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International Travel Health Insurance - Pharmacy Rx Drugs Claim Process
Q: Are prescription drugs covered in the visitors insurance? How much is the co pay?
A: Visitors insurance covers prescription drugs just like any other medical expense. In fixed coverage plans, just like any other eligible expense, there is a sub-limit for prescription drugs as well. In comprehensive coverage plans, just like other medical expenses, there is no sub-limit for prescription drugs.
There is no concept of co pay in short term plans. Please refer to the plan brochure or the policy wording for the coverage amounts and your responsibility.
Q: Are over the counter medicines, blood pressure machine, birth control pills etc. covered in visitors insurance?
A: No, for all covered expenses, you pay one deductible cumulative. If you have already specified your deductible visiting a doctor's office, for example, as long as you have already specified your deductible, you don't have to pay separate deductible again for the prescription drugs, .
A: You can go to any pharmacy you like. There is no PPO network in any of the visitors insurance plans.
A: Some of the IMG visitors insurance plans provide a prescription drug discount card. When you go to the participating pharmacies, for covered drugs, they give you a certain amount of discount. You will have to pay the rest of the amount and file for reimbursement. The insurance company will pay according to the terms of the particular plan.
E.g., if you have purchased Patriot America from IMG. Lets assume that your total Rx cost is $100. And they give you the discount of $30. You pay $70 and file a claim. As long as it is covered expense, and assuming that you have already met your deductible, IMG will pay you 80% of $70 back if the total expenses so far are below $5,000 or 100% of $70 back if the total expenses so far are above $5,000.
For those plans that don't provide a prescription drug discount card, it does not mean that prescription drugs are not covered. It just means that you don't get an additional discount.
Q: When I went to the pharmacy, they didn't accept the insurance. How does it work? I had to pay up front, how do I get it reimbursed?
A: There is no PPO network for pharmacy in any of the visitors insurance. Pharmacies do not have the set up with the visitors insurance companies for billing them directly. You will have to first pay and file for reimbursement.
For all the plans, present the original prescription from the provider to the pharmacy. In order to get prescription drugs from the pharmacy in the U.S., make sure that you have the prescription from the provider licensed to practice medicine in the U.S., as they don't accept foreign prescriptions.
In case of eligible IMG plans, additionally present the Rx discount card and they will give you an instant discount. Pay to the pharmacy as if you have no insurance. You can file a claim for eligible expenses.
Follow the claims submission process for reimbursement. In addition to the documents mentioned there, you must also send the copy of the prescription and the documents given by the pharmacy for each drug.
A: The card you received after you purchased the insurance is for availing health services and is not a prescription card. Pay the pharmacy as if you have no insurance and file for reimbursement as described above.
Q: I ran out of my regular prescription drugs supply that I brought with me from my home country. Can I get it refilled in the U.S.?
A: In order to get prescription drugs from a U.S. pharmacy, you will need a prescription from a doctor licensed to practice medicine in the U.S. Therefore, you will have to visit the doctor, get an appropriate prescription and get it filled at the pharmacy of your choice.
However, none of the above expenses would be covered by any of the visitors insurance plans as they are not meant to cover pre-existing conditions. As you brought the medicines from your home country, the problem you have is obviously a pre-existing condition. Even any plan that covers any acute onset of a pre-existing condition would not cover such expenses as they are routine expenses and not really an acute onset of a pre-existing condition.
Disclaimer: The information within this article is intended as a broad summary of benefits and services and is meant for informational purposes only. The information does not describe all scenarios, coverages or exclusions of any insurance plan. The benefits and services of an insurance plan are subject to change. This is not your policy/certificate of insurance. If there is any discrepancy between the information in this article and the language of your policy/certificate wording, the language of the policy/certificate wording will prevail.