Q&A: Out-of-Area Services

Q: How do students/dependents living out of the service area access services?

A: If a student/dependent lives outside of the ODS Plus Network service area, the member must notify the ODS customer service department by calling (888) 923-0409.  Be prepared with the dependent's name, address of residence and the name and address of their school, if applicable.  (Note: Occasionally a less-experienced customer service rep may refer you back to your employer when you offer them this information.  If this happens, ask to speak with the rep's supervisor.  We have confirmed with ODS management they really are supposed to take this information.)

When an insured dependent child under age 19 (26 if a full-time student at an accredited college, university, or vocational school) resides outside the service area, ODS will extend Plan benefits for treatment of an illness or injury, preventive healthcare (including routine physicals and immunizations) and maternity services, as if the care were rendered by in-network physicians or providers. Out-of-area dependents must access benefits within a 30-mile radius of the dependent child’s residence in order for the benefit level to apply. Fees charged by out-of-area physicians and providers of care will be reimbursed at the maximum plan allowance for those services.

Q: What are my benefits when traveling?

A: For non-emergency care while traveling within the United States, ODS has a nation-wide network of providers you can utilize to get the maximum benefit from your insurance.  Visit the ODS website and look under the headings "The ODS Plus Network" and "Search for a provider".  Select the appropriate link for the area in which you are seeking services.  (See the next Q&A for emergency care.)

Q: How do I obtain proof of medical coverage overseas to show to customs officials when I'm traveling abroad?

A: You should call ODS Customer Service at (866) 923-0409 to request this documentation.  (Note: Occasionally a less-experienced customer service rep may refer you back to your employer when you request this documentation.  If this happens, ask to speak with the rep's supervisor.  We have confirmed with ODS management that they really are the appropriate entity to provide this documentation to members.)

Q: What if I am out of the service area and have a medical emergency?

A: If you are out of the service area and have a medical emergency, go to the nearest emergency room.  Benefits will be paid at the in-network benefit level, subject to maximum plan allowable, for medical emergencies.  If traveling outside the United States, you may need to pay for emergency services and submit the receipt to ODS for reimbursement, since providers in other countries rarely accept U.S. insurance.

Q: I'm going to be traveling to a remote location where I won't have access to a pharmacy or mail delivery.  Is it possible to stock up on my prescriptions before I leave?

A: In rare circumstances like this, ODS may approve an "override" allowing your pharmacist to dispense more than the standard maximum amount of your medication.  Depending on the details of the situation, you may be asked to pay the full cost of some or all of the medication up front, then submit the receipts for reimbursement after ODS is able to verify your insurance was still in place at the time a refill would have normally occurred.  Whatever the circumstances, ODS can usually work something out to ensure you have the medication you need when you need it.  Initiate the process as far in advance as possible by calling ODS Pharmacy Customer Service at (866) 923-0411.