Am I covered overseas?
Yes, your Service Benefit Plan coverage protects you around the world. Benefits for covered services under both Standard and Basic Option are paid at the Preferred level. Physician care performed outside the U.S. is paid at the Preferred level using an Overseas Fee Schedule or a provider negotiated amount. You may be responsible for differences between our payment and the provider charge since overseas providers do not agree to accept our payment as payment in full in all cases. See Section 5(i) in the Service Benefit Plan brochure for more information about how benefits are paid for care performed overseas.
How do I file a claim?
You can file your Overseas claims by completing your claim form online through your MyBlue account or by mailing or faxing your claim. You can also file your claim online using MyBlue.
How do I file a claim online?
Filing your Overseas Medical and Pharmacy claims online will provide faster processing and rapid claims payment. Submitting your Overseas Medical and Pharmacy claims online is easy. Just follow these simple steps to access MyBlue and set up or sign in with your username and password and you will be ready to get started.
- To register, go to MyBlue, and click on the 'Sign Up' link.
- Follow instructions under Get Going with MyBlue member registration and click the orange submit link.
- You will then be taken back to MyBlue where you can log in using your new username and password. That’s it!
Once you have signed in or registered click on the “Submit an Overseas claim” link on MyBlue.
How do I file a claim by mail or fax?
You can find our Overseas Medical Claim Form and the Retail Prescription Drug Overseas Claim Form in the forms library, or you can call 1-888-999-9862 to request that we send you some claim forms.
If you access a claim form on our web site, you can enter the information directly on the claim form; print a copy to send to us and save a copy for your records.
In most situations, you will need to pay the provider up front and submit a completed Overseas Claim Form and itemized bills to us at Federal Employee Program, Overseas Claims, P.O. Box 261570, Miami, FL 33126. You may also fax your claims to us at 001- 410-781-7637 (or 1-888-650-6525 toll-free). Payment for covered services will be sent to you. If the provider does not require payment at the time the care is performed, you may request we pay the provider directly by filling out 6B of the claim form and leaving 6 and 6A blank. Send the claim form along with the itemized bills from the provider to the address or fax number listed above and on the back of the claim form. Box 4 must include the diagnosis or reason for the services in order to process your claim.
To file a claim for covered drugs and supplies you purchase from pharmacies outside of the United States, Puerto Rico, and the U.S. Virgin Islands, send a completed FEP® Retail Prescription Drug Overseas Claim Form, along with itemized pharmacy receipts or bills to Blue Cross and Blue Shield Service Benefit Plan Retail Pharmacy Program P.O. Box 52057, Phoenix, AZ 85072-2057, or fax your claim to 001-480-614-7674.
How do I fax overseas claims to a toll free number?
There is a two step process for faxing claims to our toll free number in the United States from most overseas locations.
- The international caller first dials the AT&T Direct Access Code for the country from which they are faxing.
- The caller will hear a recording asking them to enter the U.S. toll free number they want to fax. A "1" is not required before the toll free number.
AT&T has a dialing guide and a list of access codes available at
What is an itemized bill?
An itemized bill must be on the provider’s letterhead or the equivalent and must include:
- Name of the patient
- Name and address of person or firm providing the service or supply
- Date for each service or supply
- Type or description for each service or supply
- The diagnosis for each service or supply
- The charge for each service or supply
Please note, we cannot accept a statement of account or a payment reminder as an itemized bill. To be considered valid and itemized, the bill must include the information listed above.
Why was my claim returned to me?
We need certain information in order to determine benefits and therefore, properly process your claim under the Service Benefit Plan. When we do not have the necessary information, it will delay the processing of your claim while we try to obtain it from you. Listed below are some commonly omitted items which cause claim delays. We hope that providing this information to you will enable us to serve you better by reducing delays.
Commonly MISSING items on the Overseas Medical Claim Form and/or the provider’s bill include:
- Diagnosis or reason for treatment
- Accident date or date of onset of injury
- Patient’s complete name on both bill and claim form
- U.S. brand name (or generic equivalent) for drugs purchased - if you do not have this information, please provide the insert that comes with the drug (usually a white sheet of paper which describes the drug )
- Description of medical or dental services performed
- Description of surgical procedure performed
- Length of time patient was anesthetized
- Signature of the patient or subscriber
- Dates of service - a range of dates, such as indicating “10 visits between January and March”, is not sufficient. We must have each individual date that medical service was provided. We also need to have inpatient dates of service when you are hospitalized.
How do I receive reimbursement?
If you would like a wire transfer or payment in a foreign currency for your medical claims, be sure to follow the directions, and fill out boxes 6 and 6A on the Overseas Medical Claim Form. Please note the wire transfer or a check in the local currency may take longer to process than a paper check in U.S. dollars. If you do not request these options, payment will be made by check in U.S. dollars.
Payments for covered drugs and supplies you purchase from pharmacies outside of the United States and Puerto Rico will only be made by check in U.S. dollars.
Note concerning the Authorization For Assignment of Benefits section on the claim form - Please remember that if you would like to have our payment assigned (made payable to the provider of service), item 6B, which is the Authorization for Assignment of Benefits section on the Overseas Medical Claim Form, must be completed in its entirety.
What if my claims are in a different language and currency?
That is not a problem. When your claim is received, we will do the translation and currency conversion. The currency conversion is based on the date of service or the date you paid the bill, if you provide that information. For the most accurate currency conversion, please provide us a receipt with the date the bill was paid, the amount you paid and the exchange rate used, if available.
What if I have Medicare or supplemental travel insurance?
Medicare does not provide benefits for care performed outside the U.S. Therefore, if you have Medicare as your primary insurer and services were rendered outside the United States and U.S. Territories, there is no need to send your claim first to Medicare. Please send the completed claim form and itemized bills to us. We will consider benefits at 100% of our plan allowance.
If you choose a supplemental insurance plan to cover you while overseas, we will remain the primary insurance. This means that you will submit any claims for medical care to us first.
Do I have benefits for evacuation?
Our Worldwide Assistance Center offers emergency evacuation services only to the nearest facility that is adequately equipped to treat your condition. Benefits are not available to transport you to a facility in the United States unless it is the closest facility that can provide adequate treatment. Benefits are not available for evacuation in the event of a natural disaster.
Does Caremark send drugs overseas?
If you have Standard Option, your coverage includes our Mail Service Pharmacy benefit. You can order prescription drugs through the Mail Service Pharmacy if your address has a U.S. zip code, and the prescribing physician is licensed in the U.S. We suggest you contact Caremark directly to ensure your specific drug can be mailed overseas. You may contact them by calling (800)-262-7890 or by writing to them at Caremark, P.O. Box 52057, Phoenix, AZ 85072-2080. You may be eligible for an extended filling of the prescription from Caremark while overseas or before going overseas, so you may also want to discuss this with Caremark. Please note this will require a prescription from your doctor for 12 months and is not applicable for controlled substances.
What if I need to find a provider?
The Worldwide Assistance Center can help you locate a hospital or physician in our network closest to your area. You may also view a list of our network providers on our website.
If you are overseas and need assistance locating providers (whether in our out of network), contact the Worldwide Assistance Center, by calling the center collect at 1- 804-673-1678 or email the Worldwide Assistance Center at firstname.lastname@example.org. Members in the United States, Puerto Rico, or the U.S. Virgin Islands should call 1-800-699-4337 or email the Worldwide Assistance Center at email@example.com.
What types of providers are in your international provider network?
We have a network of participating hospitals overseas, as well as a network of professional providers who have agreed to accept a negotiated amount as payment in full for their services. The Worldwide Assistance Center can help you locate a hospital or physician in our network closest to your area. If you are overseas and need assistance locating providers (whether in our out of network), contact the Worldwide Assistance Center, by calling the center collect at 1-804-673-1678 or email the Worldwide Assistance Center at firstname.lastname@example.org. Members in the United States, Puerto Rico, or the U.S. Virgin Islands should call 1-800-699-4337 or email the Worldwide Assistance Center at email@example.com.
Can I get a printed copy of the Overseas Provider directory?
The Blue Cross and Blue Shield Service Benefit Plan is going even greener with the help of our members. Because of your encouragement, and that of the Office of Personnel Management, FEP we will no longer produce printed Overseas Provider directories. The online provider directory is your best source for provider information. It’s updated frequently and offers detailed, fully searchable information about our overseas network. You can also call the Worldwide Assistance Center to print a list of hospitals and providers in your area. If you are overseas, please call 1-804-673- 1678. Members in the United States, Puerto Rico, of the U.S. Virgin Islands should call 1-800-699-4337.
How can I get a directory if I don’t have a computer?
If you don’t have internet access, please contact the Worldwide Assistance Center to locate a hospital or physician in your area. If you are overseas, please call the center collect at 1-804-673-1678. Members in the United States, Puerto Rico, or the U.S. Virgin Islands should call 1-800-699-4337 or email the Worldwide Assistance Center at firstname.lastname@example.org.
My provider is not listed in the directory. Do I need to change providers?
You can maintain your existing provider relationship. You can confirm your out-of-pocket costs by calling the Worldwide Assistance Center. If you are overseas, please call the center at 1-804-673-1678. Members in the United States, Puerto Rico, or the U.S. Virgin Islands should call 1-800-699-4337.
Can my provider join AXA’s network?
The Blue Cross and Blue Shield Service Benefit Plan is committed to expanding our Overseas Provider network. If you would like to nominate your doctor, please complete a Provider Nomination Form and email your form to email@example.com, or fax to 305-893-5055, Attn. International Medical Network. Click the link to download and save the form to your computer.
Is precertification required when a member is hospitalized?
No, precertification is not required for inpatient services provided outside the U.S.
Will I be expected to pay out-of-pocket for inpatient care?
If the member is hospitalized at a participating facility, our Worldwide Assistance Center will arrange for cashless access to set up direct billing and payment to the provider. When cashless access is arranged, you will not pay upfront for medical services. You will only pay the usual out-of-pocket expenses, such as deductible, coinsurance and copayment amounts. If you are hospitalized at a non-participating hospital, our Worldwide Assistance Center will try to negotiate this same cashless access but may not get the hospital to agree. In this case, you may be required to pay a deposit at the time of admission and all charges upon discharge. To request help with this type of care, contact our Worldwide Assistance Center directly at 800-699-4337 if you are in the U.S. or collect at 804-673-1678, if you are calling from outside the U.S.
I am a Standard Option member who lives in Germany, how does that affect delivery of my drugs through the mail?
Effective December 4, 2012, Caremark cannot accept orders through their mail order or specialty pharmacy for members with APO and FPO shipping addresses in Germany, due to changes in German law. Standard Option members must obtain their prescriptions at a local German pharmacy and submit the claim for reimbursement. Standard Option members will be charged the lesser of their mail order or retail cost share or, for specialty drugs, the lesser of their specialty or retail cost share when submitting paper claims for covered drugs obtained at a local retail pharmacy in Germany on or after December 4, 2012. Claims should be submitted by fax to 001-480-614-7674 or online for reimbursement. Members residing in Germany with DPO military addresses may continue to receive delivery of mail order and specialty drugs through CVS Caremark.