CurrentAlaska Native Tribal Health ConsortiumPolicy N/A

Purchased/Referred Care (PRC) Traveler Program

This document governs ANTHC's Purchased/Referred Care Traveler Program that provides limited emergency medical coverage for eligible Alaska Native and American Indian patients traveling outside Alaska (including internationally); it outlines eligibility, covered services, exclusions, documentation and notification requirements.

Policy Summary

PayerAlaska Native Tribal Health Consortium

PolicyPurchased/Referred Care (PRC) Traveler Program

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionNotify ANTHC PRC within 72 hours after receiving medical treatment and submit supporting receipts and documents as required.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

72 hourstimeframe to notify PRC after receiving medical treatment

30 daystimeframe to submit supporting documents after treatment

180 daysmaximum absence while retaining residency / emergent coverage period

907-729-2470PRC office phone

Traveler Program Coverage and Requirements

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Traveler Program coverage and requirements

Covered when ALL of the following are met:

Traveler Program covers emergent medical care for eligible Alaska Native and American Indian (AN/AI) patients who are traveling outside Alaska (including internationally); emergency defined as any condition requiring immediate medical attention to prevent death or serious impairment.

ALL of the following

Member meets ANTHC eligibility and residency requirements: resides in Alaska, has not been absent from Alaska for more than 180 days, and intends to live in Alaska indefinitely (individuals who move back must live in Alaska at least 180 days).
Proof of Tribal enrollment or descent is provided; legal dependents (including foster, adopted children, and non‑AN/AI women pregnant with an AN/AI man's child) must provide additional documentation as required (eg, birth certificate, marriage certificate, proof of paternity).

ALL of the following

Patient or family notifies ANTHC PRC within 72 hours (including weekends/holidays) after receiving medical treatment. For international care, patient may need to pay up front and must notify PRC within 72 hours and provide receipts.
Patient submits supporting documents within 30 days of treatment (medical bills/statements, medical records, flight itinerary/boarding pass, proof of eligibility). Coverage will not be reviewed until necessary documentation is received; coverage may be approved or denied based on documentation.

ALL of the following

PRC is payer of last resort per federal regulations; members and providers must provide other insurance information and may be contacted for health benefits screening.

ALL of the following

Coverage is limited to the initial emergency; further care beyond the initial emergency and scheduling outpatient care beyond an emergent event will not be authorized and may not be covered.
Services not covered include non-emergent care, routine care, dental care, medications purchased while traveling, inpatient/outpatient mental health services, and inpatient/outpatient substance misuse services.
If moving out of Alaska, PRC provides emergent coverage for up to 180 days from the date you left Alaska. Contact local PRC if your permanent/last residence is in certain regional service areas.

ALL of the following

Patients should ensure PRC receives all claims and applicable health insurance information in a timely manner; contact PRC or Health Benefits Specialists for questions and to provide 72‑hour notices.

Notifications, Reimbursement, and Payer Responsibilities

Denial Risk

Payer of last resort — provide other insurance information

PRC is payer of last resort. If the patient has other health insurance, the provider and patient must provide that information to ANTHC PRC so benefits can be properly screened and billed before PRC pays. Ensure the member’s eligibility and any third‑party coverage are documented in the medical record.

Provide any other insurance information to the provider and to ANTHC PRC.
Ensure health benefits screening is current and reflected in the medical record.
ANTHC PRC will coordinate payment only after other available coverage is applied.

Documentation Required

Notification and initial reimbursement process — 72‑hour notice and 30‑day documentation

Notify ANTHC PRC within 72 hours (including weekends and holidays) after receiving medical treatment. For international emergency care you may need to pay upfront — retain receipts and submit them. The patient (or family) must submit supporting documents within 30 days of the treatment to complete reimbursement: medical bills/patient statements, medical records, flight itinerary or boarding pass (if travel related), and proof of eligibility.

Call PRC at 907-729-2470 or 800-478-1636 to report treatment within 72 hours.
If treated outside the U.S., keep and submit receipts if you paid up front.
Submit all supporting documents to PRC within 30 days of the date of treatment.

Key Definitions

Emergency

DefinitionAny medical condition for which immediate medical attention is necessary to prevent the death or serious impairment of the health of the individual.

ScopeApplies to emergency medical care while traveling outside Alaska, including internationally; further care beyond the initial emergency may not be covered.

Related actionContact PRC case management for questions and discharge planning; outpatient scheduling beyond an emergent event will not be authorized.

Residency requirement

Residency criteriaMust reside in Alaska, not have been absent from Alaska for more than 180 days, and intend to live in Alaska indefinitely.

Returning residentsIndividuals who move back to Alaska must live in Alaska for at least 180 days with the intent to remain indefinitely before eligibility is established.

Coverage when movingIf you are moving, ANTHC PRC provides emergent coverage for 180 days from the date you left Alaska.