Common use of Health Care Services Furnished Outside of Massachusetts Clause in Contracts

Health Care Services Furnished Outside of Massachusetts. Blue Cross and Blue Shield has a variety of relationships with other Blue Cross and/or Blue Shield Licensees referred to generally as “Inter-Plan Programs.” Whenever Members access health care services outside of Massachusetts, the claim for those services may be processed through one of these Inter-Plan Programs and presented to Blue Cross and Blue Shield for payment in compliance with the Inter-Plan Programs policies then in effect. The Inter-Plan Programs available to Members under this Agreement are described generally below. Typically, Members accessing care outside of Massachusetts obtain care from providers that have a contractual agreement (that is, are “participating providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (Host Plan or local Blue Cross and/or Blue Shield Plan). In some instances, Members may obtain care from non-participating providers. Members’ health care benefits for participating and non-participating providers are fully described in the Subscriber Certificates for your benefits plans.