International Insurance Issues

Claim Submission

Medical claims incurred while traveling or living outside of the United States (if incurred when not actively at work*) should be submitted to Independence Blue Cross/Keystone using the International Claim Form.

Dental claims incurred while traveling or living outside of the United States should be submitted using the Delta Dental Claim Form.  Delta does request that the claim be translated into English.

Medical Coverage

Emergency room claims are reimbursed the same internationally as in the U.S.

Non-emergency claims on the Personal Choice plans are processed at the out-of-network level unless a Blue Cross Blue Shield Global Core provider is used.  Information on this network is available through Independence Blue Cross.

Non-emergency claims on the Keystone POS plan are processed at the self-referred level.  There is no international coverage beyond emergency and urgent care available on the Keystone HMO plan.

Please note that billing practices differ by country and it's possible that some charges included on the bill will not be covered by insurance.

Dental Coverage

The Delta Dental network does not extend outside of the United States and all care received outside of the United States will be processed at the out-of-network level.

Travel Insurance

While traveling on College-related business outside of the U.S., emergency medical expenses resulting from an accident or illness are covered by the College's Global Medical insurance policy. Medical evacuations and repatriation are components of the Global Medical insurance plan; routine medical care is not. Faculty and staff may purchase coverage under this policy for spouses or dependents who will be traveling on the same trip. More information is available on the Travel-Related Insurance and Issues page.


A prescription issued by a physician in the United States can only be filled in the United States.  If you need a medication filled while visiting another country, you will need a prescription to be written by a physician in that country.  Prescriptions issued by a physician from outside of the U.S. are not reimbursable under the College medical plan.

In order to have the prescriptions covered by a College medical plan, affected employees and dependents should have prescriptions filled before leaving the United States.  In order to obtain a prescription beyond 30 days maximum that is applicable when filled in a pharmacy, mail order should be considered.  This permits a 90-day supply to be obtained for maintenance medications.

Prescriptions beyond 30 days (90 if mail order) can be filled by requesting a vacation override.  This process is initiated by calling the Member Services number on the medical ID card at least two weeks in advance of the departure date.  Human Resources will need to send Independence Blue Cross a letter that indicates the individuals who will be out of the country, the countries visited, the departure and return dates, and the specific medications that need to be filled for more than the standard period.

Please note that this should not be done immediately before the trip in case the vacation override has not been processed.  Also please note that certain controlled medications will require a letter from the prescriber stating approval of the early refill.

Keystone HMO and Keystone POS Residency Requirements

Both Keystone plans have an underwriting requirement that you are to disenroll from the plan if you will be living outside of the plan service area for 90 or more consecutive days.  This is a life-qualifying event that permits a mid-year change in your medical coverage.  Please note that this is based on the residency of the person with employee medical coverage.  A dependent moving out of the plan service area does not constitute a life-qualifying event.

High Deductible Health Plan Coverage Considerations

You may be enrolled in the Personal Choice plans including the HDHP when living outside of the United States for more than 90 days. However, other than emergency room coverage and Blue Cross Blue Shield Global Core providers, coverage under the Personal Choice plans will be at the out-of-network level, which has very high deductibles and low coinsurance.

The regular Personal Choice PPO provides better out-of-network benefits than the HDHP.  If you are enrolled in the Personal Choice HDHP and want to switch to the regular Personal Choice PPO, you will need to do this during Open Enrollment.  There is no life-qualifying event based on a change of residency applicable to Personal Choice plans.  Open Enrollment occurs in September, for a November 1 effective date.

Health Savings Account (HSA) and Flexible Spending Account (FSA) Considerations

The FSA Medical Spending Account and the HSA associated with the HDHP can be used to reimburse qualified medical expenses incurred outside of the United States. The care must be considered legal in the country in which it was administered as well as in the U.S.  Prescriptions are reimbursable as long as the medication is consumed while outside of the U.S. and is legal in both countries.

FSA Dependent Care expenses are reimbursable if the qualifying person (receiving the custodial care) is a U.S. citizen or national or a resident of the U.S., Mexico or Canada. 

*Please note that claims incurred while actively at work are processed as Worker’s Compensation regardless of where the claim was incurred.  You should contact the Office of Environmental Health and Safety for all work-related claims.  You should not submit claims for work-related injuries to Independence Blue Cross.