With the Blue Cross and Blue Shield Association’s BlueCard® program, your Small Group and Individual PPO clients never have to travel alone. Whether they’re traveling for work or on vacation, going to an emergency room or urgent care center isn’t something they need to worry about. They can get the care they need anywhere in the United States or abroad with BlueCard.
Our PPO plans cover emergency and urgent care in all 50 states through BlueCard* — as well as non-emergency care when members visit participating BlueCard providers in this country or worldwide. Your Small Group and Individual PPO clients can see any provider they wish, but they’ll pay less out of their own pocket when they use BlueCard doctors and hospitals.
Outside the U.S.
BlueCard Worldwide connects our members traveling or living abroad to a network of more than 9,000 hospitals and 21,000 health care professionals and outpatient care centers around the world. Through the BlueCard Worldwide Service Center, members get claims support, referrals to doctors, translation services and medical monitoring — 24/7. This center may also coordinate medical evacuation and provide other services, depending on the member’s benefits and home plan.
Full access in 2016
You may recall that in 2015, BlueCard was limited to hospital and urgent care only for Individual PPO members, while Small Group PPO members enjoyed full BlueCard access. But all that changes for 2016, when our Individual PPO members will also now have full access to BlueCard. So for example, if they want to go to a chiropractor while traveling, it’s a covered service under BlueCard.
From the Evidence of Coverage document, Anthem Blue Cross Bronze 60 D HSA Tiered PPO
BlueCard® Program
Under the BlueCard® Program, when You obtain Covered Services within the geographic area served by a Host Blue, Anthem still fulfill its contractual obligations. But the Host Blue is responsible for: (a) contracting with its Providers; and (b) handling its interactions with those Providers.
Whenever You obtain Covered Services outside the Anthem Service Area and the claim is processed through the BlueCard Program, the amount You pay is calculated based on the lower of:
· The billed covered charges for the Covered Services or supplies; or
· The Negotiated Price that the Host Blue makes available to Anthem.
Often, this “Negotiated Price” will be a simple discount that reflects an actual price that the Host Blue pays to the Provider. Sometimes, it is an estimated price that takes into account a special arrangement with that Provider or Provider group. Sometimes, such an arrangement may be an average price, based on a discount that results in expected average savings for services provided by similar types of Providers. Estimated and average pricing arrangements may also involve: types of settlements; incentive payments; and/or other credits or charges.
Estimated and average pricing arrangements going forward, also take into account certain adjustments to their basic rates. These may be made to correct for an over- or underestimation of changes of the past pricing for the types of transactions noted above. But such adjustments will not affect the price on the claim that Anthem will use to determine the amount You pay.
Also, federal law or laws in a small number of states may require the Host Blue to add a surcharge to a claim calculation. If federal law or any State law mandate other liability calculation methods, including a surcharge, Anthem calculates a Member’s liability for any Covered Service according to applicable law.
Check out this BlueCard flier for full details.
Editors note: Blue Shield of California also offers the Blue Card travel benefits on their individual and plans as well. See the Evidence of Coverage for full details on how the BlueCard program works.