One of the waiver criteria is that the student’s insurance must provide inpatient and outpatient medical care in Oregon. If you are enrolled in a HMO plan that does not meet this requirement you will be asked to formally acknowledge that you understand you may have to return home for uncovered services. If you are outside of your normal health insurance service area, your health insurance policy may work differently than it would at home. It is important to know exactly what your health plan covers and what’s excluded. If you don’t know the answers to the following questions, we encourage asking your health care insurance company.
- Does your policy cover routine care and preventative care outside your service area? (The service area is usually the local region where your primary care physician, the local hospital, and then network of specialists specified by your insurance are located.) Routine care included sprains, rashes, colds, etc. Preventative care may include any type of physical exam, immunization, PAP smear, etc.
- Does your policy specify that out-of-area will be limited to emergency care provided in a hospital emergency room or an urgent care clinic? Ask if they will pay for routine care at an Urgent Care if out of area? If you have an out-of-area HMO is there a rider that could be purchased for your plan to provide coverage in Oregon?
- Do you need prior authorization from your health insurer before seeking care out of your normal health service area? What are your co pays and deductibles?
- Do you need prior authorization for specialist referrals from your primary care provider in your home service area, and will the cost of specialist care here be reimbursed at the same rate as if you were at home?
- Are laboratory, X-ray, and other diagnostic tests covered by practitioners outside your normal service area?
- Do you have mental health coverage?