Xplorer Health Plan | Frequently Asked Questions (FAQ)

Who is eligible to buy an Xplorer plan?

All U.S. citizens living abroad who are 74 or younger at the time of application are eligible to apply for coverage or;
All legal residents of the U.S. (citizens and foreign nationals) who are age 74 or younger at the time of application are eligible if they live in the U.S. or;
An employee of a U.S. company, whereby the company is domiciled in the U.S. and the company pays the insurance premium.

Do all eligible family members have to apply for Xplorer?

Yes. The Xplorer plan is available to individuals and their dependents, but all eligible family members must apply for coverage. You can enroll in an Xplorer plan up to age 84.

Will my policy automatically renew? At what rate?

The policy does not automatically renew upon your request. You will be notified of your new plan rate at least 30 days prior to your policy expiration date. You must confirm your new policy rate in writing or by accepting the rate when logged in to our secure website.

Plan rates are based on age at time of enrollment and are impacted by medical inflation. You will not be asked any medical questions and your personal health history will not determine your new rate. Xplorer rates are standard rates for all members re-enrolling.

How long will the medical underwriting process take?

The underwriting time frame depends on the medical history listed on the application. Turnaround can be as quick as one day or as long as one month. GeoBlue’s commitment is to respond to a submission in writing within 3-5 business days. This may mean that they send a request for additional information to the applicant, such as a specific medical questionnaire, or notify the applicant that he/she mistakenly missed a question on the application form. Occasionally we have to obtain medical records from hospitals or providers. Their turnaround time in these situations will depend on how quickly the provider responds to their request.

If they receive the application before the requested effective date, we can honor the effective date even if the approval comes through thereafter.

When does my coverage end?

We may terminate your coverage if:

1. You no longer meet the eligibility requirements
2. You fail to pay your premium
3. We discover that you committed fraud or misrepresented a material fact to us, except as indicated in the time limit of certain defenses provision
4. We terminate the plan in your geographic service area

Can I cancel my plan?

At the time of enrollment, most GeoBlue plans have a 6 month enrollment minimum. However, customers are not locked into a contract. You may cancel any month you choose with no cancellation fees or penalties, however GeoBlue does not refund premium for a partial month. Retroactive cancellations are not permitted. Please note, we cannot accept cancellation requests over the phone. To cancel your plan, please send us an email at info@internationalstudentinsurance.com.

Who is the insurer?

GeoBlue Xplorer is underwritten by 4 Ever Life International Limited (4ELI). 4ELI is an independent licensee of the Blue Cross and Blue Shield Association and a wholly owned subsidiary of BCS Financial Corporation. BCS is owned by a consortium of Blue Cross and Blue Shield plans and the Blue Cross Blue Shield Association. 4 Ever Life International Limited is an A.M. Best “A-” rated (Excellent) carrier.

Does my plan deductible apply to all services?

No; your deductible is waived for office visits. You simply pay a small copay at time of service with the contracted provider. For non-contracted providers, you pay the provider directly and submit a claim for reimbursement.

How are out-of-pocket expenses calculated?

Out-of-pocket expenses are defined as the expenses a member incurs when satisfying the plan’s deductible and coinsurance requirements. The deductible and coinsurance level varies based on where treatment is delivered as shown in the illustration below. The total annual out-of-pocket expense limit is calculated by adding the deductible and coinsurance maximum together.

Deductibles must be satisfied before any benefit is paid by the insurer. Note, the plan deductible is waived for office visits with physicians.

Coinsurance is applied as a percentage of the payable medical charges, after the deductible is satisfied. No coinsurance charge applies to care delivered outside the U.S. and covered benefits are insured up to 100%. Coinsurance charges do apply to care delivered in the U.S. at a rate of 20% for in network services and 40% for out of network services. Stated another way, the plan insurer covers services at 80% in network and at 60% out of network in the U.S. Members are protected by the coinsurance maximum, should they incur large medical expenses. The coinsurance maximum is designed to limit a member’s out of pocket expenses.

How are the deductible and coinsurance calculated for families?

Deductibles reflected in the Xplorer benefit table are per person deductibles. For a family, the maximum deductible and coinsurance are increased by a factor of 2.5., regardless of the size of the family. For example, a family covered under the 1000 plan pays a maximum deductible of $2,500, calculated by multiplying $1000 (per person) by 2.5. The coinsurance maximum is $10,000, calculated by multiplying the coinsurance maximum of $4,000 (per person) by 2.5. The family’s annual out-of-pocket expenses limit is $12,500 ($2,500 + $10,000).

How do I qualify for maternity benefits?

After 364 days of continuous coverage, Xplorer members may apply for a new plan that covers maternity costs in the same way as all other medical conditions. You will be sent a notification of renewal 30-60 days before your plan expires and will need to select if you would like to add maternity benefits.

Will my pre-existing condition be covered under an Xplorer plan?

If you were previously covered by a U.S. health plan that issues you a Certificate of Creditable Coverage, GeoBlue will credit you for this prior coverage. The number of months of coverage shown on the Certificate will reduce or eliminate the six-month pre-existing condition waiting period. If you have six or more months of creditable coverage, your waiting period will be eliminated. If you have less than six months creditable coverage, your waiting period will be reduced by the number of months you had creditable coverage. For example, if you have two months of creditable coverage, your waiting period will be reduced from six months to four months.

Am I guaranteed to be issued Xplorer coverage if I apply?

No, Xplorer is not a guaranteed issue plan. Each application is medically underwritten. Your application may be:

1. accepted; or
2. accepted with a rate increase due to your health status; or
3. denied

Is the quote I receive binding?

No. The quote you receive may not apply if:

1. you provided us with an inaccurate zip code
2. you misstated a material fact on your application, or
3. we increase the rate due to your health status.

When determining a rate while overseas, what zip code should I use?

Policies for U.S. citizens residing overseas are issued through the Global Citizens Association office in Washington, D.C. The zip code that applies is 20036.

How can I access participating doctors or hospitals?

GeoBlue’s Global Health and Safety services help members identify, access and pay for quality healthcare all over the world, including a contracted community of elite providers in 180 countries. Members can access these carefully selected providers and arrange for the bills to be sent directly to GeoBlue. Please note that in the U.S. a member can simply show his/her ID card at time of service and participating providers will only bill the member for any applicable deductible or copayment. Members have access to the Blue Cross and Blue Shield Network. Whether overseas or in the U.S., members can choose to use any doctor or hospital. Members are never restricted to a network. Please see the benefit schedules to see how coinsurance may apply.

How do pharmacy benefits work?

GeoBlue offers members the convenience of a direct billing service inside the U.S. so that the member is only responsible for co-payment at participating pharmacies. Most major pharmacies participate in this program administered by Universal RX.

Outside the U.S., members pay the pharmacy directly and then submit a claim to GeoBlue for reimbursement. The optional pharmacy benefit is not subject to the deductible or to the co-insurance on the plan. Within the United States, members pay $10 for generic drugs and $25 for brand name medications. Members are also eligible to use mail order pharmacy service.

To access mail order prescription drugs outside the U.S.: Online: Complete the online order form at www.expatps.com.
Email: Email a copy of your prescription(s) to eps@universalrx.com .
Phone: Call an EPS representative to order within the U.S. at 540-777-1450; Hours: 8:30am–5:00pm EST, USA.
Fax: Fax your prescription(s) to: Universal Rx, Attention: EPS Team, 540-777-7184.

Does my plan cover telemedicine?

GeoBlue offers their TeleMD app with the option of telemedicine at no cost. You can access doctors by telephone or video call anywhere in the world.

Do these plans meet the J-1 program visa requirements?

No, the Xplorer plan will not meet the J visa insurance requirements as it doesn’t offer medical evacuation and repatriation benefits inside the US. You must purchase additional coverage for medical evacuation and repatriation.

Are school sports and recreational sports covered under the GeoBlue Xplorer plan?

Injuries resulting from school sanctioned sports and sports for recreational purposes could be covered under this policy. Some adventure or extreme sports may be excluded. Please check the plan certificate for details..

Where can I view the full details of the plan?

To see plan definitions, limitations or to review a sample certificate, please click here.