Worldwide Coverage for Foreign and Domestic Travelers

Worldwide Coverage For Foreign and Domestic Travelers Get quality health care no matter Take this reference card with you where you are in the world. when you travel. Whether you’re traveling within the When you need care, you’ll be prepared. ®’ United States or abroad, BlueCard ® and Blue Cross Blue Shield Global Core make sure you have access TEAR HERE to top doctors and hospitals and Urgent Care concierge-level service. 1. Call 1-800-810-BLUE (2583), or visit bcbs.com to find nearby doctors and hospitals anywhere in the world that participate in the Blue Cross Blue Shield network. 2. Show your member ID card when you get care. 3. If you’re admitted, or if you have questions about your coverage, call Member Service at the number on the front of your ID card. Your Passport to Good Health Always carry your Blue Cross Blue Shield of Massachusetts ID card. Call 1-800-810-BLUE (2583) FOLD HERE for a list of participating doctors and hospitals, or to obtain an international Emergency Care claim form. For emergency services, call the local emergency number or go to the nearest hospital immediately. An Association of Independent Blue Cross and Blue Shield Plans

Getting Care in the United States For Inpatient Services: More than 85 percent of all doctors and hospitals in the United • Call the Service Center at 1-800-810-BLUE (2583), or States participate in the BlueCard program. If you need care outside Member Service at the number on your ID card, for your plan’s service area, call 1-800-810-BLUE (2583), or visit precertification or preauthorization bcbs.com to find a doctor near you. Be sure to show your ID card • In most cases, all you pay is the copayment, co-insurance, before you receive service. or deductible When you get service: • The hospital should submit the claim on your behalf • There’s no paperwork For Outpatient Services: • Participating doctors and hospitals submit claims for you • Show your ID card • All you pay is the copayment, co-insurance, or deductible • Pay the doctor or hospital • If you receive care from a non-participating doctor or hospital, ® Core International Claim • Fill out a Blue Cross Blue Shield Global you may need to pay for the services up front and submit a claim form for reimbursement (Call 1-800-810-BLUE (2583) or visit for reimbursement bcbsglobalcore.com for the form) BlueCard PPO Members Only: If you see this symbol, , • You’re only responsible for copayments, co-insurance, or on your ID card, you’re a BlueCard PPO member. To save the deductible when seeing in-network doctors and hospitals most money when getting service, use a participating BlueCard • You’ll pay more when seeing out-of-network doctors and hospitals PPO doctor or hospital. In Case of Emergency Doctors and Hospitals In most cases, participating doctors and hospitals will file the claim For emergency services, call the local emergency number for you. If they need information about eligibility or your coverage, or go to the nearest hospital immediately. have them call 1-800-676-BLUE (2583). Getting Care Outside the United States Your Member Responsibilities ® The Blue Cross Blue Shield Global Core network gives you access As a Blue Cross Blue Shield of Massachusetts member, you’re to doctors and hospitals around the world. If you need care, call the still responsible for any copayments, co-insurance, deductible, Service Center at 1-800-810-BLUE (2583), or call collect at or non-covered services. For out-of-country services, Blue Cross 1-804-673-1177, 24 hours a day, 7 days a week. An assistance Blue Shield of Massachusetts payments will be based on the coordinator, along with a medical professional, will arrange a provider’s charge. doctor’s appointment or hospitalization if necessary. You can also visit bcbsglobalcore.com. TEAR HERE An Association of Independent Blue Cross and Blue Shield Plans FOLD HERE Primary Care Provider’s Name: Blue Cross Blue Shield of Massachusetts complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, Doctor’s Phone: sexual orientation, or gender identity. ATTENTION: If you don’t speak English, language assistance services, free of charge, Doctor’s Hospital Affiliation: are available to you. Call Member Service at the number on your ID Card (TTY: 711). ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. Your Blue Cross Blue Shield Member ID: Llame al número de Servicio al Cliente que figura en su tarjeta de identificación (TTY: 711). ATENÇÃO: Se fala português, são-lhe disponibilizados gratuitamente serviços de assistência de Member Service Phone Number (from your ID card): idiomas. Telefone para os Serviços aos Membros, através do número no seu cartão ID (TTY: 711). ® Registered Marks of Blue Cross and Blue Shield Association. ®´ Registered Marks of the Blue Cross and Blue Shield Association. © 2018 Blue Cross and Blue Shield of Massachusetts, Inc., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. 182617M 32-5585 (02/18)