When you’re a Blue Shield member, healthcare coverage extends beyond your home. Through programs like BlueCard and Away From Home Care, access to necessary medical services is available wherever life takes you, including urgent and emergency situations. This guide focuses on the Away From Home Care Program, detailing how it ensures you’re covered even when you’re not in your usual service area.
BlueCard Program: Coverage Nationwide and Globally
The BlueCard Program provides Blue Shield members with access to a vast network of healthcare providers, both nationally and internationally. Globally, the Blue Shield Global Core network includes providers in over 200 countries. Within the United States, an impressive 85% of providers participate in BlueCard’s national network.
For members with PPO, POS, or Active Choice plans (excluding dental, vision, and prescription drugs), the BlueCard Program offers seamless access to covered benefits. It’s important to remember that certain services, such as inpatient and outpatient surgeries, and hospital stays, require prior authorization. Your Evidence of Coverage (EOC) or Certificate of Insurance (COI) booklet outlines all services needing this pre-approval. For specific details on your covered services, always refer to these documents or contact Blue Shield Customer Service using the number on your ID card.
Alt text: Example of a Blue Shield member ID card highlighting key information for accessing healthcare benefits.
For HMO members, coverage extends to emergency and urgent care services when outside their HMO service area, as well as authorized follow-up medical care. In a life-threatening emergency within the U.S., dial 911 or immediately go to the nearest medical facility. Authorization can be obtained afterward when feasible. For comprehensive details on covered services, consult your EOC booklet or call the Blue Shield Member Services number on your ID card.
Finding a participating doctor is straightforward. Visit the Find a Doctor tool on the Blue Shield website and select “Providers Outside of California.” This will direct you to the National Doctor and Hospital Finder on the BlueCard Program website. Alternatively, you can call the Blue Shield Global Core Service Center at (800) 810-BLUE (2583), available 24/7.
Using your coverage with a BlueCard provider is simple. Just present your Blue Shield member ID card. This card contains your member ID number, which identifies your Blue plan and facilitates the claims process for providers.
When it comes to claims and payments with BlueCard providers, you may be asked to pay your standard copayment or deductible at the time of service. The provider will then directly receive payment for your claim from BlueCard. Blue Shield will send you an Explanation of Benefits (EOB) detailing the payment made on your behalf. You don’t need to submit bills when using a BlueCard provider. For claim status inquiries, visit blueshieldca.com or contact Blue Shield Customer Service.
Traveling internationally? Finding a BlueCard provider is also easy. Use the Find a Doctor tool and select “Coverage Outside U.S.” to connect to Blue Shield Global Core. From within the U.S., call the Blue Shield Global Core Service Center at (800) 810-BLUE (2583). If you are already abroad, call collect at (804) 673-1177.
In situations where BlueCard providers are unavailable in your travel destination, seek care from any provider, pay for services directly, and then submit a claim for reimbursement to Blue Shield. International claims must be submitted within one year of the service date. An international claim form is available for download on blueshieldca.com. Further details about this benefit are available in the program flyer and your EOC or COI booklet.
Away From Home Care Program: HMO Coverage Outside California
Specifically designed for HMO members, the away from home care program ensures access to HMO-level care when residing outside of California. This program is particularly beneficial for students studying out of state, long-term travelers, and families living in different locations. To qualify for this program, members must meet one of the following criteria:
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Long-term traveler: Members or dependents traveling outside their plan’s service area for a minimum of 90 consecutive days, up to a maximum of 180 days, with the intention to return to their permanent residence. This caters to snowbirds, extended vacations, or temporary work assignments.
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Families living apart: This applies when a court order mandates a member to cover a dependent’s medical expenses, and the dependent or custodial parent lives outside the member’s service area. Unlike the long-term traveler category, there is no time limit for this condition, but membership is reviewed annually to ensure continued eligibility.
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Student: Dependents of members who live outside the service area while attending school, but whose primary residence remains the member’s permanent address. Student guest memberships are effective each September for one year and can be renewed annually with a new application for each academic year.
Alt text: Image of a student using a laptop outdoors, representing students eligible for the away from home care program while studying outside their home state.
For benefit coverage under the away from home care program, members or dependents must reside within a Host Plan service area outside California. When utilizing away from home care program services, members will receive the benefits package offered by the Host Plan in their location. This ensures consistent HMO-level care, regardless of location.
To delve deeper into the specifics of this valuable away from home care program, you can download the program flyer. For personalized assistance and answers to specific questions, contact a Customer Service representative at (800) 622-9402. The away from home care program is designed to provide peace of mind, ensuring Blue Shield HMO members have access to quality healthcare, even when life takes them away from home.
