What is BlueCard coverage?
The BlueCard® Program gives access to covered services when you and your family are away from home.
For most Individual and Family plans, both PPO and Trio HMO, covered services while traveling outside California are limited to:
- Emergency care: Care for an illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid severe harm.
- Urgent care: Care for an illness, injury, or condition serious enough to seek care right away but not so severe it requires emergency room care.
- Follow-up care: If the emergency room or urgent care doctor asks you to come back for a follow-up visit within 10 days of initial visit, then this is considered follow-up care.
Any other services received outside California are not covered.
If you have a grandfathered plan that was purchased prior to or on March 23, 2010, then covered services include the above, plus routine services as defined in your plan’s Evidence of Coverage.
Will my prescription drug benefits be impacted?
Prescription drug benefits are not impacted. Covered prescriptions may continue to be filled at participating pharmacies while traveling outside of California.
Am I able to obtain a prior authorization for a non-emergency or non-urgent care visit?
No. BlueCard coverage for members with an Individual and Family plan is limited to emergency or urgent care services and some follow-up care related to this initial emergency or urgent care visit. Other non-emergency and non-urgent visits outside of California are not covered.
I have a student living in another state. How does this change impact his or her care?
With your PPO or Trio HMO plan, your eligible dependents who are studying outside of California are still covered for emergency and urgent care services as well as some follow-up care visits related to the initial emergency or urgent care visit out of state. Routine preventive visits, such as an annual physical or immunizations, and other non-emergency or non-urgent visits are covered only when received within your plan’s local service area in California. To save money with a PPO plan, you should choose network providers. For Trio HMO members, routine visits must be provided by your primary care physician.
Students can choose to receive non-emergency and non-urgent care outside of California, for example, at their school’s health center, but will pay the entire cost out of pocket. To save on costs, students can plan routine visits with covered providers in California while home during school breaks.
How do I use BlueCard in the United States?
If you need assistance finding a doctor or hospital in the United States, Puerto Rico, or U.S. Virgin Islands, you should call the service center at (800) 810-BLUE (2583) or visit provider.bcbs.com.
When you see a BlueCard network provider outside of California, you will be responsible for any copayments, coinsurance, and deductibles as noted in your plan’s Summary of Benefits. The BlueCard network provider will submit a claim for you.
If you see an out-of-state provider who does not participate in the BlueCard network, you will have to pay the entire bill up front and then submit a claim yourself to Blue Shield of California for reimbursement.
Covered services from out-of-state, non-network providers may be reimbursed up to the negotiated rates, depending on your benefits and the services provided. You will be responsible for any costs above the negotiated rates (or allowable amount). Be sure to keep a copy of all records, such as a receipt and medical records, to submit with your claim.
For more details about claims for BlueCard, please review your Evidence of Coverage and Health Services Agreement.
How do I use BlueCard when I travel internationally?
For international travel, you can use Blue Shield Global Core. If you need assistance finding a doctor or hospital outside the United States, you should call the service center at (804) 673-1177, 24 hours a day, seven days a week. Provider information is also available at bcbsglobalcore.com.
When you receive care from providers outside the United States, you will typically have to pay the providers and submit the claims yourself to get reimbursed for covered services. Learn more at bcbsglobalcore.com.
I live in a city near the border of California and my PCP or specialist is located in the neighboring state. Can I still receive covered services from providers even if they’re out of state?
You can use the Find a Doctor tool to search for network providers in your area, including in neighboring border cities outside of California. The search results will display providers who have negotiated contracts with Blue Shield of California. If you see a network provider who has contracted rates with Blue Shield of California but is located outside of California in a neighboring border city, you can continue to receive covered services from this provider as a network benefit. Please ensure your network provider bills Blue Shield of California directly and not through the BlueCard program. If your network provider bills through BlueCard, the service will be denied.
Additionally, if you are referred to another provider in the out-of-state neighboring city who does not have a negotiated contract with Blue Shield of California, then that service will not be covered unless it is an emergency, urgent, or related follow-up care visit as this situation falls under the BlueCard program. For non-emergency and non-urgent care, you will need to seek care from a network provider instead.
How can I learn more about using Teladoc or NurseHelp when out of state?
View other ways to access care especially when you’re traveling out of state.