Summer Health Insurance Tips

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Summertime usually means more play time, vacation and, hopefully, some relaxation and travel. The following reminders are intended to help you before you need your health insurance benefits.

¨ Make sure your insurance ID card is in your possession at all times. In other words, don’t leave home without your ID card.

¨ The emergency room is the most expensive place in the world for medical treatment. If you have a true medical emergency, by all means get to the emergency room as quickly as possible. However, if this is not a life threatening medical emergency, you may find it more economical to contact your physician first to determine where he wants you to go for the care that you require.

¨ If you do end up in the hospital or in the emergency room, check your insurance ID card to see if it is necessary to call an 800 #, notifying your insurance company that you are in a hospital. In New Jersey, if you are covered under an individual health insurance plan that you purchased yourself or if you are covered under a small group (less than 50 employees) plan, there is a state mandate that says that you will have a $50 penalty if you are seen in the emergency room and are not admitted within 24 hours.

¨ If you are leaving the country, depending on your destination, you may need certain immunizations. Your insurance may or may not pay for these immunizations. Medicare will not pay because Medicare does not cover routine services and an immunization is considered routine.

¨ If you are covered by the traditional Medicare program and remain within the fifty United States, Medicare will cover any bonafide claim that you have. The claim must be submitted, by the provider, to the Medicare carrier for the state in which you received the medical care.

¨ If you are covered by the traditional Medicare plan and leave the United States, Medicare does not pay for any medical service rendered outside of the country, regardless of the reason. Medicare is only good in the United States. Hopefully, you have other health insurance besides Medicare. Check with them to see if they cover any foreign travel. If you have a Medicare supplement that is identified with the alphabet letters C through J, you do have foreign travel emergency coverage. There is a $250 deductible and then your expenses are paid at 80 percent up to a lifetime maximum of $50,000. Note that this is just for emergencies – illness or injury while you are abroad. If you are going to a foreign country for medical care, it will not be covered. For example, some people may wish to try a cancer treatment in Mexico or in Europe and travel there regularly for such care, because the care is not available in the United States. This will not be covered by your Medicare supplemental insurance.

¨ Check with your HMO if you leave the immediate area. Find out just what it will cover in the event you become ill. Most HMO’s cover medical emergencies no matter where you are.

¨ If you give birth this summer, remember to add the baby to your health insurance plan. It will be necessary to complete an application within thirty days of birth. Your insurance agent or Employee Benefits Department can help you with this.

Best wishes from all of us at Medical Insurance Claims for a happy, healthy, relaxed summer.

Irene Card & Betsy Chandler share the responsibilities of running Medical Insurance Claims, Inc. a health insurance services company. If you have questions relative to this column or other related topics, we invite you to call (973) 492-2828, or visit our contact page.