Learn More About Your Employer Group Insurance

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 you want to connect with them via email or phone for more detailed information on your international employer group medical insurance.

1. Understanding your international employer group deductible
2. Understanding your medical out of pocket maximum (Part 1 of 2)
3. Understanding your medical out of pocket maximum (Part 2 of 2)
4. Submitting my international employer group insurance claim
5. Understanding Eligible International Employer Group Medical Expenses: What is covered and what is not?

The phone rings at our office here in Gilbert, Arizona. “My doctor here in Malaysia says I need an EKG.  What is my deductible I have to pay before my international employer group medical starts paying” asked one of our clients who is residing in Malaysia?

“Ask Doug – About Employer Group Insurance” is a series of videos pertaining to your international employer group insurance. Today, we will be sharing key things to keep in mind with your international employer group deductible.

Here are a few key points about your international employer group medical insurance? (a) International group insurance has an “annual” deductible, not a per incident deductible. (b) Some employer group plans have the annual deductible based on the calendar (January 1 through December 31) and others based on the policy year (when the policy started during the year). (c) Deductibles are also calculated according to the service date, not according to when the claim was filed. (Sometimes people think they have to submit the claim in the same calendar year, but 90 days after is fine.) (d) Some employer group plans have a lower- or zero-dollar deductible for medical expenses incurred outside the U.S. This is to encourage you to have medical care in your country of service. Lower medical costs, mean lower increases to your premium next year. ( e) Some employer group plans have a higher deductible “out of network” expenses.  That’s because the insurance company does not get a discount with that hospital or doctor. (f) All employer group plans allow deductibles to cross-accumulate, which means, any deductible met in one place will apply to the other. So if you already met your U.S. deductible and go back overseas, any additional medical care in that year won’t need to meet the deductible.

Karen, our international employer group director shared this with our client over the phone.  And then added this.  “Jim, the best way to find out if your EKG is covered or where to get it, is to call the phone number on your medical card.  The customer care representative will be able to answer your questions on this. You can call collect 24/7/365.

“Another way is to email Customer Service or go online to your secure portal.  You should receive an immediate auto-response and then within 24 hours an actual answer should come,” Karen mentioned on the phone.   “Now, if you are still unsure, Jim, send me an e-mail with the details, including dates, and provider contact information and we will make sure that you get an answer. 

Jerry connected with us at Good Neighbor Insurance and had questions relating to the different international employer group insurance options we provided for his organization.

A general definition of “out of pocket maximum” – These are expenses that the patient (or the Patient’s parents) can expect to pay themselves before the insurance company covers the rest at 100%.  Every international medical insurance company has their own formula for how the Out-of-Pocket Maximum is Calculated.

Here are the four major components that may be used to calculate out-of-pocket maximum expense.  (Not all companies count all of these components.) (a) Deductible (b) Co-insurance (c) Co-pays (d) And International, U.S. In-Network, U.S. Out-of-Network

First, adding your responsibility on each of these four components will show you what your out of pocket maximum will be.  Also, you will have, on your schedule of benefits, the total amount of your out of pocket maximum in U.S. dollars international and U.S. in-network.  Expenses in the various locations, cross accumulate in the other locations.

Glad we took a short coffee break, Jerry.  Now let’s get back to the exciting world of “out of pocket maximum” of your international employer group insurance!

Here is more information on co-insurance, Jerry – (a) International expenses are paid 100% after the international deductible is met. (b) For U.S. in network expenses, typically, the company percentage is around 80% (sometimes 70%) to a certain limit and then once you have paid up to that limit, the company pays 100%. 

For US Out-of-Network expenses, the percentage that the company pays is often 60% or 50%. The limit that you are responsible for, is usually higher too.

Key note – (a) Once you have met your out of pocket maximum (one person) for all covered medical services, the company will pay all the other eligible medical expenses at 100% for the rest of Policy or Calendar year (depending on your policy). (b) The family maximum out of pocket is 2 or 3 times the individual.

Co-pays – (a) Some international insurance companies add the deductible, co-pays and co-insurance together to come up with the out-of-pocket maximum.  (b) Sometimes, only the co-insurance is counted in the out of pocket maximum with the deductible and copays as separate expenses that are the patient’s responsibility.

Joe is on his employer group policy with his school in Guatemala but has never been sick, so has never used the benefits.

“I have a doctor’s appointment tomorrow for some backpain. Do I have to pay out of pocket and file the claim for services outside the U.S?”

First – check with the service provider before or at the time of the scheduled visit (a) Outside the U.S. you may need to file the claim unless you visit a provider that has a direct payment arrangement or has obtained a guarantee of payment from your insurance company and (b) if a provider has a direct settlement with your insurance company all you need to do is present your ID card.

Then – search your international insurance company web site.  To find if the provider you plan to visit has such arrangements visit your insurance company web site and look for a tool usually named “Provider locator” or “Find your doctor”.

“The provider I am visiting does not have a direct settlement agreement with my insurance company. What should I do?” (a) First – collect receipts, itemized invoices and diagnosis from your doctor’s office. If you are in a situation like this, you will have to pay the provider directly and submit the claim form and required documents to your insurance company. (b) Second – fill out the claim form, scan or copy all documents and send the claim to your international insurance company The fastest way to submit the claim is through your smartphone or web application. Alternatively, you may submit via e-mail. Technically, you may submit by fax or mail, but these claims tend to get lost. If you have questions or need help with your claims like Joe did, you can always call us at 480-813-9100- or chat with us online at gninsurance.com

Joe called to give Doug and the GNI team an update. “My doc sent me to the specialist and he sent me for some lab work. Now I am waiting for the results.”  “Everything was paid with my credit card. Should I wait for my follow up appointments and file the claim after I’m done with all my doctor visits?”  “And how much time do I have to submit the claim?”

So glad you were able to connect with your medical doctor, Joe.  Great questions on how to handle your claims.  As you know, we are a bit spoiled in the U.S. with having our providers send all the paperwork to the insurance company.  However, with different electronic systems, international laws, and differences in insurance process there is a bit of hand holding when dealing with international insurance claims from outside the U.S.  First – If you visited more than one medical doctor, you’ll need to fill out a separate form for each visit. Each claim form must be signed and filled out completely. Add diagnosis or type of treatment…

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, at our Good Neighbor Insurance headquarters in Gilbert Arizona, we get great calls and e-mails from our clients about their international employer insurance coverage.  Our clients here at GNI, have questions about what benefits are covered on their international employer group insurance.

These questions do come a lot of times once a visit from the medical facility has transpired or will be coming up. 

Here are a few examples (with names and places changed) that may help provide general coverage information on your international employer group insurance through GNI.

Scenario 1 – Last week, I had an e-mail from Shelly. She was having some challenges at her assignment in Malaysia and wanted to know if counseling was covered.  Shelly had heard that her friend’s claim from another international employer insurance policy had been denied, and wanted to know if that would happen to her?

This is a great question, because although Mental Health is covered on most international employer group medical insurance policies, “counseling” per se isn’t necessarily considered a mental health benefit. 

Usually, treatment is covered if there is a medical / mental diagnosis.  Such as in the areas of: anxiety disorders such as panic attack, mood disorders such as depression, eating disorders such as bulimia, substance abuse disorders, personality disorders, and psychotic disorders.

Additional Takeaways – The invoice from your mental health provider, must include a mental health diagnosis in one of the above types of categories, or most likely it will not be covered.  Usually, the following expenses are not covered: marriage / family counseling, relationship counseling, pastoral / spiritual counseling, and career counseling.

Scenario 2: This morning, I had a call from Jacob. He said, “we have four kids and we think our quiver is full.  Does our international employer group medical insurance cover a vasectomy?.