If you need medical care overseas and have an FEHB plan – here’s an overview of what to consider.
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Whether you are living overseas, working internationally, or plan to take an extended vacation to a foreign country – Federal Employees enrolled in an FEHB (Federal Employee Health Benefits) plan should be aware of the following.
Each health insurance plan under FEHB is different, but in regard to overseas coverage, “section 7” of your plan’s brochure should detail what is covered and what is not when it comes to health coverage outside of the 50 states.
Living Overseas
An HMO (Health Maintenance Organization) plan is not a good idea if you plan to live outside of the United States. There are some HMO plans that cover US territories such as Guam and Puerto Rico, but if a federal employee or retiree intends to live in another country, an HMO will not be very helpful. And if living in a US territory, ensure that the HMO plan covers the given location.
Overseas Providers
Depending on the country, there might be participating hospitals in the area that will work with FEHB plans. However, even in these cases, most providers that are international will require payments upfront. If the care is covered by your FEHB plan, then the healthcare insurer will typically reimburse these expenses. Note, however, that most plans reimburse at the “preferred providers” benefit level so any difference between that amount and the money actually paid will have to come from out-of-pocket. For certain medical conditions, your FEHB plan must have what is known as a “2nd opinion arrangement” where an electronic opinion via the internet is given by a medical provider based in the US. Without this ensuring second opinion, the selected medical procedure might not get approved by your FEHB insurance company. On a similar note, if the medical care received overseas is considered “experimental” or “investigational” by US standards, it is highly unlikely that your FEHB plan will provide coverage.
Prescriptions
For some FEHB plans, a file can be claimed for prescription drugs purchased internationally. The medicine usually has to be prescribed by a physician with a medical license approved by the United States and for drugs approved by the FDA.
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Until Next Time,
**Written by Benjamin Derge, Financial Planner, ChFEBC℠ The information has been obtained from sources considered reliable but we do not guarantee that the foregoing material is accurate or complete. Any opinions are those of Benjamin Derge and not necessarily those of RJFS or Raymond James. Links are being provided for information purposes only. Expressions of opinion are as of this date and are subject to change without notice. Raymond James is not affiliated with and does not endorse, authorize, or sponsor any of the listed websites or their respective sponsors.
