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Out of Area Care
When out of town on vacation, school, or business, health care can sometimes be required for unexpected illness or injury. As a Medical Associates Health Plans member, there are coverage considerations to keep in mind when traveling.
The Health Plan only provides coverage for emergency care when you are outside your immediate hometown area.
Emergency Care can be defined as “medical and health services provided in cases of life-threatening, disabling, or serious illness or injury, including severe pain which arises or worsens suddenly and which, if not treated immediately, could result in loss of life or permanent damage to a person’s health.”
Routine Care, which is NOT covered outside your hometown area, includes such services as physical examinations, sports physicals, immunizations, routine eye exams.
Minor medical problems require pre-approval of coverage, such as an office visit for a sore throat or earache. We recommend that you call ahead when possible to let us determine coverage and help you locate the appropriate source of care for your problems. Our Patient Services/HELP Nurses are available 24 hours.
- Always carry your Health Plans Identification Card when you travel, and present it whenever medical care is sought.
- Call the toll-free number on the back of your card before seeking medical care, if possible. If not, have a relative call for you.
- Our Health Care Services nurses must be notified within 48 hours after an emergency hospital admission out of the area. They will communicate with the hospital and doctor to confirm your coverage and determine the most appropriate timeframe for transfer of medical care back home.
- If you experience a minor medical problem that may require attention before you return home, please do not hesitate to call the Health Care Services nurses. With the proper pre-approval from the Health Plans, coverage can be granted on a limited basis, and any necessary medical follow-up provided back home.
- Receipts for pre-approved services you’ve paid for or billings you’ve received should be forwarded to us for review and handling. Reimbursement for approved care out of the area is made based on your contract stipulations such as copays, deductibles, and usual/customary allowables.
Health Care Services - 563-584-3275 or 800-325-7442
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