Employee Matters

This column is prepared by staff of the Employee Compensation and Benefits Services office. E-mail the office at employee@bussvc.wisc.edu, or call 263-7556 or 262-5650.

Health Insurance Coverage While Out of the Area

What happens to my health insurance if I move out of the plan’s service area?

If you move out of your heath plan’s service area temporarily (three months or more), you may enroll in the standard plan or another plan available in the area to which you are moving. You will be eligible to change back to your original plan when you return to the service area.

If you move out of the health plan’s service area permanently, it requires that you change to the standard plan or another available plan in the area to which you move.

You must complete a new health insurance application within 30 days of the date of the move, and the application must indicate your out-of-area address. If your application is received after the 30-day deadline, you are eligible only for the standard plan with a 180-day waiting period for pre-existing conditions (excluding pregnancy).

The change in plans will be effective on the first day of the month on or after your application is received by your department benefits coordinator or by the Employee Compensation and Benefits (EC&BS) office.

Will I be subject to a different contribution rate?

Possibly. If offered a different HMO in your new area, that plan may be in a different tier rate.

What will the cost of the standard plan be if that is my only option?

If the standard plan is your only option when you move out of the HMO’s service area, you would pay the premium rate for coverage. If you move out of state, you would pay the out-of-state premium rate for standard coverage.

What if my relocation is temporary but longer than three months?

As long as your move is three months or more, you can change plans to standard or another plan available in your new area, and then change back to your original plan when you return to the service area.

What is the advantage of changing plans if I move out of my plan’s service area?

If you are enrolled in an HMO and you move out of your plan’s service area, you will be covered for emergencies only, not routine medical services. To have routine medical services covered, you would be would be required to travel back to the HMO’s service area.

Can I change plans if my spouse is moving out of the service area, if I am the subscriber?

No, eligibility to change plans is based on the subscriber. Because you as subscriber are not moving, you would not be eligible to change plans. A change can be made during the annual dual choice enrollment period held every October.

Questions?

For more information, visit the EC&BS Web site, or e-mail employee@bussvc.wisc.edu.