Some commonly asked questions
Most of the policies have their own definition of a pre-existing condition which you can find in the brochure. Below, however, is a general definition:
Pre-existing Condition(s) are any medical condition, sickness, Injury, Illness, Disease, Mental Illness, or Mental Nervous Disorder, regardless of the cause including any congenital, chronic, subsequent, or recurring complications or consequences related thereto or resulting therefrom that with reasonable medical certainty existed at the time of application or any time during the “x” months prior to the effective date of coverage under this policy, whether or not previously manifested, symptomatic, known, diagnosed, treated or disclosed.
Pre-existing conditions are typically excluded. There are some policies (e.g. Atlas America, Patriot America, Liaison Continent, Inbound USA, Visitors Care, etc.) however which can provide some benefits for an acute onset of a pre-existing condition.
When you are in another country, it is not only pre-existing conditions that need to be taken care of. One can get illnesses due to the new climate, new location, new food, traveling long distances, or simply by tripping and falling down. May it be a simple thing like a common cold, flu, or anything major where you need hospitalization, these insurance policies can take care of the expenses related to the treatment as long as it is not related to a pre-existing condition. In the event of an acute onset of a pre-existing condition where treatment is sought within 24 hours of the symptom, there are various plans that can provide some protection for people under the age of 70 years.
You only need to complete the application and submit it to the insurance company along with the payment. This can be done online. It is a good practice to have a medical check-up in one’s home country done before travel; however, there is no medical examination that needs to be completed in the home country before arrival or even after coming to the US for the application process to be completed or the policy to be issued.
The earliest the policy can begin is the next day after you complete the application and pay for the premium. The insurance can provide benefits accordingly to the policy as long as the treatment is for something that has happened after the effective date of the policy and is not related to a pre-existing condition.
It is very difficult to say how much is enough as it would depend on the treatment you need in the event of an illness/injury. Typically most travelers opt for a $50K to a $100K policy maximum with a deductible of $250 in case of a comprehensive policy. The higher the policy maximum higher will be your premium. The higher your deductible, the lower will be the premium. The policy maximum affects your benefits while the deductible only affects the premium.
Once the application has been submitted online, you do get a confirmation immediately after purchase. This confirmation will have your ID card with your name and Certificate number mentioned on it. The ID Card will also have the insurance phone numbers to reach in case of an emergency situation. The ID Card along with your policy information will be emailed to you at the email address you provide on the application.
The insurance company does not restrict you from going to any doctor/hospital in the event of an illness/injury. However, it is a good practice to go to a network provider if your policy does follow a PPO network. There are always advantages in going to providers in the network. In-network pricing could be different and the network providers can bill the insurance company directly saving you the hassle of filing claims.
Each policy has its own Claims Form that needs to be completed and submitted in the event of a Claim. Typically for each policy, you need to complete the Claims form and submit it to the address mentioned on the form along with the bills within 90 days from the date you received treatment. In the event this is not followed, a Claim can be rejected due to untimely filing of the claim. This Claims Form is available for download and is also sent to you in the Fulfillment package when you buy the visitor insurance. Once all these documents are submitted, the Claims Departments after evaluating the medical reports sent by the treating physician will mail you the check for the eligible amount. You do get an Explanation of benefits describing the charges, your policy benefits, and the amount paid. This process can take a minimum of 4 weeks from the time the Claims Department receives your paperwork.
To qualify for health insurance through the Marketplace a person must live in the United States, be a U.S. citizen or national (or be lawfully present) and cannot currently be in jail.
The following is a partial list of immigration statuses that are classified as lawfully present and qualify for Marketplace coverage.
- Lawful Permanent Resident (LPR/Green Card holder)
- Paroled into the U.S.
- Conditional Entrant Granted before 1980
- Granted Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT)
- Individual with Non-immigrant Status (includes worker visas, student visas, and citizens of Micronesia, the Marshall Islands, and Palau)
- Lawful Temporary Resident
- Adjustment to LPR Status
U.S. citizens living abroad are not required to get health insurance coverage under the Affordable Care Act.
The health care law requires most people to have health insurance by Jan. 1, 2014, or face a penalty. A penalty of $95 or 1% of an individual’s income (whichever is greater) will be levied next year if the person does not have insurance in place. The penalty does not start until you have three uninsured months.
Under regulations published in August 2013, international students with valid student visas are exempt from the individual mandate and do not need to enroll in an ACA-compliant plan.
Yes, International students with valid visas are eligible to purchase insurance from their State Exchange. But it is not clear if they will qualify for any subsidies.
Visitors to the US on a temporary visit, who do not reside in the US cannot purchase insurance from the Health Exchange. They also do not qualify for any subsidies. They must purchase visitor insurance to cover their medical expenses.
Fixed Benefit plans offer a fixed amount / limited amount for each covered expense. This limit is different from the overall maximum limit for the plan. For example, a policy with a $50,000 maximum limit may pay a maximum of $55 for a doctor visit, $1400 per night in the hospital after the deductible has been met. The policy brochure lists the Schedule of Benefits which describes these limits in detail.
The Fixed Benefit plans offer coverage at lower premiums than the comprehensive plans. It is a good idea to check the brochure to see the protection limits for each expense so you are aware of the limits in the plan. The Inbound USA, Visitors Care, Visitors Secure are examples of Fixed Benefit plans.
Comprehensive plans do not have individual sub-limits for each expense. The plan covers eligible expenses up to the policy maximum (less the deductible and any applicable coinsurance). The premiums are typically higher but the insured has the benefit of having a capped out-of-pocket maximum for eligible expenses.
Atlas America, Patriot America, Liaison Continent are some popular examples of Comprehensive plans.
Hospitalization is when you are confined and/or treated in a Hospital as an Inpatient. This involves an overnight stay at the hospital. ER visits are not considered as Hospitalization as these visits are considered outpatient where typically the member is treated and sent back home. Hospitalization and ER visits are subject to deductible and coinsurance (if any).
Settlement of claims will be based on the type of policy (Fixed vs Comprehensive) you opt for. If the policy you opt for does follow a PPO network and if the hospital is part of the network, claims are settled with negotiated rates. Fixed benefit plans typically do not have negotiated rates and will have a daily sub-limit for the amount that the policy will pay either for Hospitalization or an ER visit.
Yes, you can see a doctor when you are traveling in the event you are not feeling well. The policy can offer benefits for your visit as long as this Doctor’s visit was due to an illness/injury after the effective date of the policy and not linked to an excluded or preexisting condition. Annual visits/ preventive care visits are not covered under most travel policies and will have to be paid out of pocket. Doctor visits are subject to deductibles and coinsurance (if any). Some plans do offer copays and waive deductibles for Urgent Care visits. For something like the Flu, stomach ache, etc. an Urgent Care might be a good option to get treatment.
Almost all plans do offer Prescription drug benefits. However, plans will not cover a refill of a prescription drug in the event of an ongoing condition (illness/injury before the start of the policy e.g. Diabetes medicines or insulin, Cholesterol, and Blood Pressure, etc.) for which you have been taking the prescription. The policy can offer protection for a prescription drug for a new covered illness/injury after the effective date of the policy. The prescription drug is subject to deductible and coinsurance. As pharmacies are out of network, the member will have to submit the bills for reimbursement.