Traveling out of the country is considered out of area. If the member has an accident or a medical emergency, they should seek medical attention at a hospital emergency room. Treatment for accidents and medical emergencies are covered when the appropriate diagnosis code is indicated on the claim form for the inpatient or outpatient provider. Benefits for follow-up care will be covered if the services were a result of an accident or medical emergency and the member is unable to return home to their medical group/IPA for treatment.
The member is responsible for paying the claim out of pocket and submitting it to HMO Illinois for reimbursement. All reimbursements for foreign claims are made to the member.
If traveling outside the United States, prescriptions should be obtained in the quantity needed for the duration of the stay, before the departure date.
There are NO exclusions for war or acts of terrorism under the HMO IL plan.