Coverage for Services Provided Outside of the. Service Area (BlueCard) You may receive covered health care services when you are outside of the geographic area that we service. When you do so, your services will be covered as if you received services from a network provider if the servicing provider participates with the local Blue Cross and Blue Shield plan where the services were provided. You are responsible for copayments, deductibles, and/or the difference between the maximum benefit and the negotiated price, if any. This use of another Blue Cross and Blue Shield regional network is made available through a program called BlueCard. When you obtain health care services through BlueCard outside the geographic area we serve, the amount you pay for covered health care services is calculated on the lower of: • The billed charges for your covered health care services, or • The negotiated price that the on-site Blue Cross and/or Blue Shield plan (“Host Blue”) passes on to us. Often, this "negotiated price" will consist of a simple discount which reflects the actual price paid by the Host Blue. However, sometimes it is an estimated price that factors into the actual price expected settlements, withholds, any other contingent payment arrangements and non- claims transactions with your health care provider or with a specified group of providers. The negotiated price may also be billed charges reduced to reflect an average expected savings with your health care provider or with a specified group of providers. The price that reflects average savings may result in greater variation (more or less) from the actual price paid than will the estimated price. The negotiated price will also be adjusted in the future to correct for over or underestimation of past prices. However, the amount you pay is considered a final price. Statutes in a small number of states may require the Host Blue to use a basis for calculating your liability for covered health care services that does not reflect the entire savings realized, or expected to be realized, on a particular claim or to add a surcharge. Should any state statutes mandate your liability calculation methods that differ from the usual BlueCard method noted above in this section or require a surcharge, we would then calculate your liability for any covered health care services in accordance with the applicable state statute in effect at the time you received your care. Because of the many different arrangements between state Blue Cross and Blue Shield plans and their part...
