Services Received Outside Of North Carolina. BCBSNC 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 the geographic area BCBSNC serves, the claim for those services may be processed through one of these Inter-Plan Programs and presented to BCBSNC for payment in accordance with the rules of the Inter-Plan Programs Policies then in effect (“Policies”). Typically, Members, when accessing care outside the geographic area BCBSNC serves, obtain care from healthcare Providers that have a contractual agreement (i.e. are “participating Providers”) with the Host Blue. In some instances, Members may obtain care from non-participating healthcare Provider. BCBSNC’s payment practices in both instances are described below.
1. Blue Card® Program Under the Blue Card® Program, when Members receive covered health care services within the geographic area served by a Host Blue, BCBSNC will remain responsible to the Group for fulfilling BCBSNC’s contract obligations. However, in accordance with applicable Inter-Plan Programs policies then in effect, the Host Blue will be responsible for providing such services as contracting and handling substantially all interactions with its participating Providers. The financial terms of the Blue Card Program are described generally below. Individual circumstances may arise that are not directly covered by this description; however, in those instances, BCBSNC’s action will be consistent with the spirit of this description.
Services Received Outside Of North Carolina. BCBSNC 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 the BCBSNC service area, the claim for those services may be processed through one of these Inter-Plan Programs and presented to BCBSNC for payment in accordance with the rules of the Inter-Plan Programs policies then in effect. The options for care are as follows: • Members may obtain care from non-BCBSNC service area healthcare providers that have a contractual agreement (i.e. “participating providers”) with the Host Blue. • Members may obtain care from a non-BCBSNC service area non-participating healthcare provider(s). These “non-participating providers” do not have a contractual agreement with the Host Blue. The BCBSNC payment practices for the above two options for care are discussed below. limited services are described elsewhere in the Benefit Booklet and/or Plan Sponsor, Plan Administrator, and/or Group Health Plan summary plan description.
