there is an exception to this if you are in the U.S. for your annual wellness and preventative checkup.

Out-of-Network – In the U.S., if you go to out-of-network medical providers for your annual wellness and preventative checkup, then sometimes your deductible is applied as well as your out-of-network co-insurance.  

Please avoid using out-of-network medical providers, if at all possible.  There are two ways to avoid this from happening. First, when in the U.S., stay in your network of medical providers.  The second way to avoid going to an out-of-network provider is by having your annual wellness and preventative checkup done outside the U.S., where any western style medical facility will be in your in-network of providers.

Key note to remember pertaining to immunizations, especially for your children Joey and Sally. Usually immunizations, especially for children, are covered at 100% as part of your annual wellness and preventative checkups. But please keep in mind, that you cannot expect any and all immunizations to fall under your annual wellness and preventative checkup. Sometimes travel immunizations are not covered. There are certain immunizations, dependent on a person’s age, that are covered under your annual wellness and preventative checkup.  Other immunizations are not.  

Here are two ways to find out what immunizations are part of your annual wellness and preventative checkup. First: Check the benefit chart of your policy. If you aren’t sure about a specific one, you can e-mail Customer Service or us here at Good Neighbor Insurance.  Second: You may also check out the CDC schedule: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

There are tests and lab work that need to be ordered by your physician and there is a schedule as to at what age some of them should be done. If you have a family history of certain disease, exceptions to the schedule can be made. Here is a great web site to provide more information on what wellness and preventative checkup benefits will be provided by age group – https://www.publichealth.org/public-awareness/preventive-care-schedule/adults.

We do recommend that each year, you and your family take advantage of the annual wellness and preventative benefits offered by your international employer group insurance, Joey and Sally. This is one of the best ways to catch any possible medical conditions while they are more easily treatable and you have the best outcome.

Hannah called our GNI office, https://www.gninsurance.com, this past week and had great questions on what she needs to do if her family has a medical emergency and needed to connect with her international employer medical insurance. She and her family have just arrived to serve in eastern Indonesia with a local social good organization. Being 8 hours away, by a bumpy jeep ride, to the nearest hospital, Hannah wanted to know who she should call to ask for help from her international medical insurance if she or one of her family members needed to be medically evacuated to the nearest and best medical hospital.

Karen and her team, at Good Neighbor Insurance group department –https://www.gninsurance.com/group-health, was able to share on the phone what Hannah should do if she needs to call her international employer medical insurance in case of a medical emergency. Karen said – Hannah, besides calling 911 or the equivalent in your country of service, your next call should be the Customer Care, Customer Service or Member Services of your international employer medical insurance which is on your medical ID card.

Your medical ID card has an emergency phone number that you may call. These phones are monitored 24/7 and they will take collect calls. If you have to leave a message, be sure to leave your phone number.  Please also include your telephone country code, if you are outside of the U.S.

We at Good Neighbor – https://www.gninsurance.com/group-health, here in Gilbert Arizona, are at your service also, Hannah. However, we do not monitor our phones 24/7. We work regular office hours, so are therefore unavailable evenings or week-ends.  If unexpectedly you are unable to reach your international employer medical insurance company, we will be happy to reach out on your behalf.  Please provide a phone number that we can pass on to your international employer medical insurance company so that they can reach you. Relying only on e-mail can be tricky, it doesn’t allow for the back and forth questions and answers that you would have on a phone call. And the e-mails from your insurance company may end up in your junk mail folder.

Your mobile app can be very helpful too in finding nearby medical providers that your insurance company may already have a direct billing relationship. You may also communicate with your international employer medical insurance company via their mobile app…

Utilization of your international employer group health insurance internationally and in the U.S.

Ask Doug – About International Employer Group Insurance is a series of videos created by Good Neighbor Insurance, here in Gilbert, Arizona – https://www.gninsurance.com. Almost every week, we get great phone calls and e-mails from our clients around the world about their international employer insurance coverage – https://www.gninsurance.com/group-health.

Jim and his wife are on Jim’s international employer medical group policy, https://www.gninsurance.com/group-health, with his school in Thailand. They never used their international medical insurance.  But now they have good reason to use their overseas medical cover because Jim’s wife is pregnant.

Jim was sharing with Armin this week on the phone and said this – “We would like to deliver our baby in the U.S.  But our international medical insurance policy with our employer here in Thailand has a plan design with no deductible outside the U.S. and a $5,000 deductible in the U.S.  What would you suggest?”

Congratulations on your addition to your family, Jim.  I bet your son is also excited to soon have a little sister or brother. This is a great question, Armin stated to Jim.  Before we jump into answering this great question, I want to encourage you about your international employer medical insurance (all amounts are in USD).  Yes, you are correct that your outside the U.S. deductible and coinsurance is zero dollars out of your pocket.  And yes, you are also correct about your U.S. deductible per policy year comes right at $5,000. 

But it also is good to know that if you were residing in the U.S. your ACA (Affordable Care Act) employer group insurance policy or an individual ACA policy that your U.S. annual out of pocket for a typical plan currently is right under $8,200 (double that amount for a couple and family annual maximum out of pocket).  You actually have a very good international employer group medical cover when it just comes to maximum out of pocket for an individual / family of only $5,000 here in the U.S.

Now let’s dive into your question and find the best answers for you and your family! Since you are already overseas in Thailand, why don’t you all consider delivering abroad?  You can take advantage of lower costs of maternity and birthing care that we in the U.S. do not have. Another great benefit is your policy includes hospital indemnity (most of the international plans offer this perk) for each day you are hospitalized.

The definition of a hospital indemnity – This is extra money that you get when you are hospitalized outside the U.S. The purpose is to cover any extra expenses you may have in regards to your hospitalization. Payment is based on a daily amount for each day hospitalized. Here is more information on hospital indemnity benefits outside the U.S.  When you are hospitalized outside the U.S., the patient will receive money back (the dollar amount will differ from insurance company to insurance company).  Sometimes your employer will pay the indemnity and sometimes the international medical insurance company will pay.  This is in addition to the normal eligible medical expenses. Please consult with your HR department to find out if you have this benefit and how you may receive it or call us here at Good Neighbor Insurance here at 480-813-9100 or our email address at info@gninsurance.com.

 

Going back to your question, Jim – You may find that you can have the birth of your baby at no cost or minimal cost to you outside the U.S.  Your international employer group health insurance allows you to use any western medical facilities outside the U.S.  They also have recommended medical facilities and hospitals for you, even in Thailand.

Here are some additional thoughts, Jim, pertaining to your newborn.  Once your little one is born please contact with the U.S. embassy as soon as possible to get his or her passport. Your little one will have insurance coverage under your policy for the first 30 days under mom’s international employer group medical insurance policy.  We will need you to fill out an enrollment form to us right away.  I will have that form attached in an email to you today.  Please send that back to me once your little one is born and both mom and baby are discharged from the hospital.

” That sounds great”, Jim said. “It is great news that we can have our baby born outside the U.S. and save money and put that money to good use, like our children’s educational fund.  I have a couple more questions about the utilization of our international employer medical insurance.  Should we get our yearly check-ups, immunizations, and as many physician visits (planned or unplanned) outside the U.S.? Yes, having your employer international medical insurance policy have a great plan design where you have no out-of-pocket outside the U.S. will help save you money for your family.  It is best to use your policy, as much as possible, outside the U.S.  Also, Jim, keep in mind, the more you save the more the insurance company also saves.  This will help the annual premium to stay low.

“I have one last question,” Jim said. Last year we were visiting family back in the U.S. and my wife had to visit an Urgent Care for some nausea she experienced. Everything was fine, nothing major, yet the charge for service was much higher than we expected.  Why were we charged over double than what I think is a normal office visit?  Even my sister also thought that was not right since her visit to the same Urgent Care was a lot cheaper?

After a quick look at the Explanation of Benefits for Jim’s wife Urgent Care visit, Armin had an answer right away.  Jim, your international employer medical insurance has no deductible amount for services provided outside the U.S.  However, deductible, co-insurance, and co-pays are applied to most of the medical benefits when used in the U.S. I see, from the information you provide me today, that the Urgent Care your wife visited is not part of the preferred network of your international employer medical insurance.  If you look at your schedule of benefits, you will see that your deductible and co-insurance are much higher when the medical service provider is outside of your preferred network (out of network).

Jim asked – How would we know about in-network and out-of-network providers? She had nausea and went to the closest Urgent Care. They had accepted our medical insurance card. We paid the co-pay and that was it we thought. And a few weeks later, we received an Explanation of Benefits that we still owe an amount that I showed you.

Very good questions, Jim.  I can understand the frustration, especially when outside the U.S. you do not have to worry about in and out-of-network medical providers. However, one of the ways to keep cost down for all of us here in the U.S., through lower medical insurance premium, is to use in-network medical facilities.  It is similar to having a subscription to Costco or Sam’s Warehouse.  You pay an annual subscription fee and you and your family are able to purchase more of the products and services at a discount.  Thus, your insurance medical card is your annual subscription to use medical facilities at a lower cost to you using all the in-network providers in the U.S.

Jim, you said they accepted your medical insurance card and that is the keyword. Accepting your insurance and being “in-network” are not the same thing.  Medical providers may accept your medical insurance, however that does not mean that they are an in-network provider of your employer group medical insurance policy. Jim, let me put the difference this way, “In-network” providers have contracted with your insurance company to accept discounted rates. On your claims and explanation of benefits statements, you’ll see these savings listed as a discount. “Out-of-network” providers charge full price for their medical services.

“Ah, I see, lesson learned”, said Jim “Maybe it is a stupid question, but how one can find if the medical provider is in or out of network? I know it is explained somewhere in our Certificate, but ours has over 200 pages.” Actually, that is a great question. People forget that it is often up to you, the policyholder, to determine whether a given medial provider is in or out of network for your medical insurance policy.  The best way to check if the provider is in-network is through the Insurance app on your smart phone, or through your account on the insurance companies web site, or you may call the customer service number on your card and verify with a representative the provider’s network status.

Jim, you can always ask us here at Good Neighbor Insurance too, https://www.gninsurance.com.  We will be glad to help you.  We are always here to serve you and your family when it comes to your international employer medical insurance policy. We can’t wait to make your day the best day possible!