You can get access to covered services wherever you are, including urgent and emergency services, through the BlueCard and Away From Home Care programs.
BlueCard Program
As a Blue Shield member, you have access to coverage through the BlueCard® Program, no matter where you live or travel. Providers in more than 200 countries belong to the Blue Shield Global Core network, and 85% of providers in the United States belong to BlueCard's national network.
For PPO, POS, or Active Choice plan members
If you're a member of our PPO plan (including Shield SavingsSM), Point of Service plan (POS), or Active Choice® plan, you may use the BlueCard Program for access to covered benefits, except dental and vision care, and prescription drugs. For more information on covered services, please refer to your Evidence of Coverage (EOC) or Certificate of Insurance (COI) booklet, or call the Customer Service number that appears on your Blue Shield ID card.
You will need to get prior authorization for certain services, including inpatient surgeries, hospital stays, and outpatient surgeries. Your EOC or COI booklet shows all services requiring prior authorization.
For Blue Shield HMO members
HMO plan members have coverage for emergency and urgent care services, or authorized medical follow-up care, when they are out of their HMO service area. In case of a life-threatening emergency, call 911 if you are in the U.S., or go immediately to the nearest medical facility, and then get the necessary authorization when it's possible for you to do so.
For more information on all covered services, please refer to your EOC booklet, or call the Blue Shield Member Services number on your member ID card.
Finding a doctor
To locate a provider, go to Find a Doctor and select the Providers Outside of California link under Accessing Care Outside CA. This takes you to the National Doctor and Hospital Finder on the BlueCard Program's website. Or, you can call Blue Shield Global Core Service Center at (800) 810-BLUE (2583), seven days a week, 24 hours a day.
Accessing your coverage
When seeing a BlueCard provider, all you have to do is show your Blue Shield member ID card to any participating provider or hospital. Your member ID number identifies your Blue plan and helps providers process your BlueCard claims.
Claims and payments
A BlueCard provider may request that you pay your regular copayment or any remaining deductible at the time of service. Your claim will be paid directly to the local participating BlueCard provider. We'll send you an Explanation of Benefits, which details what Blue Shield paid on your behalf. If you get care from a BlueCard provider, you don't need to send us your bill.
If you have any questions, you can check your claim status on blueshieldca.com. Or, call Blue Shield Customer Service at the phone number on your member ID card.
Travel outside the United States
It's easy to find a BlueCard provider outside the United States. You can find providers in or near your destinations by going to Find a Doctor and selecting the Coverage Outside U.S. link under Accessing Care Outside CA to connect to Blue Shield Global Core. Or, you can call the Blue Shield Global Core Service Center at (800) 810-BLUE (2583) from within the United States. If you're already outside the country, call collect at (804) 673-1177.
In the event that there are no BlueCard providers in the country you're visiting, go to any provider, pay directly for your healthcare services, and then submit the bill to us for reimbursement. All international claims should be submitted to us within one year from the date of service. You can download an international claim form on blueshieldca.com.
For more information about this benefit, download our program flyer or refer to your EOC or COI booklet for more information.
Away From Home Care Program for HMO members
By using the Away From Home Care Program, members and their dependents can access HMO care when they reside outside of California, providing students, long-term travelers, and families living apart convenience and flexibility. Members must meet one of these criteria to qualify:
- Long-term traveler: A member or covered dependent who travels outside the plan's service area for a minimum of 90 consecutive days, but no more than 180 days, and returns to their permanent residence.
- Families living apart: Applies when a member is required by court order to take responsibility for a dependent's medical coverage, and the custodial parent or dependent child lives outside the member's plan service area. There is no time limit on this condition, however this membership is subject to annual reviews.
- Student: A member's dependent who lives outside the plan's service area to attend school, but whose principal residence is still the member's permanent residence. Student guest memberships are effective in September for one year, however students may extend guest membership benefits for subsequent school years by completing a new application.
To receive benefit coverage, members or their dependents living outside California must live in a Host Plan service area. Members using Away From Home Care services outside California will receive the benefits offered by the Host Plan in the state they are visiting.
To learn more about this program, download our flyer or speak with a Customer Service representative by calling (800) 622-9402.
