Greetings,
I am lucky to have New York City Emblem/GHI PPO health insurance NYC paid for by my employer, so if possible I would like to avoid paying close to $2000 annual to get Massachusetts health insurance option offered by my son’s college, Emerson. I don’t see any in-network providers in Boston for our current GHI insurance. Am I missing something? Does anyone with NYC Emblem/GHI PPO insurance have Boston doctors? Any suggestions about if we should buy the $2k local/Boston insurance? What do other folks do?
Thanks in advance for any advice.
-Lisa
calling your plan??
PPO’s seldom have in network providers outside your home region. Either pay for the Emerson plan or pay the out of network costs for coverage in Boston with your plan. call your insurer to confirm.
@TomSrOfBoston actually PPO networks often have coverage out of the area.
It’s HMO plans that don’t have coverage outside of the immediate area in many cases.
We have PPO coverage with in network providers in all 50 states. Our kids never had to get insurance from ther colleges. This was the Anthem Blue Card network.
But this poster needs to contact their plan. And the college. In most cases, the college will have a minimum coverage requirement. The only thing an HMO will cover is ER…and that usually doesn’t meet the local college requirements.
Except for kids with chronic health problems, it is usually cheaper to pay the out of network charge.
I did buy the school coverage for my daughter because our local insurance would only cover emergencies and has no out of network associates, but she played a sport and I was too afraid of a broken bone. This last year she did have the flu twice (Type A and type B!), and she had several strep tests, but even if we didn’t get the reduced price it would have been about $200 total, and I paid about $1500 in premiums.
Thanks to all for the helpful replies!
This is absolutely going to be dependent on the plan, but I was able to get in-network insurance in my college state with the state’s affiliate of my family’s insurance company - I just got a second card with the local version of the company’s name and a roughly comparable plan (copays were slightly cheaper actually). Definitely worth asking your insurer for recommendations and seeing if they offer anything.
- Many insurers have provisions for covered individuals who will be away from home for extended periods. BCBS calls it "away-from-home care." Call your plan.
- If your plan does not have provisions for out of town coverage and your child doesn't have any ongoing health issues, you can just pay OOP. Urgent-care walk-in centers and CVS Minute Clinics are not that expensive for the typical illnesses that college students have (sore throat, bronchitis, etc.) Many schools also have a campus health center that's free or low-cost. For young women, Planned Parenthood has low-cost gyn exams and birth control.
In the event of a true emergency that requires an ER visit, all insurance companies have to cover that by law. So you might not need to pay the $2,0000 for local coverage.
I would caution people to speak directly with their insurer to be clear on what is and isn’t covered. People will tell you that an emergency visit has to be covered…which is true. But any follow up care may not be as it isn’t an emergency. An example is your child has an ankle injury and goes to the ER. It gets splinted, etc…and that ER visit is covered. But they refer your child to see an Orthopedist in a few days…and surgery is needed…this is no longer “an emergency” and wouldn’t be covered. I had an HMO a few years ago and my S was OOS. We had to buy the insurance through the school that year for this very reason.
@brantly makes a good point IF your health insurance meets the requirement for the college. You need to contact the college…and find out if your current home state plan meets their minimum requirements.
@thumper1 What kind of requirements? I don’t think a university can require more of an insurance plan than is required under ACA. If your plan meets the minimum ACA requirements – which 99% of U.S. plans do – then you should be fine. To clarify: Meeting ACA requirements does not mean that you bought a plan “on exchange.” Every plan, no matter how you acquired it (through your employer, bought privately, or on exchange), has to meet certain minimum coverage requirements.
Many universities do require that the care be available IN the area. UCSB was rejecting the Kaiser policies as there was no Kaiser facility in the area. Many of the Mass schools are picky too.
My kids’ schools allowed us just to reject the school policies by opting out. Other schools require you to submit the policy and they will review it. If they don’t feel the coverage is adequate IN THE AREA, they require you to buy the school’s policy (or another).
Our kid colleges required that they have medical coverage in the area. This included hospital coverage, and doctor coverage.
My DDs current school requires the same. The HMO plan she had here covered only ER in her new place. She had to get a plan in that state. This was an individual plan.
Our kid’s colleges were very specific that ER coverage only was NOT sufficient coverage.
So…if a family has a fully ACA compliant HMO family plan in their home state, it very well might NOT meet the college requirement for health insurance coverage in a different state.