Am I guaranteed to be issued a GeoBlue Xplorer policy if I apply?
No, GeoBlue Xplorer is not a guaranteed issue plan. Each application is medically underwritten. Your application may be 1) accepted, 2) accepted with a rate increase due to your health status, or 3) denied.
Is the quote I receive binding?
No, the quote you receive is not binding. The quote you receive may not apply if 1) you provided us with an incorrect zip code, 2) you misstated a material fact on your application, or 3) we increase the rate due to your health status.
When determining a rate while overseas, what zip code should I use?
Policies for U.S. citizens/permanent residents applying from overseas are issued through the Global Citizen Association office in Washington D.C. The zip code that’s used is 20036. Enter “0” in the quoting tool if applying online while living overseas.
How long will the medical underwriting process take?
The underwriting time frame depends on the medical history listed on the application. Turnaround can be as quick as one day or as long as one month. Our commitment is to respond to a submission in writing within 3-5 business days. This may mean that we send a request for additional information to the applicant, such as a specific medical questionnaire, or notify the applicant that they erroneously missed a question on the application form. Occasionally we have to obtain medical records from hospitals or providers. Our turnaround time in these situations will depend on how quickly the provider responds to our request.If we receive the application before the requested effective date, we can honor the effective date even if the approval comes through thereafter.
Once I’m approved for coverage do I have to go through medical underwriting again?
You do not need to go through medical underwriting when you re-enroll into your current plan design without changes. You may be medically underwritten again if you decide to select different benefits (see below). Plan changes can only be requested at the time of re-enrollment.If a member would like to increase benefits(by lowering a deductible or adding pharmacy coverage), they must complete a new underwriting application. If a member would want to reduce their benefits, they do not need to complete a new underwriting application.
How do I calculate out-of-pocket expenses and the annual limit?
Out-of-pocket expenses are defined as the expenses a member incurs when satisfying the plan’s deductible and coinsurance requirements. The deductible and coinsurance level varies based on where treatment is delivered as shown in the illustration below. The total annual out-of-pocket expense limit is calculated by adding the deductible and coinsurance maximum together. Deductibles must be satisfied before any benefit is paid by the insurer. Note, the plan deductible is waived for office visits with physicians. Coinsurance is applied as a percentage of the payable medical charges after the deductible is satisfied. No coinsurance charge applies to care delivered outside the U.S. and covered benefits are insured up to 100%. Coinsurance charges do apply to care delivered in the U.S. at a rate of 20% for in-network services and 40% for out of network services. Stated another way, the plan insurer covers services at 80% in network and at 60% out of network in the U.S. Members are protected by the coinsurance maximum shown below, should they incur large medical expenses. The coinsurance maximum is designed to limit a member’s out of pocket expenses. In the table illustration below, the most a member would pay out of pocket, assuming all care is delivered out of network in the U.S. is $6,000 ($2,000 deductible and $4,000 coinsurance). The most a member would have to pay out of pocket, assuming all care is delivered in the network in the U.S., is $5,000 ($1,000 deductible and $4,000 coinsurance).
|Xplorer Plan 1,2,3,4,5||Outside U.S.||U.S. In Network||U.S. Out of Network||Coinsurance Maximum|
Out of Pocket Expense Example:
- A GeoBlue Xplorer Member is covered under the Xplorer 1,000 plan and receives services from an in-network hospital in the U.S.
- Incurred hospital charges are $80,000. The $1,000 deductible must be satisfied by the member. After the deductible is paid, a 20% coinsurance charge applies to the $79,000 balance. The Member pays the 20% coinsurance amount OR the maximum coinsurance level, whichever is less. In this example, 20% of $79,000 equates to $15,800. The coinsurance maximum of $4,000 is less than $15,800 and would apply in this instance.
- Member is responsible for $5,000 in out-of-pocket expenses ($1,000 deductible + $4,000 coinsurance).
How are the deductible and coinsurance calculated for families?
Deductibles reflected in the Global Citizen plan grid are per person deductibles. For a family, the maximum deductible and coinsurance are increased by a factor of 2.5., regardless of the size of the family. For example, a family covered under the 1000 plan pays a maximum deductible of $2,500, calculated by multiplying $1000 (per person) by 2.5. The coinsurance maximum is $10,000, calculated by multiplying the coinsurance maximum of $4,000 (per person) by 2.5. The family’s annual out-of-pocket expenses limit is $12,500 ($2,500 + $10,000).
Will my policy automatically renew? At what rate?
You can enroll in a GeoBlue Xplorer policy up to age 84. The policy does not automatically renew upon your request. You will be notified of your new plan rate at least 30 days prior to your policy expiration date. You must confirm your new policy rate in writing or by accepting the rate when logged in to our secure website. Plan rates are based on age at time of enrollment and are impacted by medical inflation. You will not be asked any medical questions and your personal health history will not determine your new rate. GeoBlue Xplorer rates are standard rates for all re-enrolling members. Rates are reviewed and approved by state insurance regulators, which protects your rights and guarantees fairness. By contrast, offshore/surplus lines insurers are not required to file rates for approval.
When does my coverage end?
We may terminate your policy if:
- You no longer meet the eligibility requirements
- You fail to pay your premium
- We discover that you committed fraud or misrepresented a material fact to GeoBlue
- We terminate the plan in your state or geographic service area
Why would I want this insurance if the country I am going to offers me National Health Insurance?
National or Public Health Insurance can be very different from what most Americans are used to and can be of limited service for mobile citizens. Many public plans offer less in terms of medical services than what is covered under a private plan. In particular, public plans generally only cover you in your host country or region. For an expatriate that travels for business or returns home throughout the year, benefits stop at the border. When covered under a national plan you may not have access to the leading private facilities or specialists. You may experience different treatment protocols or long waiting periods for elective surgeries. It is unlikely you will be covered for medical evacuation benefits under a public health plan. With GeoBlue you are covered all around the world with comprehensive coverage and access to the best treatment options. If you select one of our plans with the US coverage area, you are free to return home for treatment and to convalesce. You can also keep the coverage for up to 9 months upon repatriation, guaranteeing future insurability. Purchasing plans like GeoBlue’s Expat policies offer better benefits, unrivaled networks and a high degree of consumer protection.
Will my pre-existing condition be covered under a GeoBlue Xplorer plan?
If you were previously covered by a group or individual U.S. health plan that issues you a Certificate of Creditable Coverage, GeoBlue will apply this prior coverage to the pre-existing conditions waiting period, provided you meet GeoBlue’s medical underwriting criteria. GeoBlue will also consider private health insurance issued in other countries as creditable coverage. GeoBlue does not consider surplus lines insurance sold in the U.S. as creditable coverage. The number of months of coverage shown on the Certificate will reduce or eliminate the six-month pre-existing condition waiting period. If you have six or more months of creditable coverage, your waiting period will be eliminated. If you have less than six months creditable coverage, your waiting period will be reduced by the number of months you had creditable coverage. For example, if you have two months of creditable coverage, your waiting period will be reduced from six months to four months.
How do I access participating medical providers outside the U.S. and avoid claim forms?
GeoBlue’s Global Health and Safety services help members identify, access, and pay for quality healthcare all over the world. This includes a contracted community of elite providers in 180 countries. Members can access these carefully selected providers and arrange for the bills to be sent directly to GeoBlue for payment as follows. (Please note, direct billing may not be available everywhere.) Direct billing can be requested by calling the assistance telephone number listed on your member ID card, or by emailing [email protected] Please note that in the U.S. a member can simply show their ID card at the time of service and participating providers will only bill the member for any required deductible or co-payment.
Related: GeoBlue Provider Network
I am based in the U.S. Can you help me find participating doctors in my hometown?
Inside the U.S., GeoBlue has a network of over 700,000 providers available to its members. You can find a doctor in the network by searching the Bluecard network.
I am trying to find a doctor in the U.S. in your network, but there is no one listed within 25 miles of where I am searching. What should I do?
In the U.S., if a member does not have a participating physician in an appropriate specialty available to them within 25 miles, GeoBlue will apply in-network benefits (80%) to the provider they see. Outside the U.S., 100% coverage always applies after any applicable deductible or co-payment.
I am a Canadian citizen planning to move to the U.S. Am I eligible for your GeoBlue Xplorer plan?
To be eligible for the GeoBlue Xplorer plan, you must be a citizen or a resident of the United States. If you are in the U.S., you must reside in an approved state. As a Canadian, once you arrive in the U.S. you can apply for coverage. To ensure that you meet our medical underwriting standards before arrival in the U.S., you may wish to complete a GeoBlue pre-screening form.
I purchased a plan but would like to cancel my insurance before its expiration. Will I have to pay any cancellation fees?
Any cancellation requests must come from the insured subscriber and be received by GeoBlue in writing via email, fax or regular mail. There are no cancellation fees or penalties. However, GeoBlue does not refund premium for a partial month. Retroactive cancellations are also not permitted.
Are acts of terrorism covered under this plan?
Yes. The GeoBlue Xplorer plan does not exclude illnesses or injuries related to terrorism or a terrorist act. To be covered in countries where there are open hostilities, such as Iraq and Afghanistan, a member must not be engaged in hostile or combative activities. If you are moving to or are in a country with a state department travel warning, contact your agent or GeoBlue to see if you are eligible to be issued a plan. Note, once issued coverage is afforded to members in all countries.
How does the optional pharmacy benefit work?
The optional pharmacy benefit provides coverage inside the U.S. and a higher benefit limit outside the U.S.GeoBlue offers members the convenience of a direct billing service inside the U.S. so that the member is only responsible for co-payment at participating pharmacies. Most major pharmacies participate in this program administered by Universal RX. Outside the U.S., members pay the pharmacy directly and then submit a claim to GeoBlue for reimbursement. the optional pharmacy benefit is not subject to the deductible or to the co-insurance on the plan.Within the United States, members pay $10 for generic drugs and $25 for brand-name medications. Members are also eligible to use our mail order pharmacy service.
How are medical evacuations decisions made?
The evacuation benefit pays for a medical evacuation to the nearest Hospital, appropriate medical facility or back to the U.S. Transportation must be by the most direct and economical route. All evacuations require written certification by the attending physician that the evacuation is medically necessary.
Is birth control covered?
Use of birth control is not automatically excluded from the policy. GeoBlue reviews the medical condition for which birth control is being used. If it is being used solely as a contraceptive, it is excluded. If it is being used to treat an approved condition, it will be covered. In this instance, the member will have to pay for the prescription up front and submit a claim to GeoBlue, along with a letter from the prescribing doctor indicating the medical necessity of the contraceptive.
How do I qualify for maternity benefits?
After 364 days of continuous coverage, GeoBlue Xplorer members are eligible to enroll in a new plan that covers maternity costs in the same way as all other conditions. Members do not need to submit a new health statement.
Who is the insurer?
GeoBlue Xplorer is underwritten by 4 Ever Life International Company. 4 Ever Life International enhances protection with unique underwriting solutions nationwide for insurance companies, brokers, agents, administrators, employers, employees, and individuals. With over 60 years experience in enhancing protection, 4 Ever Life International is rated “A-” (Excellent) by A.M. Best and licensed to provide health and life insurance solutions in all 50 states, the District of Columbia, and Puerto Rico. 4 Ever Life International is an independent licensee of the Blue Cross and Blue Shield Association. BCBS collectively covers over 100,000,000 members.
Does this plan meet the Affordable Care Acts requirement for Minimum Essential Coverage?
This plan does not provide Minimum Essential Coverage and therefore does not meet the requirements of the Affordable Care Act (ACA). It is filed as a limited duration policy designed specifically for international living. Coverage by the insurer can be 1) accepted, 2) accepted with a rate increase, or 3) denied based on the health history of the applicants(s). A waiting period for pre-existing conditions applies unless you have six months of prior creditable coverage. There is no tax penalty for purchasing this policy if you are outside the U.S. for 330 days or more in a calendar year.