The Blue Card Program for
International & Domestic Travel

 

Steve talks about International Travel Insurance

The Blue Card program  worldwide 1-800-810-BLUE (2583)  gives Blue Cross/Blue Shield PPO members access to doctors and hospitals in participating local Blue plan networks throughout the nation. The program features assistance in locating these participating providers from a roster including more than 70 percent of doctors and 80 percent of hospitals in America. Blue Card extends “Power of Blue” cost savings and the security of access to quality health care, wherever you travel within the U.S. Blue Cross GROUP Sales Brochure Page 12  Blue Shield GROUP – Blue Card Brochure  Blue Shield International Claim Form

Read your specific EOC – Don’t trust general information on the Internet.  Even OUR prestigious site!

Resources & Links

Blue Shield CA on Blue Card Program  for providers

Anthem Blue Cross Blue Card

Find a doctor in New York

FOR MEDICAL EMERGENCIES OUTSIDE OF CALIFORNIA ppo_share_1500

The Blue Cross and Blue Shield Association, of which we are a member/Independent Licensee, administers a program called the Blue Card Program, in which we participate, which allows our Members to have the reciprocal use of Participating Providers that contract with other Blue Cross and/or Blue Shield Plans. Providers available to you through the Blue Card Program have not entered into contracts with Anthem Blue Cross. If you have any questions or complaints about the Blue Card Program, please call us at 1-800-333-0912.

If you are traveling outside of California and require medical care or treatment, you may use a local Blue Cross and/or Blue Shield Participating Provider. If you use one of these providers, your out-of-pocket expenses may be lower than those incurred when using a provider that does not participate with a local Blue Cross and/or Blue Shield Plan.

In order for you to receive access to whatever reductions in out-of-pocket expenses may be available, we must abide by the rules Blue Card Program rules, as set by the Blue Cross and/or Blue Shield Association.

When you obtain health care services through the Blue Card Program outside of California, the amount you pay for Covered Services is calculated on the lower of:

The billed charges for your Covered Services, or

The Negotiated Price that the on-site Blue Cross and/or Blue Shield (“Host Blue”) passes on to us.

Often, this “Negotiated Price” will consist of a simple discount which reflects the actual price paid by the Host Blue. But sometimes it is an estimated price that factors into the actual price expected settlements, withholds, any other contingent payment arrangements and non-claims transactions with your health care provider or with a specified group of providers. The Negotiated Price may also be billed charges reduced to reflect an average expected savings with your health care provider or with a specified group of providers. The price that reflects average savings may result in greater variation (more or less) from the actual price paid than will the estimated price. The Negotiated Price will also be adjusted in the future to correct for over-or underestimation of past prices. However, the amount you pay is considered a final price.

Statutes in a small number of states may require the Host Blue to use a basis for calculating Subscriber liability for Covered Services that does not reflect the entire savings realized or expected to be realized on a particular claim or to add a surcharge. Should any state mandate Subscriber liability calculation methods that differ from the usual Blue Card method noted above in the preceding paragraph four of this item or require a surcharge, we would then calculate your liability for any covered health care services in accordance with the applicable state statute in effect at the time you received your care.

BLUE CARD PROVIDER TYPES

PPO Providers

These are primarily Hospitals and Physicians who participate in a Blue Card PPO network and have agreed to provide PPO Members with health care services at a discounted rate that is generally lower than the rate charged by Traditional Providers.

Traditional Providers

These are providers who might not participate in a Blue Card PPO network, but have agreed to provide PPO Members with health care services at a discounted rate.

Non-Participating Providers

These are providers that do not have a contract with their local Blue Cross and/or Blue Shield plan and have not accepted the Blue Card PPO or Traditional Provider negotiated rates.

To locate a Blue Card PPO or Traditional Provider, when outside of California, call 1-800-810-BLUE (2583) or visit the Blue Card web site address: www.bcbs.com. When traveling outside the United States, in cases of emergencies only, call 1-800-810-BLUE (2583) to inquire about providers that may participate in the Blue Card Worldwide Program. Page 13 ppo_share_1500_EOC

FAQ’s

Are there health insurance companies/policies available in California that do not do underwriting over again when you move across state lines I may be out of the country over half the time. I am hoping this does not trigger some kind of residency red flag.

For an individual that is currently insurable but plans to travel and relocate not only in the USA but also out of the country extensively, I would recommend an individual Global Citizen Policy that will be good in  the USA and anywhere in the world and is subject to evident initially and then renews every 12 months at the market rates.

***On PPO they cover everything don’t they?  The question is not if they will cover out of country, but if they will cancel the coverage if he don’t have residency.

Inter-Plan Programs

Blue Shield has a variety of relationships with other Blue Cross and/or Blue Shield Plans and their Licensed Controlled Affiliates (“Licensees”) referred to generally as “Inter-Plan Programs.” Whenever you obtain healthcare services outside of California, the claims for these services may be processed through one of these Inter-Plan Programs.

When you access Covered Services outside of California you may obtain care from healthcare providers that have a contractual agreement (i.e., are “participating providers”) with the local Blue Cross and/or Blue Shield Licensee in that other you may obtain care from non-participating healthcare providers. Blue Shield’s payment practices in both instances are described in this booklet.

 

BlueCard Program

Under the BlueCard® Program, when you obtain Covered Services within the geographic area served by a Host Plan, Blue Shield will remain responsible for fulfilling our contractual obligations. However, the Host Blue is responsible for contracting with and generally handling all interactions with its participating healthcare providers.

The BlueCard Program enables you to obtain Covered Services outside of California, as defined, from a healthcare provider participating with a Host Plan, where available. The participating healthcare provider will automatically file a claim for the Covered Services provided to you, so there are no claim forms for you to fill out. You will be responsible for the member copayment and deductible amounts, if any, as stated in this Evidence of Coverage.

Whenever you access Covered Services outside of California and the claim is processed through the BlueCard Program, the amount you pay for covered healthcare services, if not a flat dollar copayment, is calculated based on the lower of:

1) The billed covered charges for your Covered Services; or 2) The negotiated price that the Host Plan makes available to Blue Shield.

Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Plan pays to your healthcare provider. Sometimes, it is an estimated price that takes into account special arrangements with your healthcare provider or provider group that may include types of settlements, incentive payments, and/or other credits or charges. Occasionally, it may be an average price, based on a discount that results in expected average savings for similar types of healthcare providers after taking into account the same types of transactions as with an estimated price.

Estimated pricing and average pricing, going forward, also take into account adjustments to correct for over- or underestimation of modifications of past pricing for the types of transaction modifications noted above. However, such adjustments will not affect the price Blue Shield uses for your claim because they will not be applied retroactively to claims already paid. Laws in a small number of states may require the Host Plan to add a surcharge to your calculation. If any state laws mandate other liability calculation methods, including a surcharge, we would then calculate your liability for any covered healthcare services according to applicable law. Claims for Emergency Services are paid based on the Allowable Amount as defined in this Evidence of Coverage.

4 comments on “Blue Card Program

  1. I have a small employer Blue Cross HMO group health plan, in CA. My child will be going to school in New York.

    Will she be covered under our plan?

    If not, what do we do?

    • I’m double checking on the definition of service area. If that means Blue Cross of CA or if that includes anywhere BC/BS has a list of MD’s. See our page on residency.

      Normally for visits and travel, it’s not a problem.

    • Here’s the reply from Blue Cross Broker Support:

      Because you are on a Select HMO plan, coverage out of the state of CA is limited to emergency services only.

      If you were on a PPO plan, she would be subject to in network doctors in NY through the “blue card” program regardless if the services are for emergency or not.

      Unfortunately, her going to school isn’t a qualifying event to change your plan to a PPO.

      I have attached a flyer for more information on the Anthem Guest Membership Program, for further information you can call 800-827-6422. Please note, that in very tiny print on the flyer it does indicate that applicants can still be declined if a region within a guest states does not have providers.

      New York is on the list.

    • This link will allow you to search based on the 3 letter Alpha Pre-Fix that is on the member’s card. Or you can just select the BlueCard PPO/EPO network option under browse plans.

      the blue card network does not apply to HMO’s.

Leave a Reply

Your email address will not be published.

wp-puzzle.com logo