Benefit Spotlight: Out-of-Area Dependent Rider

  • October 18, 2019
  • |Quartz
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OOA
Starting in 2020, more large groups will be able to take advantage of the Out-of-Area Dependent Rider.

In 2020, more large groups will be able to take advantage of the Out-of-Area Dependent Rider. Previously offered to Wisconsin large groups only, this benefit will be expanded to Illinois, Iowa and Minnesota in 2020. It can be added at a group’s renewal.

This rider offers additional coverage for Quartz members who have a child or grandchild on their plan who lives elsewhere for several months. If the dependent child or grandchild is outside of Quartz’s service area for more than three months per year, they can visit a nearby doctor for an office visit under the same coverage as if they were in-network.

Eligible services include primary care, chiropractic care, behavioral and mental health, in-office therapy sessions, and routine procedures and care in office. Please note –

  • Quartz must provide our okay ahead of time before the dependent sees a doctor. Members need to call (888) 829-5687 for prior authorization.
  • Services other than a doctor’s office visit, like outpatient surgery, non-emergency hospitalizations, etc., require the dependent to return to the Quartz service area for care.
Allowed amounts for cost-sharing will be based on usual, customary and reasonable charges (the amount other providers in that area usually charge for the same kind of service).

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