Emergency Care Abroad

For plans that cover members who experience a medical emergency while traveling internationally.

Emergency Medical Condition: A medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably result in placing the patient's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part, in accordance with the definition under federal law (Emergency Medical Treatment and Labor Act, EMTALA) and applicable Plan provisions.
Emergency Care: Services provided for the evaluation, stabilization, and treatment of an emergency medical condition. Includes inpatient, outpatient, urgent care, or transport services required to stabilize the patient.
International Travel: Travel outside the United States and its territories, including but not limited to Canada, Mexico, Europe, Asia, Africa, Central America, and the Caribbean.

Emergency Services
- Covered under applicable plan benefits when a member experiences an emergency medical condition while traveling outside of the United States.Coverage includes:
Coverage includes:
- hospital emergency room care
- medically necessary transportation to the nearest appropriate facility
- Onboard infirmaries on cruise ships, when care is required for an emergency medical condition
Stabilization
- Coverage includes stabilization services required to ensure the patient can safely return to their home country or to a facility where follow-up care can be provided.○ Covered under applicable plan benefits when a member experiences an
Post-Stabilization Care
- Services required after stabilization to treat ongoing conditions may be covered if medically necessary and prior authorization is obtained, subject to Plan rules and network considerations.
Transportation Costs
- Medically necessary emergency transportation (ambulance or air ambulance) to the nearest appropriate facility is a covered benefit on the Plan.
- Medical evacuation to the United States may be covered if medically necessary and approved by the Plan or its designated Utilization Management Vendor.

Members should seek emergency care at the nearest medical facility when experiencing a medical emergency.
The Plan recommends contacting the Care Coordinators/ Nurse Navigators Line as soon as possible for support and guidance.
If a Member requires an Emergency admission to a Facility, the Participant, or an individual acting on behalf of the Participant, should follow the Provider’s instructions carefully and contact the Plan within 72 hours, or 1 business day after the services were incurred.

Members or providers should submit documentation including:
- Emergency room records
- Hospital admission records
- Diagnostic testing and treatment notes
- Travel dates and location

Submit claims with international provider information, including address, tax ID (if available), and currency.
Use CPT/HCPCS codes when applicable; international billing may require plan-specific claim forms.

Claims will be reimbursed according to Plan allowances.
Currency conversion is based on the exchange rate at the date of service.
Members may be reimbursed directly if they paid out-of-pocket, subject to Plan limits and documentation.

Non-emergency care while traveling internationally is generally not covered, unless prior authorization is obtained.
Elective procedures abroad are not covered.
Services not medically necessary for the emergency condition may be denied.

Members may appeal denied claims related to emergency care abroad in accordance with the Plan’s standard appeal procedures.
Appeals should include medical documentation, explanation of the emergency, and supporting evidence of medical necessity.

Emergency care abroad is treated the same as emergency care within the United States in terms of coverage for stabilization.
Members are encouraged to carry proof of insurance and emergency contact information

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