Out-of-Town Coverage and College Students

Out of Area Coverage

It is important to understand the coverage options available to you, especially if you are out of the area and a medical event occurs. If you are covered under a Point-of-Service (POS) plan, you have access to benefits outside the Network Health service area. If you are covered under a Health Maintenance Organization (HMO) plan, you have coverage for emergency care received in a hospital-based emergency room outside the Network Health service area, until you can be safely moved to a Network Health participating facility.

A Network Health participating provider must provide any follow-up care or regularly scheduled office visits. If that isn’t possible and you must visit a doctor or hospital outside our network, the provider must call our utilization management team at 866-709-0019 for prior authorization before the appointment. One of our nurses or doctors will review the request and determine if you can receive care from an out-of-network provider.

Coverage for College Students

The fall semester is fast approaching, and you may have questions about the health insurance coverage your child(ren) have access to while away at college. The information outlined above applies to your college-bound dependent(s) in the same manner it applies to you—it’s based on whether you have a POS plan or an HMO plan.

However, there are some other items you may want to keep in mind as the school year approaches.

• Get a summer physical. Time your child’s annual wellness visit to coincide with the start of the fall semester so you know he/she is healthy and ready to begin the school year. This is also a good time to make sure all vaccinations are up to date. • Use the school’s health clinic. Most, if not all, college campuses have on-campus health clinics providing convenient and cost-efficient services to enrolled students. These services can include general medical care; illness and injury care and prevention; immunizations; physical exams; and a variety of procedures.