How a volunteer abroad used Worldwide Non-Profit health coverage

Grace Whitfield is 38 and lives in Greensboro, North Carolina. She taught fifth grade for eleven years. Then a small literacy nonprofit she had volunteered with for years asked her to spend two years in a rural district of northern Uganda, training teachers and setting up reading programs in village schools. She said yes.

Leaving her teaching job meant leaving the health plan that came with it. She also knew she would be living six hours by road from the capital, Kampala, in a place where the nearest clinic is small. She needed coverage that would work where she was going, for as long as she was there.

This story follows her first year with Worldwide Non-Profit, a plan from BlueCross BlueShield Global Solutions (formerly GeoBlue).

Why coverage from home wasn’t the answer

The carrier makes a plain point about this: when you’re outside your home country, medical evacuations aren’t always covered by your current health insurance. For someone working far from a city, the cost of getting to a hospital that can treat you can be as big a worry as the treatment.

As for relying on a country’s national health insurance, the carrier notes that you lose it if you move on or go back to the U.S., and that if you need to be flown home because of an injury or illness, you pay for that yourself.

Why this plan

Worldwide Non-Profit is described by the carrier as worldwide coverage designed for NGOs, missionaries and people involved in humanitarian work. Grace fit the eligibility rules:

• She is a U.S. citizen and was under 75 when she applied.
• She would live outside the U.S. for more than three months a year.
• She was working as a volunteer for a sponsoring organization, doing NGO work.

The plan is not guaranteed. The carrier reviews each application, including the applicant’s health, and it can be accepted, accepted at a higher rate or denied. Grace’s was accepted.

Her asthma. Grace has mild asthma and uses an inhaler. The carrier says current health conditions are covered under its plans for living abroad, and that for coverage to start right away you supply a letter from your previous health insurer showing you were covered for at least 6 months. Without that letter, the waiting period for current conditions on Worldwide Non-Profit is 12 months. Grace had been on her school district’s plan for years, so she asked for the letter and sent it in. Her school coverage ended in June and the new plan started August 1, well inside the certificate’s 63-day limit.

The deductible. The plan offers several deductible options. Each one has a deductible for care outside the U.S., a deductible for care in the U.S. inside the network, one for care in the U.S. outside the network, and a coinsurance maximum. Grace chose the 1,000 option:

• Outside the U.S.: $500 deductible
• In the U.S., in network: $1,000 deductible
• In the U.S., out of network: $2,000 deductible
• Coinsurance maximum: $4,000

Deductibles are per person per calendar year. Outside the U.S., the plan pays 100% of covered expenses after the deductible. In the U.S. it pays 80% in network and 60% out of network. Since nearly all her care would be in Uganda, the $500 deductible was the number that mattered most.

There is no annual or lifetime maximum on the medical benefits, though some services, like prescriptions and travel vaccines, have their own yearly limits. The plan is issued by 4 Ever Life International Limited, with BlueCross BlueShield Global Solutions as the administrator.

Before she left

Grace chose a start date on the first of the month, as the plan allows, so her coverage began a few weeks before her flight.

Her first use of the plan was in Greensboro. She went to an in-network travel clinic for the vaccines her doctor recommended for Uganda. Travel vaccinations are covered with no deductible, up to a calendar-year maximum of $500. In the U.S. in network, the plan pays 80%.

Step 1. The clinic’s covered charges for her vaccines: $450.

Step 2. The plan pays 80%: 80% of $450 is $360.

Step 3. Grace pays the rest: $450 minus $360 is $90.

The $360 was under the $500 yearly maximum, so nothing was cut off.

She also registered on the Member Portal and downloaded the app. It holds her digital ID card, a provider search with detailed profiles, claim tracking, medical translations, a medication equivalents finder and safety alerts based on her location. She looked up the local name for her inhaler before she packed. Prescriptions are paid at 100% of the actual charge with no deductible, up to $5,000 per calendar year, with a maximum 90-day supply at a time.

A video visit from the village

In her third month, Grace woke up with an itchy rash across both arms. It wasn’t an emergency.

Every plan includes unlimited telemedicine at no extra cost. The carrier lists rashes and allergies among the non-emergency needs it’s meant for. Same-day remote appointments are available around the clock with multilingual doctors, and the consultation notes are sent to your phone.

Grace booked a video visit that afternoon. The doctor thought it was a reaction to a plant near the school compound and recommended a cream. Grace used the medication equivalents finder to find the local name for it, and a pharmacy in the nearest town had it. The visit cost her nothing.

The emergency in November

In November, Grace developed sharp pain low on the right side of her stomach and a fever. The doctor at the local clinic suspected appendicitis. There was no surgeon there.

She called the Global Service Center at the number on her ID card, which is how the plan’s evacuation benefit starts. It covers a sudden accident or unforeseen illness that is life-threatening or limb-threatening, when the carrier’s medical director decides adequate care isn’t available locally. The carrier then arranges transport to the nearest or most appropriate facility, weighing her condition, her ability to travel, weather and distance.

The medical team agreed and arranged her transfer to a hospital in Kampala that night. The hospital was one the carrier contracts with, so it billed the plan directly and Grace did not have to pay up front and file a claim.

The transfer. The deductible doesn’t apply to emergency medical transportation. The benefit covers up to $250,000 for emergency medical evacuation, repatriation and repatriation of remains; the plan documents set how that maximum applies. Her transfer cost $7,800, and the plan paid all of it.

The hospital. Grace had her appendix removed and stayed three nights. She came in through the emergency room. The plan adds a $100 copay for an emergency room visit, but waives it if you are admitted, so she didn’t owe it.

Step 1. Covered hospital and surgeon charges: $6,200.

Step 2. Subtract her outside-U.S. deductible: $6,200 minus $500 is $5,700.

Step 3. Outside the U.S. the plan pays 100% after the deductible, so it paid $5,700.

Grace paid $500 for the surgery and hospital stay. The plan paid $5,700 to the hospital and $7,800 for the transfer.

After she was discharged she filled prescriptions for pain medicine and antibiotics at a pharmacy for $38, paid, and sent in the receipt. Prescriptions have no deductible, so the plan paid her back $38.

Two details helped her later. Amounts paid toward one deductible are credited to the others, so her $500 also counted toward her U.S. deductibles. And because she paid it in November, the plan applies deductible amounts from October, November and December toward the next year’s deductible too.

The follow-up visits

A week later, the surgeon saw her for a check at the same hospital. Office visits outside the U.S. are covered with no deductible and a $10 copay, and the copay is waived at a contracted provider. She paid nothing.

Back in her district, she had a wound check with a local doctor who wasn’t contracted with the carrier. She paid the $60 bill herself and submitted the claim. Two rules applied. For providers outside the U.S., the plan bases covered expenses on its usual and customary fee, which may be less than the bill, and the provider can bill you for the difference. And the $10 copay is waived only at contracted providers.

Step 1. The plan’s usual and customary fee for the visit: $45.

Step 2. Subtract the $10 copay: $45 minus $10 is $35. The plan paid Grace $35.

Step 3. Grace’s share: $60 minus $35 is $25. That’s her $10 copay plus the $15 above the usual and customary fee.

Claims have time limits. The plan asks for written notice of a claim within 60 days of the event, or as soon as reasonably possible, and proof of loss within 90 days.

Her first year, added up

What the plan paid:

• Travel vaccines: $360
• Emergency transfer: $7,800
• Hospital and surgery: $5,700
• Wound check: $35
• Prescriptions after surgery: $38

Total: $13,933.

What Grace paid: $90 for the vaccines, plus her $500 deductible, plus $25 for the wound check, which is $615. The video visit and the surgeon’s follow-up cost her nothing.

What the plan did not do

It describes medical evacuation, not security evacuation. The plan page describes evacuation for medical emergencies. It does not describe evacuation for political unrest or natural disasters, so Grace asked her sponsoring organization what it had in place for that.

Evacuation has conditions. It must be authorized and arranged by the carrier. It does not cover minor or routine problems, or cases where the medical director decides you can be treated adequately where you are or treatment can wait until you get home. It excludes evacuation from a ship or boat. And it allows one evacuation or repatriation per medical condition.

It doesn’t cover maternity care. Pregnancy and maternity care are excluded, except for complications of pregnancy.

Routine dental and vision aren’t included. Dental care is covered only after an injury, up to $500 a year, unless you add the optional dental and vision rider. Eyeglasses and contact lenses are excluded.

Some events are excluded. The plan excludes conditions caused by an act of war or by taking part in a riot or insurrection. The carrier says it covers illnesses and injuries related to terrorism.

It isn’t ACA coverage. The certificate says the plan is not Minimum Essential Coverage under the Affordable Care Act. It is issued on a surplus lines basis, which means its terms may not follow the state insurance rules for admitted insurers, and the insurer’s inability to pay claims is not covered by state guaranty funds.

It runs period by period. Coverage ends at the end of each period of coverage, and you reapply for the next one.

The short version

Grace chose Worldwide Non-Profit because she would be living far from a hospital for two years, doing volunteer work for a sponsoring organization. In her first year the plan paid $13,933, including an emergency transfer that cost her nothing, while she paid $615. Its plan page doesn’t describe security evacuation, it excludes maternity care and routine dental and vision, and it has rules to follow on evacuation and claims.

This is an outline of how the plan works. The plan documents set the full terms, including the limits, exclusions and how each benefit applies.