Health Insurance Checklist

If you are out of your normal health insurance service area, your health insurance policy may work differently than it would at home. Knowing the answers to the following questions will help you with health insurance issues while you attend the University of Puget Sound.

  • If you are listed on your parents' health insurance policy, at what age do you lose coverage?
  • Does your policy cover routine care and preventive care outside your service area?
    (The service area is usually the local region where your primary care physician, the local hospital, and the network of specialists specified by your insurance are located. Routine care may include sprains, rashes, colds, etc. Preventive care may include any type of physical exam, immunization, PAP smear, etc.)
  • Does your policy specify that out-of-service-area care will be limited to emergency care provided in a hospital emergency room or free-standing health clinic?
  • Do you need to obtain prior authorization from your health insurer before you seek any care out of your normal health service area? Do you have any co-payments or a deductible?
  • Can you be reimbursed for out-of-pocket expenses incurred at Counseling, Health, and Wellness Services?
  • Do you need prior authorization for specialist referrals from your primary care provider in your home service area, and will the cost of specialist care here be reimbursed at the same rate as if you were at home?
  • Are laboratory, X-ray, and other diagnostic tests covered if ordered by practitioners outside of your normal service area?
  • Do you have a co-pay for prescription medications? What is the co-pay, and what does it cover with regard to brand name or generic medications? Do you need to show a prescription card when you pick up medications from a pharmacy? Does your insurer offer a mail-order service for regularly-used medications (such as blood pressure meds) at a lower rate?
  • Does your health insurer have a drug formulary and cover only certain medications?
  • Do you have mental health coverage, and what is your mental health co-pay? Are you limited to a certain number of mental health visits per year?
  • Does your home insurance company have a reciprocal agreement with an insurance company in the Puget Sound area? For example, if you have Kaiser Permanente insurance, you may be able to receive care at local Group Health Cooperative clinics.