Health coverage while traveling - UGA Human Resources

Your UGA health coverage while traveling

(Before you travel, contact Employee Benefits (706-542-2222) to see if details have changed.)

Indemnity | PPO | HMOs | HSA PPO (high deductible)

Indemnity plan:

Under the Indemnity plan, you may go to any doctor or hospital of your choice. However, to avoid balance billing* from providers who are not Blue Cross Blue Shield (BCBS) providers, contact BCBS customer service to find a BCBS provider in the area.

Indemnity within Georgia
For BCBS providers in Georgia, contact BCBS of Georgia (BCBSGA) customer service at 1-800-424-8950. This telephone number is listed on your indemnity plan identification card.

Indemnity outside Georgia
For providers in the BCBS National Provider Network (outside the state of Georgia), contact BCBS Association Customer Service at 1-800-424-8950. This telephone number is listed on your indemnity plan identification card.

Indemnity precertification situations
For services requiring precertification by Blue Cross Blue Shield, regardless of whether you use a BCBS National Participating Provider or a non-participating physician, it is your responsibility to obtain the necessary precertification from Blue Cross Blue Shield for the hospital confinement or for a prescribed outpatient procedure/diagnostic test. You should contact Blue Cross Blue Shield at least 72 hours prior to the scheduled procedure or confinement, unless it is an emergency.

Indemnity international care
If you receive medical care while traveling outside the United States, you must pay the provider at the time medical services are rendered. You will have one year from the date of service to file a paper claim and receive reimbursement from BCBSGA. International care will result in a balance billing* situation.

Indemnity emergency care
If you get an emergency room referral from 24/7 NurseLine, you'll receive a higher level of benefit coverage. Contact 24/7 NurseLine at 1-800-785-0006.

PPO plan:

PPO within Georgia
If you need medical care within the state of Georgia (and in selected areas of the border states surrounding Georgia), in order to get the highest level of benefit coverage, you should visit a Blue Cross Blue Shield of Georgia PPO provider. For information on network providers within the state of Georgia, call Blue Cross Blue Shield at 1-800-424-8950. If you choose to use an out-of-network provider, you still have some benefit coverage, but at a lower percentage. Be aware: Out-of-network services are subject to the “National In-Network/Out-of Network” deductible and balance billing* issues.

PPO outside Georgia
Outside Georgia, in order to receive the highest level of benefit coverage, you should see a provider in the BlueCard National network. For information regarding the BlueCard National PPO Network, call Blue Cross Blue Shield of Georgia Customer Service at 1-800-424-8950. If you choose to use a BlueCard national in-network provider, most eligible services will be covered at 80%. Be aware: Even if you use a national in-network provider, these services are subject to the “National In-Network/Out-of Network” deductible.

PPO out-of-network services
If you choose to use an out-of-network provider, you will have some benefit coverage, but at a lower percentage (most eligible services will be covered at 60%). Be aware: Out-of-network services are subject to balance billing* and to the “National In-Network/Out-of-Network” deductible.

PPO international care
If you receive medical care while traveling outside the United States, you must pay the provider at the time medical services are rendered. You will have one year from the date of service to file a paper claim and receive reimbursement form BCBSGA. Effective January 1, 2009, any out-of-country services will apply to the Georgia in-network benefit level using BlueCard WorldWide. You can find network doctors and hospitals on the BlueCard Worldwide page. Select "BlueCard Doctor and Hospital Finder," accept the terms and conditions, then enter your ID number (on your health card).

Blue Cross Blue Shield members are responsible for:

Calling World Access via the BlueCard Access line, 1-800-810-BLUE (2583) or call collect at 1-804-673-1177 from outside the U.S.

Notifying World Access if admitted overseas

Obtaining any required precertification from the Home Plan

Paying any deductibles, copayments, coinsurance or non covered amounts to inpatient participating hospitals

Paying the provider for outpatient or professional services and submit an international claim form and bills to:

BlueCard Worldwide Service Center
P O Box 72017
Richmond, VA 23255-2017 USA

PPO precertification situations
For services requiring precertification, if you receive medical care from a national network provider, or from an out-of-network provider, it is your responsibility to contact BCBSGa at 1-800-233-5765 for pre-certification. You should contact BCBSGa at least 72 hours prior to the scheduled procedure or confinement, unless it is an emergency.

PPO emergency care
If you get an emergency room referral from 24/7 NurseLine, you'll receive a reduction in your emergency room co-payment. Contact Blue Cross Blue Shield of Georgia at 1-800-785-0006. Important note: If you are admitted to a national network hospital or to an out-of-network hospital, it is your responsibility to contact Blue Cross Blue Shield of Georgia (1-800-233-5765) within 48 hours after the admission.

HMO plans:

BlueChoice HMO

HMO within Georgia
In network services are those services either provided or coordinated by your Primary Care Physician (PCP). In order to receive care from a specialist, you must have a referral from your PCP. You still must select a specialist provider from the network. If your PCP does not coordinate the services or you receive medical services from a provider out-of-network, these services are not covered.

HMO outside Georgia
The HMO network includes providers in the state of Georgia. There is no coverage for services provided out-of-network, except in cases of life-threatening medical emergencies.

HMO international care
There is no coverage for services provided out-of-network, except in cases of life-threatening medical emergencies.

HMO pre-authorization
For services requiring pre-authorization, your PCP or the specialist to whom you were referred by your PCP will be responsible for obtaining the necessary prior authorization for surgical procedures or inpatient admissions.

HMO emergency care
Life threatening emergency care or treatment for a medical emergency is covered at any hospital emergency room. Use of an emergency room for conditions that are not medical emergencies is not covered. If you get an emergency room referral from 24/7 NurseLine, you'll receive a reduction in your emergency room co-payment. Contact Blue Cross Blue Shield of Georgia at 1-800-785-0006.

Kaiser Permanente HMO (available only in designated areas).

For details regarding coverage while traveling, please contact Kaiser directly at 1-888-865-5813 or Atlanta: 404-261-2590.

HSA PPO (high deductible) plan:

HSA PPO within Georgia
If you need medical care within the state of Georgia (and in selected areas of the border states surrounding Georgia), in order to get the highest level of benefit coverage, you should visit a Blue Cross Blue Shield of Georgia PPO provider. For information on network providers within the state of Georgia, call Blue Cross Blue Shield at 1-800-424-8950. If you choose to use an out-of-network provider, you still have some benefit coverage, but at a lower percentage.

HSA PPO outside Georgia
Outside Georgia, in order to receive the highest level of benefit coverage, you should see a provider in the BlueCard National network. For information regarding the BlueCard National PPO Network, call Blue Cross Blue Shield of Georgia Customer Service at 1-800-424-8950.

HSA PPO international care
If you have questions about coverage while traveling internationally, please contact Blue Cross Blue Shield of Georgia at 1-800-424-8950.

HSA PPO pre-certification situations
For services requiring precertification, contact Blue Cross Blue Shield at 1-800-662-9023.

HSA PPO emergency care
Contact the 24/7 NurseLine at 1-888-724-2583.

* Balance billing is the difference between the amount a physician charges and the Usual, Customary and Reasonable (UCR) or network rate the insurance company has established as the reimbursement rate. If you are subject to balance billing, you will be responsible for paying the difference to the provider.