Navigating healthcare coverage can be complex, especially when you’re away from your primary residence. Blue Shield understands this and offers programs like BlueCard and Away From Home Care to ensure members have access to covered services wherever they are. This article will delve into the specifics of the Blue Shield Away From Home Care Program, explaining how it provides crucial healthcare access for those living outside of their usual service area.
Blue Shield BlueCard Program: Coverage Nationwide and Globally
Before focusing on the Away From Home Care Program, it’s important to understand BlueCard. As a Blue Shield member, the BlueCard Program provides access to a vast network of providers, both nationally and internationally. For members with PPO, POS, or Active Choice plans, BlueCard offers access to covered benefits (excluding dental, vision, and prescription drugs) across the United States and in over 200 countries via the Blue Shield Global Core network. With a significant majority of U.S. providers participating in the BlueCard network, accessing healthcare while traveling or living temporarily in another state is simplified. Remember to check your Evidence of Coverage (EOC) or Certificate of Insurance (COI) for details on covered services and prior authorization requirements for procedures like surgeries and hospital stays. HMO members also have access to emergency and urgent care outside their service area under the BlueCard program.
In-depth Look: Blue Shield Away From Home Care Program for HMO Members
The Blue Shield Away From Home Care Program is specifically designed for HMO members who temporarily or regularly reside outside of California. This program offers convenience and flexibility for various situations, including:
- Long-Term Travelers: If you plan to travel outside your Blue Shield HMO service area for a minimum of 90 consecutive days, but no more than 180 days, and will return to your permanent residence, you may qualify. This is ideal for extended vacations or temporary work assignments.
- Families Living Apart: In situations of joint custody where a member is legally responsible for a dependent’s medical coverage, and the dependent lives outside the member’s HMO service area, this program can be utilized. This coverage has no time limit but is subject to annual review to confirm continued eligibility.
- Students: For dependents attending school outside of the HMO service area while their primary residence remains with the Blue Shield member, the Away From Home Care Program provides coverage. Student memberships are typically effective for one school year starting in September and can be renewed annually with a new application.
To benefit from the Away From Home Care Program, members or dependents living outside California must reside within a Host Plan service area. When utilizing this program, members receive the benefits offered by the local “Host Plan” in the state they are visiting. This ensures access to local healthcare networks and services.
Accessing Care and Finding Providers
Whether you are using the BlueCard Program or the Away From Home Care Program, accessing care is designed to be straightforward.
For BlueCard: When seeing a BlueCard provider, simply present your Blue Shield member ID card. The ID card contains information needed for providers to process claims through the BlueCard network. To find a BlueCard provider, visit the Blue Shield Find a Doctor tool and select the “Providers Outside of California” link. This will redirect you to the National Doctor and Hospital Finder on the BlueCard Program website. Alternatively, you can contact the Blue Shield Global Core Service Center for assistance in finding a provider.
For Away From Home Care: Enrollment in the Away From Home Care Program is required to access benefits under this program. Contact Blue Shield Member Services to confirm eligibility and enrollment processes. Once enrolled, you will likely receive information on how to access providers within the Host Plan network.
Claims and Payments
BlueCard Claims: When using a BlueCard provider, you may be required to pay your standard copayment or deductible at the time of service. Claims are typically submitted directly by the BlueCard provider to the local BlueCard plan, and Blue Shield will then process the claim. You will receive an Explanation of Benefits (EOB) detailing the services and payments made. Generally, you do not need to submit claims yourself when using in-network BlueCard providers.
Away From Home Care Claims: Claim processes under the Away From Home Care Program will be managed according to the rules of the Host Plan. Details on claims and payments will be provided upon enrollment in the program.
International Travel with BlueCard
For healthcare needs outside the United States, BlueCard again provides valuable coverage. You can locate international BlueCard providers through the Find a Doctor tool by selecting the “Coverage Outside U.S.” link to access Blue Shield Global Core. In areas where BlueCard providers are not available, you can seek care from any provider and submit a claim to Blue Shield for reimbursement. International claims should be submitted within one year of the service date, and international claim forms are available on the Blue Shield website.
Conclusion
The Blue Shield Away From Home Care Program offers a vital healthcare safety net for HMO members living outside of California for extended periods due to travel, family situations, or education. Combined with the broad reach of the BlueCard Program, Blue Shield ensures its members have access to necessary medical services, whether they are across the country or around the globe. For detailed information about eligibility, enrollment, and specific benefits, it’s recommended to download the program flyer or contact Blue Shield Customer Service directly.
