Out-of-Area Coverage

As a member of Prevea360 Health Plan, you are covered for urgent and emergency care worldwide.

Regardless of where you travel, you do not need to take health care coverage worries with you on your vacation — Prevea360 Health Plan has you covered.

If you are outside the service area

 

You do not need an authorization for urgent care of emergency room services—no matter where you travel. We will cover urgent care and emergency room services while you are out of the Prevea360 service area, subject to policy copayments, co-insurance, eductibles and maximum allowable fees.

If you require urgent care or emergency room care outside the service area and are unable to get to a plan provider, please go to the nearest urgent care or emergency center for treatment. It is important to notify Prevea360 as soon as possible by calling the Customer Care Center at 877.230.7555.

All follow-up care should be done by a plan provider. If you are out of the area and not able to see a plan provider, call your primary care provider for an authorization to an out-of-area provider. Follow-up services with non-plan providers require prior approval by Prevea360 Health Plan.

Find a provider while traveling: If you reside outside of the Prevea360 network area, you will fall under the PPO product design and need to select that option in our provider directory to see providers. This section is intended only for those on a network or POS product when traveling out of the area or having a dependent out of the area for a period of time.

Find a provider for out-of-area dependents

When available under employer group plans. To find out if you have this coverage, refer to your member certificate or check with our Customer Care Center at 877.230.7555.

If your dependent needs services outside of Wisconsin, use the link below to go to our vendor for out-of-area services. Select the PHCS Network button. For services inside Wisconsin, but outside of the service area, select the Health EOS Network. Use our out-of-area dependent form to  tell us about your out-of-area dependent.

HMO/POS dependents outside the Prevea360 Health Plan service area or Wisconsin

What you need to know if your out-of-area dependent needs care
Prevea360 Health Plan is committed to helping your out-of-area dependents (up to age 26) get the health care coverage they need when they need it. Students who attend college outside of the area and children living in communities outside the Prevea360 Health Plan service area are common examples of out-of-area dependents.

Notify us
If your dependent needs urgent or emergency care outside the service area and is unable to get to a plan provider, he or she should go to the nearest urgent care or emergency center for treatment. It is important to notify us as soon as possible by calling the Customer Care Center at 877.230.7555.

All follow-up care should be done by a plan provider. If your dependent is out of the area and unable to see a plan provider, call your primary care practitioner for a referral to an out-of-area provider. These services require approval by Prevea360 Health Plan