The Daily Dose
The Ins and Outs of Out-of-Area Health Coverage
While no one likes to think of getting sick or injured when out of town, it’s important to know the details of your health care coverage, should the need arise.
Many health plans offer access to a national network of doctors. In the case of CDPHP, this includes 825,000 doctors, nurses, and specialists around the country.1 That means, whether traveling for business or pleasure, you’re covered by an extensive network of health care professionals for coast-to-coast coverage. But even if your plan does not include a national network, such as an HMO, rest assured that you have access to worldwide emergency care, regardless of your plan type.2
In addition to checking what type of coverage you have, there’s some other simple things you can do to prepare for your trip.
Your health insurance company may offer a mobile app that allows you to search for doctors while you’re out of town. CDPHP members have access to Find-A-Doc, an online tool that allows members locate doctors, urgent care centers, emergency rooms, and more – all on the go.
If you take regular medications, it’s a good idea to establish yourself with a national pharmacy chain. Also, get the low-down on prescription refills. Will you be able to refill prescriptions at a network pharmacy when you are away from your home state? Do you have the option to refill them by mail order, or receive a few months’ supply in advance? If you do, this is a good avenue to explore, as it is one less thing you’ll have to worry about when you’re away from home.
Always be sure to travel with complete and up-to-date contact information for family, friends, and any professionals you depend upon. If you are a CDPHP member, carry your ID cards with you at all times, and call the number listed if you have specific questions about your plan. Remember, your ID card can be as close as your smartphone if you download the My CDPHP Mobile app.
Most importantly, to limit your financial liability, make sure you contact your health plan before you seek services from an out-of-area provider. The plan will be able to answer all of your coverage questions, and avoid any surprises down the road.
A good vacation is a great way to recharge your mental batteries. In fact, a study by the Society for Human Research Management found that HR managers believe using vacation time leads to higher performance (75 percent) and increased job satisfaction (78 percent). But before you pack your bags, give your health plan a call so you can be confident in your out-of-area coverage.
1The national network is provided by CDPHP Universal Benefits,® Inc. The national network does not extend to members of the Federal Employees Health Benefit Plan, some self-funded plans, or the Medicare Choices PPO plans. Members of the HMO plan, which is insured by Capital District Physicians’ Health Plan, Inc. (CDPHP®) are also not eligible for the national network.
2CDPHP Medicaid members are covered for urgent and emergency care throughout the United States, District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. CDPHP Medicaid members must pay for emergency care in all other countries, including Canada and Mexico.
John D. Bennett, MD, FACC, FACP About the Author
John D. Bennett, MD, FACC, FACP, is president and CEO of Capital District Physicians’ Health Plan, Inc. (CDPHP), an award-winning, physician aligned, not-for-profit health plan based in Albany, NY. Bennett has held the position since 2008 after serving more than 10 years as chair, vice chair, and board member for CDPHP. During his tenure, CDPHP has been ranked among the top-performing health plans in New York and the nation, most recently named #1 in Customer Satisfaction in the 2023 J.D. Power Member Health Plan Study. Under his leadership, CDPHP has also become known as a model employer regionally and nationally and was recently named among the top five Best Companies to Work for in New York by the Society for Human Resource Management, as well as Forbes Best-in-State Employers 2022. Prior to joining CDPHP, Bennett served as founding member and CEO of Prime Care Physicians, PLLC. During his tenure, he co-led a team of 25 cardiologists and helped grow the practice to a 100-physician multi-specialty group. Bennett is board certified by the National Board of Medical Examiners and the American Board of Internal Medicine, with subspecialties in internal medicine and cardiology. He earned his medical degree at SUNY-Downstate Medical Center, Brooklyn, and a Bachelor of Science degree at Rensselaer Polytechnic Institute. Bennett completed an internship and residency in internal medicine and a fellowship in cardiovascular disease at Albany Medical Center. He is a Fellow of the American College of Cardiology and the American College of Physicians. Bennett is currently board chair for the Center for Economic Growth and the Capital Region Chamber, and vice chair for the Palace Theatre. Bennett also serves on the boards of the New York eHealth Collaborative (NYeC), the Alliance of Community Health Plans (ACHP), America’s Health Insurance Plans (AHIP), Rensselaer Polytechnic Institute, and Russell Sage Colleges. Bennett is a member of the New York Public Health and Health Planning Council where he helps shape decisions related to New York State's public health and health care delivery system. Well-known locally and nationally for advancing health care innovation, Bennett was recently named to Crain’s New York Business 2021 Notable in Health Care, as well as the Albany Business Review’s Power 50 list.
Robert Kelly
“1The national network is provided by CDPHP Universal Benefits,® Inc. The national network does not extend to members of the Federal Employees Health Benefit Plan, or the Medicare Choices PPO plans. Members of the HMO plan, which is insured by Capital District Physicians’ Health Plan, Inc. (CDPHP®) are also not eligible for the national network.”
Wouldn’t it be more informative and easier to tell us what plans are eligible for the national network??
John D. Bennett, MD, FACC, FACP
Hi Robert,
Sorry for the confusion. Generally speaking, most EPO and PPO plans have a national network, however, there are a couple that do not, including Federal Employees Health Benefit Plan and the Medicare Choices PPO plans.
Thanks for your feedback.
Merry Huber
It seems there may be a substantial number of CDPHP members who have no health insurance outside the local area and certainly no coverage in Canada or Mexico. As Canada is close enough for a weekend trip, the point of this email, would you please make suggestions as to how one may get coverage if you are going out of the US. Also, you suggest that a member contact CDHP before accessing any healthcare provider outside their home area. Is there a specific phone number one should use? Does this rule apply for all medical issues or just non-emergency issues? Thank you
Gregory Fry
Hi Merry – Thank you for taking the time to reach out! We’d like to help answer your questions based on your individual CDPHP plan. Please call us at (518) 641-3700 or toll-free at 1-800-777-2273 and we’ll be more than happy to assist.
Lori J Scheuermann
So are you saying that if you are in the Federal Employees Health Benefit program you are not covered outside the area at all?
John D. Bennett
Hi, Lori! Thanks for checking out our blog. You are correct, federal plans do not have out-of-network coverage, but it’s important to note that urgent/emergency care is covered out of the area. Also, federal employees have access to 24/7 telemedicine via Doctor on Demand, so no matter where you are, you can see a doctor from a smartphone, computer, or tablet.
Al Singer
I currently live in Schenectady County, NY, planning to move to Saratoga County next year. Can I still keep CDPHP Medicare Advantage coverage?
Natalia Burkart
Hi, Al – Thank you for your membership and for reaching out! Please contact our Medicare team at (518) 641-3950 so that they may advise on your specific plan.