GROUP
HEALTH PLANS AND OUT OF STATE
EMPLOYEES
How does California Small Group Health Insurance cover employees who reside or travel out of state?
So by now you have a basic understanding of the California health insurance plan you’ve elected, and the way it will cover your employees for typical expenses such as prescription drugs, doctor office visits, and hospitalization. The question then comes, what will happen when the employees travel or live in another state and incur medical costs?
The first answer is that in general all emergency services will be covered. Let’s say you have broken a limb and are wondering whether or not to check into a hospital…the answer is a resounding ‘yes’ even if you are on an HMO plan which as has been defined as containing benefits only at your primary care medical group, primary care doctor, and contracted correlating hospital. It is California state regulation the insurance plan must cover emergency services out of state, or out of network in state of California for that matter.
Under PPO models, or Preferred Provider Organization plans, you’ll see two situations typically out of California. Some of the health carriers, such as Anthem Blue Cross of California, Blue Shield of California, or United HealthCare are incorporated in every state, or are part of national associations which offer coverage in every state. With these national carriers you will typically receive standard benefit or ‘In-Network’ level benefits at any local contracted provider (even though the Provider is contracted with the alternate state). The negotiated or contracted rate for services is usually whatever the local contract level is, not the state of California contracted rate. Benefits then typically apply to your ‘In-Network’ deductible and annual out of pocket maximums.
Examples of Provider lookups for national associations, like The Blue Cross Blue Shield Association are located here:
www.bcbs.com
http://www.bcbs.com/healthtravel/finder.html “BlueCard Network”
http://www.uhc.com/findaphysician.htm
Alternatively, there are California health insurance carriers such as Health Net of California who contract with national physicians networks that are 3rd party organizations. These are companies whose sole purpose is to provide a national network and contracted rates for health carriers in any state to utilize on a national basis. Here is Health Net’s example of their contracted network for states where Health Net does not offer coverage and corresponding contracted provider network:
Health Net Out of State Provider Lookup
