Blue Cross Blue Shield Global Core Program Clause Samples
The Blue Cross Blue Shield Global Core Program clause defines the terms under which insured individuals can access healthcare services while traveling or residing outside their home country. It typically outlines the process for finding participating providers abroad, submitting claims for international medical expenses, and any requirements for pre-authorization or emergency care. This clause ensures that policyholders maintain access to necessary medical care globally, addressing the challenge of healthcare coverage continuity during international travel or relocation.
Blue Cross Blue Shield Global Core Program. If you are outside the United States, (the Commonwealth of Puerto Rico and the U.S. Virgin Islands) (hereinafter: “Blue Cross Blue Shield Global Core Service Area”), you may be able to take advantage of the Blue Cross Blue Shield Global Core Program when accessing Covered Healthcare Services. The Blue Cross Blue Shield Global Core Program is unlike the BlueCard Program available in the United States, the Commonwealth of Puerto Rico and the U.S. Virgin Islands in certain ways. For instance, although the Blue Cross Blue Shield Global Core Program assists you with accessing a network of inpatient, outpatient and professional providers, the network is not served by a Host Blue. As such, when you receive care from providers outside the United States, the Commonwealth of Puerto Rico and the U.S. Virgin Islands, you will typically have to pay the providers and submit the claims yourself to obtain reimbursement for these services. • Inpatient Services In most cases, if you contact the Blue Cross Blue Shield Global Core Service Center for assistance, hospitals will not require you to pay for covered inpatient hospital services, except for their any cost sharing you may owe. In such cases, the Blue Cross Blue Shield Global Core Program contracting hospital will submit your claims to the Blue Cross Blue Shield Global Core Service Center to initiate claims processing. However, if you paid in full at the time of service, you must submit a claim to obtain reimbursement for Covered Services. You must contact us to obtain Precertification for non-emergency inpatient services. • Outpatient Services Physicians, urgent care centers and other outpatient providers located outside the Blue Cross Blue Shield Global Core Service Area will typically require you to pay in full at the time of service. You must submit a claim to obtain reimbursement for Covered Healthcare Services. • Submitting a Blue Cross Blue Shield Global Claim When you pay for Covered Services outside the Blue Cross Blue Shield Global Core Service Area, you must submit a claim to obtain reimbursement. For institutional and professional claims, you should complete a Blue Cross Blue Shield Global Core claim form and send the claim form with the provider’s itemized bill(s) to the Blue Cross Blue Shield Global Core Service Center (the address is on the form) to initiate claims processing. The claim form is available from us, the Blue Cross Blue Shield Global Core Service Center or online at ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇. I...