The Cat Pack
A periodical sales packet taken from the products within the
CATALOGUE OF COVERAGES
from
Petersen International Underwriters
Comments and Questions should go to: Catpack@piu.org
Feature Product:
The USAway International Major Medical Plan
This issues Question:
I have an excellent PPO program. This plan covers
me everywhere right?
Well, yes and no. Here are some things to consider:
Most medical plans have some sort of provision to cover people when they travel outside a
network, but these provisions may often be very restrictive. Plans that go a step farther and cover
you outside the United States are often even more restrictive. A case in point is my own major
medical plan that is written by one of the most well known medical carriers in the USA. I will use it
to illustrate what costs are actually covered. Most plans are similar with respect to outside USA
coverage.
Time Limit of Travel
Most plans will indicate that International Travel cannot exceed a set period of time, usually
ranging from 60 to 90 days. For a regular trip to Europe, that may suffice. However, this is clearly
inadequate for the exchange student or a transferred executive.
Benefit Amounts
Most health plans in the USA have some form of negotiated fees. My personal plan brags about
negotiating costs at 40% of charges by providers. My plan states, “Outside the USA, benefits shall
be reimbursed at 70% of our approved rates”. Many people will assume that means that 70% of
charges are covered! That is not correct. The key words “our approved rates”. Remember this
carrier negotiates at 40% of the dollar, thus the actual reimbursement is 70% of 40% of every
dollar! The million-dollar question to ask is, “Is $0.28 for every dollar enough!” ($1.00 x .40 x .70).
To compound this lake of adequate coverage, think about this too. Whenever you exchange
dollars to foreign currency, you give up several pennies per dollar as well.
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Scope of Service Available
Standard medical plans place additional limitations that reduce the scope of coverage.
The traditional carriers plan states that “Outside the USA we will cover initial hospitalization visits,
not to exceed 48 hours for emergency medical treatment”.
We were involved with a real-life claim situation that illustrates what can happen to an insured. We
communicated with a senior claims representative from a major carrier who also had the insured
covered. Here is what happened to the insured:
An insured went to the hospital complaining of “severe abdominal pain”. Some time later the
doctor on duty told the insured to go home and just take some bicarbonate of soda. Several hours
later, the appendix COMPLETELY ruptured. The person was admitted back into the hospital and
spent several days there recovering.
The claims coverage outside the USA definition sounds adequate and complete doesn’t it? Here is
where the discussion with the senior claims person took some interesting twists.
1 - Emergency Medical Treatment is defined by the other carriers as something which is life
threatening. If you recall, this person was diagnosed with “severe abdominal pain” which, by its
nondescript wording IS NOT a life threatening condition.
st
2 – Although a rupture appendix IS a life threatening condition, it was on the SECOND
hospitalization visit and not the “initial” visit as per the terms of the contract.
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3 – Even if the claim was accepted, the carrier would only pay for two of the several days
hospitalized, AND
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4 – Even if they had accept the claim, they would reimburse at 70% of their approved rates!
th
There are many other issues to consider as well, but this provides you with the reasons why the
USAway International Major Medical exists and how it can protect your clients from these
surprising cases of under-coverage.
Where should I find possible sales leads?
Your existing block of business most certainly has people traveling abroad either for business or
pleasure. Do any of your clients have students going overseas? What about visits to family in “the
old country”? What about business clients who are sending employees abroad?
We encourage you to consider how you might use the USAway coverage to protect your clients
and we invite your questions and comments.
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