Blue Shield – Blue Cross
Out of State – Country – International Coverage – Blue Card Program
All Insurance Companies?
How do I know what my coverage is – out of area?
Questions of coverage can be quite confusing, especially what coverage might there be if your California issued coverage, is used out of your HMO local area, network, out of state or out of country. Coverage can differ if it’s for routine care, Urgent Care & Emergency or seeking out specialists at prestigious world famous clinics and hospitals.
We are editing this page in April 2022 and will be putting a lot of the information in the “Historical” section.
For an example – check out the Blue Shield PPO EOC
Please refer to your specific Evidence of Coverage EOC for details of YOUR coverage.
Blue Card & Interplan Arrangements – programs to assist BC-BS Blue Cross – Blue Shield plan members traveling out of state & outside of the united states
Insubuy Travel Health Insurance
Instant Quotes, Details and ONLINE Enrollment
Our webpage on Travel Insurance
Emergency Medical Condition
An illness, injury, symptom (including severe pain), or condition severe enough to risk serious danger to your health if you didn’t get medical attention right away. If you didn’t get immediate medical attention you could reasonably expect one of the following:
1) Your health would be put in serious danger; or
2) You would have serious problems with your bodily functions; or
3) You would have serious damage to any part or organ of your body. Health Net Glossary *
Care for an illness, injury, or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.
Prior Authorization Preauthorization
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment (DME) is medically necessary. EOC * Our Webpage * Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost. Health Net Glossary *
The BlueCard® Program links Blue plans across the United States and abroad through a single electronic network for claims processing and reimbursement. When an out-of-state Blue plan member seeks medical care from your office, use the information and tools in this section to submit those claims to Blue Shield of California. As a mission-driven, non-profit health plan, Blue Shield of California is working every day to create a sustainably affordable healthcare system that’s worthy of our family and friends.
Be sure to check the definition in YOUR EOC
- PPO Travel Guide – English (PDF) Health Net
- Policy – Travel Section
- Sorry, under ObamaCare – Blue Cross does not appear to participate in the Blue Card Program unless it’s an emergency or urgent care. Double check this – 2016 might have changed!
- Blue Shield HMO
- SBC – Federal Summary of Benefits
- How to find your Evidence of Coverage
- Kaiser – KP.org Travel Care away from home * 951-268-3900 *
- Provider Finder for all our companies
- US News & World Report 10.2015 – Coverage while outside USA
- Free Quotes, Brochures and complete information on travel coverage and International Medical Plans
- $50k Emergency Coverage in Supplemental & Advantage Plans
- Blue Shield Silver 70 PPO Off Exchange Evidence of Coverage EOC
Medical Info for American’s Traveling Abroad US State Department
Official Web Site for Canadian Health Care
Constitutional right to travel 14th Amendment
It's often so much easier and simpler to just read your Evidence of Coverage EOC-policy, then look all over for the codes, laws, regulations etc! Plus, EOC's are mandated to be written in PLAIN ENGLISH!
- Find your own Individual EOC Evidence of Coverage
- It' important to use YOUR EOC not just stuff in general!
- Obligation to READ your EOC
- Employer Group Plans
- Medi-Cal HMO – Managed Care Providers
- Our Webpage on Evidence of Coverage
- Plain Meaning Rule - Plain Writing Act
- Our Webpage on OOP Out of Pocket Maximum - Many definitions are explained there.
All our plans are Guaranteed Issue with No Pre X Clause
Quote & Subsidy Calculation
There is No charge for our complementary services
- Our Quote Engine Takes all the complexity out of using pencil and paper to figure out the premiums per the Obamacare/ACA rules under CFR §1.36B-3 *
- Get more detail on the Individual & Family Carriers available in CA
No extra charge for complementary assistance
- Appoint us as your broker
- 17 Reasons to appoint us as your agent - broker
- VIDEO on ARPA Stimulus and more Covered CA Subsidies
- Set Consultation Meeting via Phone, Skype or Zoom
- Get Instant Health Quotes, Subsidy Calculation & Enroll
- Videos on how great agents are
- I'm in Sonia VIDEO
Quotit - #Find Provider - ALL Companies
How to see MD list when using our quote engine
Medicare A & B if you don't #live in USA
- Medicare VIDEO Medicare & You: Traveling Abroad
- Our webpage on Medicare Coverage outside of USA
- FAQ - Buying Medi Gap if you live outside USA
- Get Travel Quotes & Information
- What if you work in two or more different Countries?
- International Social Security agreements,“Totalization agreements,” have two main purposes.
- First, they eliminate dual Social Security taxation, the situation that occurs when a worker from one country works in another country and is required to pay Social Security taxes to both countries on the same earnings.
- Second, the agreements help fill gaps in benefit protection for workers who have divided their careers between the United States and another country.
- TAX #Guides
Our Webpages on:
Providence Health – Difference between ER and Urgent Care
- Provider Finder – Instructions * Exclusive PPO – Trio HMO
- Urgent Care vs ER
- It seems that there are NO companies, even PPO that cover you out of state, unless it’s an Emergency or Urgent Care. We will be checking
Medical Necessity – reasonable and necessary
- USA Policies – Out of Area Coverage & Worldwide
- Blue Cross Provider Lists – Definitions HMO, Tiered – PPO, PPO, EPO
- Blue Shield Provider Finder – Instructions * Exclusive PPO – Trio HMO
- Urgent Care vs ER
- Quotit Provider Finder – All Companies
- Kaiser Provider Search
- Oscar Pharmacy, Doctor & Provider Finder
- Definitions – Glossary
Why the restrictions in Coverage?
Going to Urgent Care vs ER Emergency Room
What if you’re out of the area, out of state?
Visiting an urgent care center can cost up to five times less than a visit to the ER and significantly reduce your wait time. While the average wait at a California ER is 4 hours and 34 minutes, urgent care center wait times are usually under an hour*. That means you can bypass the crowds and take your first step on the road to recovery.
- *”Urgent Care or the ER – Which is the Right Choice?” Health Alerts, Johns Hopkins Medicine, January 2011. Read more Accessing Urgent Care
- 49 Ways to stay out of the ER – Emergency Room Kevin MD.com
- The Insurance Company might base the claim payment on final diagnosis, rather than if a reasonable person felt their life was in danger?