Out of state…read the fine print!

Posted by Phil Dougherty
March 12, 2014

171 (5)For decades the “Blues” (Blue Shield and Blue Cross) provided access to their nationwide provider network so you could stay in-network when out of state.  That was huge for families with sons or daughters in out-of-state colleges and a real advantage over HMO’s and less robust PPO’s that provided emergency only coverage when out of state.

Well, Blue Cross and some of the Blue Shield plans sold in the new private and public marketplaces today provide only emergency coverage. This is disappointing to say the least.

In the past, our recommendation to parents with kids in college outside of California was to forgo enrolling in college insurance plans. Instead, the kids could use the health center (that comes with tuition) for the small stuff and use the family’s California-based health plan for any other out-of-state claims, emergency or otherwise.  This process would save parents as much $2,000 a year from an already large college bill.

Most college plans don’t provide the necessary major medical protection offered with family coverage.  College plans appear comprehensive, but often have low maximum benefit limits ($250,000 – $500,000 limits are not uncommon).  These plans can also have eligibility requirements that can bump a student off a plan at perhaps a crucial period.  

Emergency only coverage is narrow in scope. At what point in one’s treatment does it stop being coded as emergency care?  That’s debatable and who wants to debate with an insurance company when you’re in a crisis.

So, my recommendation is to carefully read both the contract of your California-based plan and its out-of-state provisions as well as the college plan policy itself.  It’s possible that one or the other plan will suffice, but it’s also quite possible both plans will be necessary to provide appropriate coverage and peace of mind.

Note: Blue Shield PPO plans (not EPOs) and most grandfathered Anthem Blue Cross and Blue Shield plans still provide the Blue Card program which allows out-of-state provider access.

Phil Dougherty