Out-of-area coverage

Coverage for out-of-area dependents

What you need to know

Do you have dependents who live outside of the Prevea360 Health Plan service area? If your dependents (up to age 26) are college students or children living in communities outside our service area, Prevea360 Health Plan is committed to helping them get the health care and coverage they need when they need it.

This coverage is available under large employer group plans. To find out if you have this coverage, see your member certificate or check with our Customer Care Center at 877-230-7555.

Notify us

Be sure to notify us of your out-of-area dependent by completing and submitting an out-of-area dependent form.

If your dependent needs services

If your dependent is out of the service area – inside or outside of Wisconsin – you can use the First Health network to find a provider.

Before seeking medical care with First Health providers, we suggest confirming your provider's First Health network participation status at firsthealth.com. Find out how to search for a First Health provider.

If you have questions, contact our Customer Care Center at 877-230-7555.

In case of emergency

If your dependent is out of the service area – inside or outside of Wisconsin – you can use the First Health network to find a provider.

Before seeking medical care with First Health providers, we suggest confirming your provider's First Health network participation status at firsthealth.com. Find out how to search for a First Health provider.

If you have questions, contact our Customer Care Center at 877-230-7555.

If your dependent needs services

If your dependent is out of the service area – inside or outside of Wisconsin – you can use the First Health network to find a provider.

Before seeking medical care with First Health providers, we suggest confirming your provider's First Health network participation status at firsthealth.com. Find out how to search for a First Health provider.

If you have questions, contact our Customer Care Center at 877-230-7555.

In case of emergency

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 Prevea360 Health Plan 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.

Traveling? You've got coverage

Traveling and find you need health care? Prevea360 Health Plan members are covered for urgent and emergency care worldwide. Regardless of where you travel, you don’t need to take health care coverage worries with you on vacation. We have you covered.

Find a provider while traveling

HMO/POS members outside the Prevea360 Health Plan service area or Wisconsin: Search Providers Now

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.

Your coverage

You do not need a referral or prior authorization for urgent or emergency services — no matter where you travel:
  • Prevea360 Health Plan covers urgent and emergency services while you are outside of our service area (subject to policy copays, coinsurance, deductibles and maximum allowable fees).
  • Depending on the health care professional, the service could cost you more or not be paid for at all by your plan, which means you will be charged the full amount. Charging you this extra amount is called balance billing.
  • If you require urgent or emergency 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 Health Plan 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 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.