• zTourists Blog

  • Monday, September 06, 2010

A Preferred Provider Organization or a PPO is a group of doctors, hospitals and other medical facilities that provide health care at reduced rates to the insurer’s and plan administrator’s clients. Insurance companies sometimes require you to use only the members of the PPO network they are associated with. They can deny claims or require higher co payments if you visit a provider outside the network.

By using these networks that offer services at pre negotiated discounted rates, the insurance companies keep their costs low. This can also help insurers get more for their plan limits and stretch their coverage while keeping the out of pocket costs low. Using a network provider who is familiar with the billing procedure of the insurance company increases the chances of having the charges billed directly to the insurance company making it a cashless transaction for the insured.

When you are looking to purchase a visitor medical insurance plan you must first find out if the plan follows a PPO network. Look for service providers in your area who fall under the network. Find out the penalties for using providers outside the network. Become familiar with pre certification and pre notification procedures to avoid a reduction in benefits.

For more information regarding visitor medical insurance plans and the PPO networks for each call us at 877 593 5403 or visit us on the web at www.nriol.net

Is it prudent to insure a husband and wife under the same visitor insurance plan? We are often confronted with this question when a family is seeking visitor insurance coverage. The answer is - usually yes if both the visitors are adults. Visitor insurance companies do not offer premium discounts for insuring the husband and wife on the same plan. The total cost of the plan is the sum of the premiums for each individual. The benefits are also designed for each person and it is not possible to exhaust one’s benefit limit and then tap into the benefits of the other person insured under the same plan. Likewise deductibles and co-insurance must aslo be met separately by each person insured on the plan.

Consider now the benefits of having individual plans one each for the husband and wife respecitvely. Individual policies for each visitor provides the flexibility in selecting plan maximums and deductibles based on the needs of each individual. There are not many plans offering coverage for 70 years and above so if the spouse is less than 70 then it would make sense to shop the wide array of plans for the spouse while considering the few available for the 70 plus. If the visitors have different itineraries or if you desire flexibility on the return date for one of the visitors then it is advantageous to purchase separate insurance for visitors. If both members are insured under the same plan then it is not possible to modify or cancel coverage for one of the insureds while retaining coverage for the other insured.

In some cases it may be a good idea to purchase visitor coverage together. If there are children below age 18 travelling with an adult, buying one plan to cover both of them can provide substantial cost savings. Some plans offer free coverage to children if an adult is on the same plan while some others offer discounted dependant rates for children.

There is encouraging news for visitors to the US looking for emergency coverage for a sudden flare up of a pre existing condition. Most insurance plans expressly exclude any coverage for medical expenses arising out of a pre existing condition. A newly enhanced Atlas America plan offers for insureds below age 70 up to $15,000 in coverage for medical expenses arising due to a sudden acute onset of a pre existing condition.

It is important to understand the common definition for a pre existing condition first. It can be explained as an ailment or condition that was present prior to the start of the plan. Typically, ailments that manifested (regardless of being treated or not treated) 24 months prior to the start of the plan are considered as pre-existing conditions and hence excluded from coverage.


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