A Guide to HMO Blue ® Coverage Outside the Area
It's a good idea to periodically review what's covered outside the service area with your employees. A good time to review this information is during the open enrollment period. If they live, travel, or attend school outside Massachusetts or New England, they need to know the options they have, especially if there's an emergency.
For example, for many services, coverage outside the HMO Blue® service area is limited to emergency and urgent care, even for student dependents.
Not knowing how HMO Blue coverage works outside the service area can lead to employees and dependents incurring the cost of the actual services.
Use the chart below to help answer any questions your employees may have. They can also log in to Member Central at www.bluecrossma.com/membercentral and view their Subscriber Certificate.
|Plan||Service Area||What's Covered Outside the Service Area|
|HMO Blue® and Access Bluesm||Massachusetts||Emergency medical services and urgent care|
|HMO Blue New Englandsm and Access Blue New Englandsm||Massachusetts, Connecticut, Maine, New Hampshire, Rhode Island, and Vermont||Emergency medical services and urgent care|
If your plan includes Blue Cross Blue Shield of Massachusetts prescription drug coverage, your employees can get their medications at a participating national network retail pharmacy in the United States and Puerto Rico, or from the Express Scripts®Mail Pharmacy. Specialty medications administered in an office, hospital, or as part of home infusion therapy, are not covered. A covered health care provider in the service area must administer them.
Example of How It Works
John is a dependent on his mother's HMO health plan. He attends college out of state in Chicago. He broke his leg at school and went to the nearest hospital (in Chicago) for urgent care. John is outside his service area, so he is covered for the treatment of his broken leg because it is urgent care. However, John will also require ongoing physical therapy for several weeks, which is not urgent care. In order for his physical services to be covered, John will need to get the services at home (in the service area).
If John needs to get any prescription drugs while he is at school in Chicago, those are covered if they are filled at a participating national network retail pharmacy, or Express Scripts® Mail Pharmacy.