Travel Coverage FAQs

What if something happens and I get admitted to the hospital or have to have surgery while traveling? • If it’s an urgent or emergency situation, we’ll still cover your claims at the in-network level anywhere you go. • Once you’re stabilized, we ask that you return to in-network providers to ensure we can coordinate your recovery.

What happens if I need routine care (like diabetes blood checks) while staying out of network for an extended period of time? • If you have an HMO plan, you won’t have coverage. • If you have a POS plan, you can use your out-of-network (OON) benefits for routine care. If you know you’ll spend extended periods of time out of network, we recommend a POS plan.

What if I need to see a specialist while out of network?

• If you have a POS plan, you can use your out-of-network benefits to see an out-of-network specialist or provider without prior authorization. • If you have an HMO plan, you’ll need to receive prior authorization from Simplete for your claims to be covered. • If the specialist is in the Simplete network, we don’t require a referral or prior authorization to go to that provider. The specialist may request that you get a referral from your primary care provider (PCP), but that’s the specialist’s policy, not a Simplete policy.