United States of America
United States of America:
ProtExPlan and IMG in the USA use the First Health Network of preferred providers of 4,700 hospitals, 200,000 clinics and 360,000 doctors that direct bill us.
On-line List of US Medical Facilities that direct bill ProtExPlan and IMG:
Health Insurance in the USA:
The US does not have a national government run health insurance system as do other G7 countries. Insurance companies sell medical insurance, and are licensed and separately incorporated in each State. The US is the most expensive place in the world for healthcare.
There are companies in the USA whose main function is to control costs for insurance companies. We know one cost control company that settles on average 65% of the bill they are initially presented with. Their fee is a percentage of the savings negotiated with hospitals. Faced with this balkanized and difficult environment, US insurers use Preferred Provider Organizations (PPO's) that are networks of medical facilities for which set fee schedules have been agreed to in advance in order to control costs.
You will find that European expat medical insurance plans are two to three times more expensive for cover in the USA than ProtExPlan, and won't cover Americans in the USA for return medical treatment, or only for a limited 30 day period. One reason is they don't have good cost control in the USA. The other reason is that European providers do not wish to become licensed in every State in order to comply with local insurance law. If they don't comply, they could be subject to huge penalties, or rather their underwriter’s US subsidiary would end up facing the fines.
If you are American, the obvious solution is an American style plan like ProtExPlan. We let you return to the USA for medical treatment and get full cover. If you are non-American and living in the USA, you can get cover initially provided you have a correspondence address outside of the USA. At renewal, you may be asked to sign a document called an "Affidavit of Eligibility".
Once insured and claiming in the USA, always make sure you pre-authorize and attend a PPO network medical facility. All insurance companies will penalize failure to pre-authorize medical treatment, but IMG actually rewards you for following the required procedures by cutting your deductible in half, and waiving all co-insurance. IMG uses the First Health Network as its PPO. It is the largest PPO in the US having 4000 hospitals, 200,000 clinics and 360,000 doctors to choose from.
US Federal Health Insurance Legislation you may wish to know about:
What is COBRA?
COBRA is the acronym for the “Consolidated Omnibus Budget Reconciliation Act” of 1986 that mandates temporary continuation of medical insurance cover by group plan members after termination. This means that employees and dependents in the event of termination, retirement, or reduction in working hours, can continue membership for up to 18 months. The COBRA premium is much greater than the regular contribution since the employee must now pay the employer’s portion that was formerly contributed as a benefit. Continuation of benefits under COBRA lasts a maximum of 18 months, and only applies to groups with 20 or more members.
What is HIPAA?
HIPAA is the acronym for the US Federal “Health Insurance Portability and Accountability Act” of 1996. It applies to employees moving from one group to another when changing jobs. It prevents discrimination on the basis of pre-existing conditions, or at least limits the use of pre-existing conditions clauses that would deny cover or charge extra. It also guarantees the right of groups to renew. This applies to small groups that might have one very sick individual that might otherwise be dropped because of a bad loss record. The US can be a health insurance nightmare and even if you are covered by a US group plan, you may not be able to continue cover beyond the COBRA mandated 18 months, or buy private health insurance if you have developed a pre-existing condition. For better or worse, health insurance in the US is not a right as in other countries with national health systems. IMG has HIPAA qualified group plans available for US expat groups of 5 or more upon request.