Health and repatriation insurance: tips that help
Health and repatriation insurance: tips that help
Some of our fellow citizens travelling to the United States for professional reasons, visiting family or simply enjoying some holidays, often encounter complex situations with financial consequences when their health and repatriation insurance do not cover the medical costs abroad.
It is opportune to remind you, as well as to remind your friends and relatives visiting, the importance and necessity of having coverage in case of an accident or health issue during their stay.
We give the word to an expert in the topic, Mr. Jean-Paul Barre, who directs an insurance office in West Palm Beach.
Mr. Barre, allow me, first and foremost, to thank you for answering our questions. At times, the Consulate has to accompany families on holidays in Florida who have to deal with traumatizing and costly situations after a health accident to one of their group/family members resulting from the lack of health insurance coverage.
1. To start with, can you give us an idea of the medical and hospital fees in Florida, for instance, for a consultation, a day at the hospital, or an MRI scan?
I would like to thank you as well for giving me the opportunity of possibly assisting some compatriots while they are in the United States and who have to face an illness or an accident.
It is difficult to answer your question accurately, because there isn’t a real rule in the United States even though there is a table that often serves as a base for pricing. This table is called “The Unusual, Reasonable, and Customary Table.”
Some of the sample costs, for someone that does not have insurance, could be:
¤ General consultation could cost around $100.
¤ Half-day at the hospital, after a renal colic, therefore no intervention, $6000.
¤ An MRI session, depending on the area to be scanned, could go from $500 to $4000.
2. How and at what cost does a travel insurance and/or health insurance cover these type of expenses?
The subscription of travel insurance is quite simple. It could be done online without medical questionnaires and the insurance cards could be printed immediately.
Some examples, with total coverage of $1,000,000, without deductible, for 15 days in the United States:
¤ Man or Woman between 40 and 49 years old = $88.13
¤ Man or Woman between 30 and 39 years old = $60.56
¤ Family with 2 children (18 years and younger) = $174.19
3. With an insurance in due form, do families need to pay out a minimum sum or will the insurance take care of the totality of the fees?
In the given example, the insurance will take care of all charges. It is possible; however, if you want to pay less, to choose a deductible of $100 to $2500.
4. Does a registration with a given insurance allow visits to the doctor, a specialist or the hospital of choice or must one respect a list of hospitals and offices previously established by the insurance company?
As in France, in the United States, there is a network of doctors approved by the Department of Heath whose fees are refunded (also known as, Preferred Provider Organizations, PPO), and on the other hand, that of private practices. The Preferred Provider Organizations abide by the “Usual, Reasonable, and Customary Table” and provide with 100% reimbursement.
In private practices where there is no arrangement, and uniquely for the treatment in the United States and Canada, there is a co-payment of 20%, which is often limited to $1000.
5. Knowing that social security does not cover the medical fees incurred in the United States and in case the National Health Insurance Card does not work, is it advised to subscribe to a complementary insurance for a long or short stay, which are they and what do they cover?
French Social Security and certain complementary insurances can disburse for medical care carried out in the United States. The amount reimbursed is rather less in comparison to the expenses and must be paid out in advance.
To subscribe to a temporary travel insurance, with an American insurance agency, is not expensive as this allows the insurance company to take direct assumption of the expenses, i.e. in the case of hospitalisation.
6. In case of a medical emergency or of an accident, is it possible to call the fire fighters or the rescue nearby without prior acknowledgment of the insurance company, will the charges be paid by the insurance?
In case of an emergency in the United States (911), the fire fighters are paid by the community, whereas the ambulance fees are covered by the insurance companies.
7. Are the medicines and other medical products reimbursed? Should one carry out the purchase? If so, is the cost reimbursed?
Prescribed medicine is reimbursable, but often at 80% to encourage patients to buy them at lower prices.
There is no exact rule for this, for instance, the price for a specific medicine can range between Wal-Mart and CVS from $10 to $400.
8. What are the documents that should be presented for consultations and medicine prescriptions in order to be reimbursed?
You should always send the original documents and keep a copy. I suggest you attach receipt or proof of payment.
9. What are the bases for medical reimbursements (hospital, consultations, medicine, emergency)?
The pricing is always based on the “Usual, Reasonable, and Customary Table”.
Those without insurance generally pay more or less the price indicated by the table.
American insurance companies negotiate to reduce about 30-40%, whereas foreign companies, that do not have previous agreements to insure travellers in the United States, are factored at 300 – 400% over the prices shown by the table.
10. When an insurance is under contract, does this one cover all the members or (relatives) of a family or is it individual? If it is individual, does this mean that every traveller needs to have his/her own coverage (for health and repatriation)?
When subscribing to insurance, it is important to mention each person who is to benefit from the insurance, including children.
Whether it is a family contract, an individual contract or a group contract.
11. Repatriation: How does the repatriation insurance work and what is the charge?
Travel insurance cover the people that are travelling, outside of their country. The guaranties and repatriation are therefore included in the contracts.
12. Until what point is the traveller covered in terms of the insurance and repatriation when he/she paid the title of travel with a bankcard? What are the restrictions given to this medical/repatriation assistance for pre-existing conditions?
Paying a flight ticket with a credit card, for a majority of credit cards, effectively allows a guarantee of travel insurance that also includes repatriation.
It is important to know that this repatriation does not intervene from the United States, Canada or another country where it is possible for you to be treated.
In fact, it is always stipulated in the repatriation contracts that the company evacuates you if the care, where you are ill or where you had an accident, is insufficient.
In the majority of the cases, the insurance companies do not cover pre-existing conditions.
What is a pre-existing condition ?
A pre-existing condition is the given fact of having an illness at the time when you subscribe to a health insurance.
Travel insurance and international insurances do not cover pre-existing conditions.
- In the case of travel insurance, there is no medical questionnaire; therefore, pre-existing conditions are simply not covered.
- In the case of international insurance, which is generally of one-year and renewable, you have to fill out a health questionnaire and declare the pre-existing conditions under pain of having the contract declared null or void.
- Insurance company acts in various ways. The most common is the exclusion of all treatment for pre-existing conditions. After this period of deficiency, you will have access to the costs. Meanwhile, the insurer may maintain exclusion if you were treated for your condition during this time period.
Last but not least, the insurer may cover your condition adding a surcharge to the tariff; this way the insurer accepts to cover the cost of treatment for your pre-existent condition, but as a result will increase the annual prime fee.