- What’s New in 2013?
- When You Live or Travel Overseas
- Overseas Assistance Center
- How Benefits Work Overseas
- Filing Claims
- 2013 Standard Option and Basic Option Benefit Comparison Chart (Services provided Overseas)
On January 1, 2013 AXA Assistance will replace Allianz Global Assistance (formerly Mondial Assistance) as the new overseas medical assistance vendor.
Founded in 1959, AXA Assistance is one of the world’s leading assistance providers, with service centers that provides 24/7 access covering 32 countries more than six million health contacts annually. AXA Assistance’s parent organization, AXA Group, serves more than 50 million clients worldwide as one of the world’s largest and fastest-growing insurance and wealth management organizations. As a division of this international financial services company, AXA Assistance benefits from the global insight and expertise of AXA Group, which operates in more than 80 countries on six continents.
AXA Assistance is one of the first assistance companies to open its doors to travelers and those seeking assistance in the areas of healthcare. AXA Assistance has been located in the United States since 1983. It is headquartered in Chicago, Illinois.
There are no changes to the service benefit plan overseas medical assistance core program. The program will continue to provide support services outside the United States, Puerto Rico and U. S. Virgin Islands. AXA Assistance will continue to offer a robust provider network that is comprised of inpatient/outpatient facilities and professional providers. In addition to the provider network the overseas program will provide FEP members with medical and dental referrals, medical case monitoring by AXA’s staff physicians, emergency evacuations, claims and customer service support, online provider directory and security and health alerts customized by country.
Allianz Global Assistance will continue to service FEP members living outside of the United States, the Virgin Islands and Puerto Rico through December 31, 2012.
For answers to additional questions about the move to AXA Assistance, please click here.
If you need medical care outside the United States, you can be assured that your Blue Cross Blue Shield Service Benefit Plan ID card entitles you to world class service. Your Service Benefit Plan coverage protects you around the world.
Our Overseas Assistance Center offers help when you are traveling outside the US, Puerto Rico and the US Virgin Islands. 24 hours a day, seven days a week. Bilingual operators are also available to help you.
The Center can help you locate a provider and you can call the Center collect at 804.673.1678 or email the center at email@example.com for assistance.
Inpatient Hospital Care: Under both options, benefits are paid at the Preferred level. Precertification is not required for hospital admissions outside the US.
Outpatient Hospital Care: Benefits under Standard and Basic Option are paid at the Preferred level.
Physician Care: Physician care and care by other covered professional providers performed outside the US are paid at the Preferred level using a customary percentage of the billed charge or a provider negotiated amount.
Prescription Drugs: Drugs and medications that require a prescription overseas may differ from those that require a prescription in the US. Drugs purchased outside the US must be an equivalent product that by US Federal law require a prescription for purchase in the US or there must be clinical evidence that prescribing the drug is consistent with the standard of medical practice in that country.
- Standard Option members can order prescription drugs through the Mail Service Pharmacy if your address has a US zip code and the prescribing physician is licensed in the US.
- For both Standard and Basic Option, if you purchase a prescription drug at a local pharmacy outside the US, you pay for the medication and then file a claim for reimbursement. Payment will be made at the Preferred level.
Members can mail claims to us, fax them to us or submit claims for medical care performed and prescription drugs purchased overseas through MyBlue Portal. For information about mailing and faxing claims to us see Section 5(i) in the Service Benefit Plan brochure.
To submit your claims electronically:
- Go to MyBlue Portal and log-in if you have already registered. If not, you will have to set up a MyBlue account.
- On the MyBlue Welcome page, select Submit Overseas Claims Online.
- Follow the step-by-step directions to submit the claim, including completing the fillable claim form PDF, scanning your bills, and uploading the files.
You can also take advantage of bank wire payment and get your payment faster for overseas medical claims. You can select to have the wire payment in a foreign currency or US dollars. Just complete Section 6 of the online overseas medical claim form to select wire payments and the currency you prefer.
Payments for covered drugs and supplies you purchase from pharmacies outside the U.S., Puerto Rico, and the U.S. Virgin Islands can only be made by check in US dollars.
Certain deductibles, copayments and coinsurance amounts do not apply if Medicare is your primary coverage for medical services (it pays first). PPA = Preferred Provider Allowance | MAC = Maximum Allowable Charge
|WHAT YOU PAY WHEN YOU USE PREFERRED PROVIDERS|
|BENEFIT||2013 STANDARD OPTION COVERAGE||2013 BASIC OPTION COVERAGE|
|Surgical Services||Subject to $350 calendar year deductible. 15% PPA.||$150 copayment per surgeon|
|Office visits and outpatient consultations||$20 per visit copayment for primary care provider.
$30 per visit copayment for specialist.
|$25 per visit copayment for primary care provider.
$35 per visit copayment for specialists.
|Routine exams and other preventive care services||Nothing for covered services.||Nothing for covered services.|
|Hospital Inpatient: Precertification required||$250 per admission copayment for unlimited days.||$150 per day up to $750 for unlimited days.|
|Outpatient Facility Care, except physical, occupational and speech therapy||Subject to $350 calendar year deductible. 15% PPA.||$100 per day facility copayment.|
|Mail Service Pharmacy
(For information about Tier 4 specialty drug benefits, see Section 5(f) of the 2013 Service Benefit Plan brochure.)*
|Up to a 90-day supply. Nothing for the first four prescription fills or refills when you switch from certain brand-name drugs to specific generic drugs.
Tier 1 (generics): $15 copayment.
Tier 2 (Preferred brand-name): $70 copayment.
Tier 3 (Non-preferred brand-name): $95 copayment.
|Not a benefit.|
|Specialty Drug Pharmacy Program**||Up to a 90-day supply.
Tier 4 (Specialty): $80 copayment when purchased through our Specialty Drug Pharmacy Program for the first 30 specialty prescriptions filled
|Up to a 34-day supply. 90-day supply for 3 copayments.
Tier 4 (Specialty): You pay a $40 copayment
|Prescription Drugs purchased outside the United States, Puerto Rico, and the U.S. Virgin Islands||Generic drugs: 20%
Brand-name drugs: 30%
|Generic and brand-name drugs: 30%|
|BENEFIT||2013 STANDARD OPTION COVERAGE||2013 BASIC OPTION COVERAGE|
|ACCIDENTAL INJURY/EMERGENCY CARE|
|Accidental Injury Care: Physician and facility care||Nothing for covered charges for services performed within 72 hours of accident.||$125 copayment — emergency room.
$25 copayment — primary care provider.
$35 copayment — specialists.
$50 copayment — urgent care center.
|Medical Emergency Care: Facility care||Emergency Room: Subject to $350 calendar year deductible. 15% PPA.
Urgent Care Center: $40 per visit copayment
|Emergency Room: $125 copayment.
Urgent Care Center: $50 copayment.
|Medical Emergency Care: Physician care||$20 per visit copayment for primary care provider.
$30 per visit copayment for specialist
|$25 per visit for primary care provider.
$35 per visit copayment for specialists
|Routine Dental Care||Benefits paid according to fee schedule in the Service Benefit Plan brochure. Your out-of-pocket costs are limited to the MAC.||$25 copayment per evaluation.|
|CHIROPRACTIC AND OSTEOPATHIC MANIPULATIVE TREATMENT|
|Manipulative Treatment||Up to 12 manipulations per year.
$20 per visit copayment.
|Up to 20 manipulations per year.
$25 per visit copayment.
|Catastrophic Benefits||100% payment level begins after you pay $5000 out-of-pocket in eligible coinsurance and copayment expenses.||100% payment level begins after you pay $5000 out-of-pocket in eligible coinsurance and copayment expenses.|
* Standard Option members may order prescription drugs from the Mail Service Pharmacy only if their address includes a U.S. zip code (such as those with APO and FPO addresses and those in U.S territories) and only if the prescribing physician is licensed in the United States, Puerto Rico, or the U.S. Virgin Islands
**Standard and Basic Option members may order specialty drugs from the Specialty Drug Pharmacy Program only if their address includes a U.S. zip code (such as those with APO and FPO addresses and those in U.S territories) and only if the prescribing physician is licensed in the United States, Puerto Rico, or the U.S. Virgin Islands
Page last updated: March 07, 2013