Understanding insurance and all the details that go with a policy can be difficult to say the least. Even more so for cruise line crew members, or anyone who requires international coverage. With so many “moving parts”, if you have never used your coverage, or learned how to maximize your coverage, it can be quite a daunting task figuring out where to even start. Which is where we come in! We have provided below information to help you better understand your coverage.
Getting Started
When you first enroll in your new insurance policy, take the time to set up a personal online account. Part of setting that up includes getting your ID cards, downloading any corresponding apps, and obtaining any policy documents. It’s also important to save these documents or know where to find them in your personal online account.
When it comes to reviewing your policy, we recommend looking at the digital copy online so you can find specific terms and sections using the search function (Ctrl+F). Also, be sure to review the Summary of Benefits, which is an overview of your coverage. It is always best to read through the entire policy document for additional conditions and requirements or exclusions. For example, Physical Therapy might be listed in your summary with limits or conditions. If you review the policy further, it may state that you are required to obtain a physician’s prescription.
Finding a Provider
When trying to find a doctor or a provider, there are some things you need to know. When outside of the United States, you are not required to see a particular provider. Most insurance companies will offer a section in their website that allows you to search for providers in different countries. However, when inside the United States, it is recommended that you see a provider within the Preferred Provider Organization Network (PPO) when possible.
A PPO provider is a group of doctors that have agreed to provide care under your plan at a certain rate. Staying within the PPO usually offers the best coverage and overall discounts. When accessing your personal account online, you can search for PPO providers in your area. If you have a doctor already, but they are not in the PPO, you are still able to stay with this doctor, but the amount you must pay may be different for some services. In your policy Summary of Benefits, you can see what the coverage is for services outside of the PPO network.
Do I Need to Pre-Certify?
First things first, what does pre-certify even mean? Pre-certification is the process used to determine whether the services delivered or scheduled to be delivered to a patient are medically necessary and appropriate. It also allows your insurance company to assist in managing your health care costs. It is required when something is “major”, such as surgery or being admitted in the hospital as an inpatient. A detailed list of all the items that require pre-certification will be in your policy. If you are not sure if your procedure requires pre-certification, you should contact your insurer directly.
There is no need to pre-certify when going through routine doctor’s appointments, check-ups, or other minor office visits. But we recommend that you always check pre-certification requirements before any procedure or treatment. Some policies reduce the percentage of coverage if you have not pre-certified your services. It can be up to 50% of a reduction in coverage, so it is important to ensure anything major be pre-certified.
These are just a few basics in understanding your insurance coverage. MHG Insurance has been helping seafaring crew throughout the world for over 30 years. We believe ensuring that crew get the insurance support they need in a timely manner is not only essential but a fundamental service as your broker.
In our next blog, we will cover Insurance Claims - When to File and Key Points to consider. For questions or assistance, please contact us at mhginsurance.com or call us at +1 954 828 1819 or +44 (0) 1624 678668. Until then, happy and healthy sailing!