We know Senior Care Plus members sometimes travel throughout the U.S. and internationally.  When traveling with Senior Care Plus, you are covered for:

• 24/7 virtual care across the U.S. with Teledoc

• Urgent and emergency care when and where you need it

When traveling, you are not  covered for routine care, like check-ups, preventive care, or vaccines. Make sure to get any routine care you need before your trip. For more details about your plan’s coverage, please check your Evidence of Coverage or other coverage documents.

To qualify for Medical Necessity Travel Benefit, the following must apply:
1. The member and/or their treating physician has requested a referral for a service that is not available within the primary network and will require travel outside of the geographic service area to either southern Nevada or Utah.
2. Utilization Management has determined that the requested services are medically necessary and tertiary care cannot be provided in the primary network.
3. Utilization Management has approved the tertiary care at a medical facility capable of providing the medically necessary level of care.
4. Covered Person has agreed to be in Case Management, and followed by Case Manager while in tertiary care if receiving ongoing care at the tertiary care facility.
5. Prior to travel for tertiary care, the member must advise Hometown Health case management (775) 982-2725 of travel to receive the benefit.
Covered Travel Expenses:
1. For an adult member age 19 or older, travel expenses will be reimbursed at $250 for the member and one additional person/caregiver.
2. Coverage will include the day prior to a scheduled service and the day following the scheduled service not to exceed $2,500 per episode of care.
3. The maximum travel reimbursement per calendar year is $10,000.
4. After approved travel, complete a Medical Necessity Travel Reimbursement Benefit form, attach all receipts, and submit to the Utilization Management Department at Hometown Health.

International emergent care

When traveling outside of the U.S. and require immediate emergency care, please go to the nearest medical facility. You do not need to obtain prior approval before receiving emergency care. However, if you are admitted to a hospital, you do need to notify Senior Care Plus as soon as possible to obtain appropriate authorizations.

Providers in many countries may require payment before or after providing care. Please be prepared to pay upfront for your care and prescriptions. You may submit a claim to Senior Care Plus for reimbursement once you have returned to the United States.

If admitted, once your condition is stable, you or the doctor treating you should call the number on the back of your ID card to notify Senior Care Plus that you have received emergency care and to determine next steps. Because providers outside of the United States are non-contracted, the responsibility is up to you to notify Senior Care Plus of the admission in a timely manner.

When receiving emergent care outside of the U.S., you will need to get Senior Care Plus approval before receiving:

• Care after your condition is stable, or post-stabilization care

• Transportation after your visit

• Outpatient follow-up care, like physical therapy or speech therapy

When you return home, contact your personal doctor to discuss the care you received on your trip and how to manage your condition.

Your care cost and payment details

If you receive emergent medical care outside of the country, Senior Care Plus will reimburse you (the member) the amount that we would pay the facilities and providers that treat you for the similar care in a Medicare contracted facility in the United States. You will be responsible for your coinsurance or copayment just as if you were getting care in the U.S. If the foreign providers and facilities do not accept the Medicare contracted rates as full payment for the services, this additional amount is your responsibility. Travel insurance typically covers this difference. If you have travel insurance, Senior Care Plus will pay secondary to travel insurance.

Request reimbursement after your trip

If you pay for emergency or urgent care when traveling, you can file a claim to request reimbursement. The amount you’re reimbursed depends on your plan’s coverage. 

How to file a claim for reimbursement:

Step 1: Gather your documents

Step 2: File a claim – Use this Medical Claim Form

Step 3: Check the status of your claim

Information to include when submitting a Medical Claim Form for reimbursement:

• Member information (complete name, address and Senior Care Plus ID number)

• Diagnosis

• Description of service(s), doctor or hospital name and address, and the country where you received services

• Itemized bill (date, description and charge for each service received)

• Billed amounts in foreign currency or U.S. dollars

• Proof of payment, such as a credit card receipt

• Medical reports, including ambulance trip reports, emergency room reports, admitting history, surgical procedures, etc.

 Tips to Stay Healthy during your International Travel

1. Read your EOC to fully understand what your coverage limits are for International Travel

2. Submit your claim and any associated documentation as soon as you can so you can be reimbursed promptly. International claims typically take more time to process than a U.S. claim due to language and currency conversion and/or the receipt of any additional information required to process the claim.

3. Remember to include any original documents along with your claim — including an itemized bill — as these documents can help expedite the processing of your claim. Be sure to keep a copy of all documentation for your records.