Coverage for Services Provided Outside of the Service Area Sample Clauses

Coverage for Services Provided Outside of the Service Area. (BlueCard) Overview We have a variety of relationships with other Blue Cross and/or Blue Shield Plans and their Licensed Controlled Affiliates (“Licensees”). Generally, these relationships are called “Inter- Plan Arrangements.” These Inter-Plan Arrangements work based on rules and procedures issued by the Blue Cross and Blue Shield Association (“Association”). Whenever you obtain healthcare services outside of our service area, the claims for these services may be processed through one of these Inter-Plan Arrangements. When you receive care outside of our service area, you will receive it from one of two kinds of providers. Most providers (“participating providers”) contract with the local Blue Cross and/or Blue Shield Plan in that geographic area (“Host Blue”). Some providers (“nonparticipating providers”) don’t contract with the Host Blue. We explain below how we pay both kinds of providers. We cover only limited healthcare services received outside of the Network Blue New England service area. As used in this section, “Out-of-Area Covered Healthcare Services” include the following services obtained outside the geographic area we serve: Emergency care (Emergency Room Services and Ambulance Services); services for which we specifically approve the use of a nonparticipating provider; and otherwise, as required by law. Any other services will not be covered when processed through any Inter-Plan Arrangements unless authorized by us. Inter-Plan Arrangements Eligibility – Claim Types All claim types are eligible to be processed through Inter-Plan Arrangements, as described above, except for Dental Care Benefits, and those Prescription Drug Benefits or Vision Care Benefits that may be administered by a third party contracted by us to provide the specific service or services. BlueCard® Program Under the BlueCard® Program, when you receive Out-of-Area Covered Healthcare Services within the geographic area served by a Host Blue, we will remain responsible for doing what we agreed to in the agreement. However, the Host Blue is responsible for contracting with and generally handling all interactions with its participating providers. The BlueCard Program enables you to obtain Out-of-Area Covered Healthcare Services, as defined above, from a healthcare provider participating with a Host Blue, where available. The participating provider will automatically file a claim for the Out-of-Area Covered Healthcare Services provided to you, so there are no claim forms for you t...