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.