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Important Facts about Overseas Coverage

Important Facts about Overseas Coverage

  • You should not be enrolled in an HMO if you are living overseas, except when the overseas geographic location is part of an HMO's service area (such as Guam).
  • See Section 7 of the plan brochure for information about filing an overseas claim.
  • Most overseas providers require payment "up front".
  • Some plans pay overseas providers as at the Preferred Providers benefit level, but you will probably have to pay the difference between the plan payment and the actual charge. Check to see whether you must provide an English translation of the bill (claim) and currency conversion information.
  • Some plans provide assistance in locating medical providers overseas or have participating hospitals and other providers.
  • Your plan may have an overseas second opinion arrangement where an e-opinion can be obtained from U.S. medical providers for certain medical conditions/treatments.
  • Most plans do not require precertification for inpatient hospitalization and other procedures outside of the U.S. and Puerto Rico
  • Some services that are "accepted practice" overseas are considered experimental or investigational by FEHB plans and are not covered.
  • Some plans provide benefits for professional medical evacuation to the nearest hospital suited to provide treatment and the patient's condition requires immediate evacuation (air or sea evacuation may be covered if emergency ground transportation is not available).
  • Prescription drugs may be available through a plan's Mail Order Pharmacy benefit (sometimes you need to have an address with a Zip Code, such as an APO and FPO address or in U.S. territories). You may be able to file a claim for prescription drugs you purchase overseas. Usually the drugs must be prescribed by a physician who is licensed in the U.S, and the drugs are equivalent to drugs that by Federal law require a prescription in the U.S.
  • The Foreign Service Benefit Plan has direct billing arrangements with hospitals in several countries throughout the world. Contact the Plan for more information.
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