Take Your Coverage With You When You Travel Or Live Overseas

When you travel outside the United States, you know it’s important to take your passport with you. You also need to take your Service Benefit Plan ID card – your passport for getting medical care when you travel or live outside the United States.

Benefits under your Service Benefit Plan coverage are available when you travel or live overseas. However, since benefits are paid a bit differently than in the United States, here are some things you should know.

Help Is Available

You are not alone when you travel outside the United States. Help is available from our Worldwide Assistance Center, online, and from CareFirst BlueCross BlueShield.

The Worldwide Assistance Center is staffed with representatives trained to help our members who travel overseas. The Center is available 24 hours a day, 365 days a year, to help you with any problems you may have getting the right medical care overseas. You can plan for the unexpected before you leave by calling the Center toll free at 1.800.699.4337. You can also call collect from outside the United States and Puerto Rico at 804.673.1678, using the appropriate AT&T overseas calling codes, if you need assistance once you reach your destination. In addition, you can email the Worldwide Assistance Center at FEPOverseas@worldaccess.com.

The Worldwide Assistance Center can help you in many ways. First, it can help you locate providers outside the United States. Second, if you need help communicating with health care professionals who do not speak English, the Center has multilingual operators that can provide assistance. Third, the Center can arrange for emergency evacuation services to the nearest medical facility to adequately treat your condition.

You can also find information about overseas health care and providers online on this web site in our Benefits section under 2008 Overseas Benefits. This will give you access to 2008 Benefits and Provider information, as well as to the 2008 Overseas Fee Schedule. The 2008 Benefits and Provider Information feature will link you to a special web site for our overseas members. You can look up providers where you are traveling or living, check out benefits, and also look at specific information about where you will be staying.

CareFirst BlueCross BlueShield will handle any benefits or claims questions you may have about overseas medical care. You can call the Plan at 1.888.999.9862, using the appropriate AT&T overseas calling code. Or you can email the Plan using the Customer eService feature on our homepage.

What Do We Pay?

As we said above, benefits are paid a little differently than when you receive care in the United States. Please refer to Section 5(i) in the Service Benefit Plan brochure for more information.

Here are some things to keep in mind when you need medical care overseas.

1. There are no Preferred providers outside the United States. So the Basic Option provision that you must use Preferred providers is waived for care performed overseas.

2. Precertification of hospital admissions is not required when you are admitted to a hospital overseas.

3. Prior approval of certain services required under your Service Benefit Plan coverage does not apply when the care is provided overseas. See Section 3 of the 2008 Service Benefit Plan brochure for information about prior approval.

Facility Care:

Under both Standard and Basic Options, benefits for inpatient and outpatient care are paid at the Preferred level. If you have Standard Option, you are responsible for any amounts applied to the calendar year deductible.

Professional Care:

Benefits under Standard Option and Basic Option are paid at the Preferred level using the Overseas Fee Schedule as our Plan allowance. You are responsible for any non-covered services under both options. In addition, you are responsible for any amounts applied to the deductible (Standard Option), and any coinsurance and copayment amounts. Since we do not have agreements or contracts with professional providers overseas, you are responsible for any difference between our payment and the provider’s charge. A copy of the Overseas Fee Schedule is available on this web site.

Dental Care:

Standard Option benefits for covered dental services are described in Section 5(h) of the Service Benefit Plan brochure. You are responsible for any difference between our payment and the provider’s charge. If you have Basic Option coverage, you pay the $20 copayment for covered services plus any difference between our payment and the provider’s charge. Under both options, you are responsible for any non-covered services.

Prescription Drugs:

To be eligible for Service Benefit Plan benefits, drugs you purchase while traveling or living overseas must be the equivalent to drugs that by Federal Law in the United States require a prescription for purchase. You can use Internet pharmacies under both Standard and Basic Option to purchase your prescription drugs. Under Standard Option, you can also use the mail service pharmacy if your address includes a United States zip code, such as an APO or FPO address, or you live in territories of the United States. The prescribing physician must be licensed in the United States or Puerto Rico.

How To File A Claim

In the United States, most providers will file the claim for you and bill you for any balances after our payment is made. Unfortunately, this is not true of providers outside the United States. You may have to file the claim for your medical care. In addition, you may have to pay for the care at the time of service and we will send the benefits payment to you. The Worldwide Assistance Center can help you discuss the claims filing process with providers overseas.

A copy of the overseas claim form is available in English and Spanish under the Contact Us & Forms feature on this web site. You can print the form, complete it, attach the appropriate itemized bills and send it to:

Mailroom Administrator
FEP Overseas Claims
P.O. Box 14113
Lexington, KY 40512-4113
USA

We provide translation and currency conversion services for these claims.

Prescription drug claims should be submitted to the retail pharmacy program. There is a special overseas retail pharmacy claim form under Contact Us & Forms. Again, you print the form, complete it, attach your itemized bills and send it to:

Blue Cross and Blue Shield Service Benefit Plan
Retail Pharmacy Program
P.O. Box 52057
Phoenix, AZ 85072-2057
USA

Translation and currency conversion services are provided for drug claims as well.

You are prepared for any unexpected medical expenses when you carry your Service Benefit Plan ID card with you when you travel, in the United States or overseas. The Worldwide Assistance Center and CareFirst BlueCross BlueShield are available to assist you before you leave and while you are away.

Written by Paula Spurway, Blue Cross and Blue Shield Association. Originally published in January 2008. Resource: 2008 Blue Cross and Blue Shield Service Benefit Plan brochure (RI 71-005).