Our individual insurance specialists have heard from Maine Community Health Options that their health plans now cover medically necessary out-of-country emergency coverage in both group and individual plans. The member must pay at the point-of-service and submit a claim form to be reimbursed. Coverage reimbursement foro this emergency care abroad will be at the usual and customary amounts. It is important to note that there is no coverage for non-emergency services out of the country.
Emergency Services received outside the U.S.
The plan provides benefits for emergency services provided in an emergency department or urgent care facility outside the U.S. The plan provides benefits for emergency transport services to the nearest medical facility that can provide emergency services. The plan does not provide benefits for follow-up care that can wait until you return to the U.S. The plan does not provide benefits for travel back to the U.S. or for repatriation. (There are other insurance policies that can provide travel or repatriation coverage; call our offices with questions about those.)
In the exclusions sections, MCHO explicitly excludes the following:
Items and services (except for emergency services covered by the plan) furnished outside the United States when you could have foreseen needing such care before leaving the U.S., including but not limited to childbirth or problems with pregnancy after the 37th week of pregnancy or after being told by a provider you should not travel.