Travel medical insurance for a year of study abroad: an example

Maya Petersen is 20 and grew up in Cedar Rapids, Iowa. She studies Spanish and international business at a university in Iowa, and this year she is spending September through June as a visiting student at a university in Salamanca, Spain. She enrolled there directly, and her home school is accepting the credits.

That arrangement left one gap. Her home university doesn’t offer a study abroad health plan for students who go on their own, and the Spanish university doesn’t provide one either. Maya is covered by her parents’ health plan in the U.S.

This story follows her year with Worldwide Education, a long-term plan from BlueCross BlueShield Global Solutions (formerly GeoBlue). It shows why she chose it, how she used it and what it did not do.

Why her parents’ plan wasn’t enough

The carrier’s study abroad page puts the problem this way: most home and campus health plans “don’t cover international care or lack required benefits like medical evacuation or visa compliance.” Its comparison page says most domestic plans offer limited coverage abroad.

Maya and her parents didn’t try to stretch their U.S. plan across a school year in Europe. They looked for a plan made for it.

Why she chose Worldwide Education

The carrier describes the plan simply: if your school doesn’t offer a study abroad plan, Worldwide Education “is made for students studying outside their home country for 3 months or more.” A few details settled it for her.

• No maximum to worry about. The plan has an unlimited annual and lifetime medical maximum.
• It comes with visa paperwork. The carrier says the plan meets Schengen visa requirements in Europe, and members who need proof of insurance can ask the Global Service Center for a letter. For a stay that long, Maya checked the Spanish consulate’s visa and insurance rules against the plan before she applied.
• It covers her at home, too. The plan’s benefits apply outside the U.S. and inside it, at different levels, so the trip home for winter break was covered.
• It covers ongoing care. Maya has an anxiety disorder. She sees a counselor and takes a daily medication. The plan covers outpatient mental health care.

To qualify, she had to be studying outside the U.S. at an institution of higher learning. The carrier notes that online courses and ESL language courses don’t count.

Applying, and the pre-existing condition question

The application asks about your health, and the carrier is clear that its living abroad plans are not guaranteed. It reviews the details you provide, including your overall health.

Maya’s anxiety is a pre-existing condition. For Worldwide Education, the carrier says there is a 12-month waiting period before current conditions are covered, unless you send a letter from your previous health insurer showing you were covered for at least 6 months. She had been on her parents’ plan her whole life, so her parents asked their insurer for that letter. The certificate credits prior coverage that was in effect no more than 63 days before the new plan starts. With the letter, her anxiety care was covered from the first day.

She chose the plan’s “250” deductible option. Under that option:

• Outside the U.S., her deductible is $125 per calendar year.
• In the U.S., it is $250 at in-network providers and $500 out of network.

The certificate says the plan starts on the first or the fifteenth of the month after it approves your application. Maya applied in early August, was approved that month, and chose September 1.

The visa letter, and what it changes

Her visa application asked for proof of health insurance, so she requested a letter from the Global Service Center.

That letter changed one thing she hadn’t expected. The certificate gives members a 10-day “Money Back Guarantee” after coverage starts. Once a confirmation of coverage letter is issued for a visa, that guarantee no longer applies, and a cancellation can take effect only after the first 31 days. The carrier also says most of its long-term plans have a 6-month enrollment minimum. Maya’s plans were for ten months, so neither rule got in her way, but a student going for a short program should read that part first.

Fall: keeping up with counseling

In her first week, Maya used the provider search in the carrier’s app to find an English-speaking psychologist in Salamanca who was in the carrier’s network. She also found a general doctor nearby to write a local prescription for her daily medication.

Here is how those visits were covered outside the U.S.:

• Outpatient mental health: 100%, no deductible, with a $10 copay.
• Doctor’s office visits: 100%, no deductible, with a $10 copay, up to 8 visits per calendar year.
• The plan waives those copays when you visit a contracted provider outside the U.S.

Both of Maya’s providers were contracted, so she paid nothing at the door for her counseling sessions or the doctor’s visit.

Prescriptions are covered at 100% of the actual charge, with no deductible, up to $5,000 per calendar year and a 90-day supply at most. Outside the U.S., the certificate says you pay the pharmacy in full and then send a claim form with the receipt. Her monthly refill cost $36. She paid it, sent the receipt, and was paid back $36 each time.

Winter break at home

Maya flew home to Cedar Rapids for the holidays. The plan still covered her in the U.S., though at different levels. At in-network providers in the U.S., an office visit carries a $30 copay, urgent care a $75 copay, and hospital care is paid at 80% after the deductible. She didn’t need care while she was home, but she checked before she flew.

February: a fall on wet stone

On a rainy morning in February, Maya slipped on the steps outside a lecture hall and landed on her left hand. Her wrist swelled up within minutes.

A classmate took her to the emergency room at a hospital in the carrier’s network. An X-ray showed a small fracture. The doctor put on a splint and sent her home the same day with a prescription for pain medicine. Over the next month she saw an orthopedic specialist, also in the network, twice.

The hospital billed the plan directly. To keep the numbers simple, this example assumes no other plan paid any part of these bills. The certificate has coordination of benefits rules for people covered by more than one plan.

The arithmetic

The emergency room visit

The certificate covers a hospital emergency room outside the U.S. at 100% after the deductible, with an additional $100 copay per visit that is waived if you’re admitted. Maya wasn’t admitted.

Step 1. Covered charges at the network rate: $640.

Step 2. Subtract her $125 deductible for the year: $640 minus $125 is $515.

Step 3. Subtract the $100 emergency room copay: $515 minus $100 is $415.

The plan paid the hospital $415. Maya owed $225: her $125 deductible plus the $100 copay.

The two specialist visits

Each visit’s covered charge was $95, so two came to $190. Specialist office visits outside the U.S. are covered at 100% with no deductible, and the $10 copay was waived because the specialist was contracted.

The plan paid $190. Maya paid nothing.

The pain medicine

The pharmacy charged $12. Prescriptions have no deductible and are paid at 100% of the actual charge.

After she sent in the receipt, the plan paid her back $12.

For the wrist as a whole: the costs were $640 plus $190 plus $12, or $842. The plan paid $415 plus $190 plus $12, or $617. Maya paid $225. And $617 plus $225 is $842.

One more detail worked in her favor. The carrier says amounts paid toward one deductible are credited to the others, inside and outside the U.S. The $125 she paid in February also counted toward her $250 in-network U.S. deductible, leaving $125 of it for the rest of the year ($250 minus $125).

What the plan did not do

It didn’t make every visit free. The emergency room copay applies to any visit that doesn’t lead to an admission. Office visits are limited to 8 per calendar year. And the $5,000 yearly prescription limit is a ceiling, not a guarantee that every drug is covered.

It can’t stop a provider outside the network from charging more. The certificate says a provider that isn’t contracted can bill you for the amount above what the plan allows. Using contracted providers is what made Maya’s bills this simple.

It doesn’t cover maternity care. The certificate lists maternity and obstetrical services as not covered.

It doesn’t cover every activity. The certificate excludes losses from any professional sport, contest or competition, and from scuba diving deeper than 20 meters or without certification or an instructor.

It has its own limits for some benefits. Emergency evacuation is included, up to a lifetime maximum of $250,000 for all evacuations, when a life- or limb-threatening condition can’t be treated adequately where you are and the plan’s medical director agrees. Maya’s wrist was treated in Salamanca, so it never came up. Accidental death and dismemberment is $10,000.

Inside the U.S., some care needs approval first. The certificate requires pre-certification for things like hospital stays and advanced imaging at U.S. providers. That rule applies only to care inside the U.S.

It isn’t Affordable Care Act coverage. The certificate says it is not Minimum Essential Coverage. Students who will spend part of the year in the U.S. should keep that in mind.

Is a student plan like this right for you?

Does your school offer a plan? If it does, start there. Worldwide Education is for students whose school doesn’t.

How long will you be abroad? The plan is for students living outside their home country for at least 3 months of the year. Most of the carrier’s long-term plans have a 6-month enrollment minimum.

Do you have a condition you manage now? Ask your current insurer for a letter showing how long you were covered, and apply early enough that there isn’t a gap of more than 63 days. The carrier’s page and the certificate describe the credit a little differently, so confirm how much of the waiting period yours removes.

Do you need a visa? Plan for the letter, and know that it changes the cancellation terms.

Are you ready for the paperwork? Network providers can bill the plan directly. Outside the U.S., you pay the pharmacy yourself and claim it back. Keep every receipt and send a claim within the certificate’s deadlines: notice within 60 days of an event, proof within 90 days.

The short version

For Maya, Worldwide Education covered a year of counseling and doctor’s visits at no cost at the door, paid back each prescription refill, and paid $617 of the $842 in costs from her broken wrist. She paid $225, her deductible and the emergency room copay. It never covered maternity care, could not control what out-of-network providers charge, and came with visa and cancellation rules worth reading before signing up.

This is an outline of how the plan works. The certificate of coverage sets the full terms, including the exclusions and the limits.