Product Disclosures – Applicable to all Plans

For Medical Policies and Guidelines, go to: https://www.amerihealth.com/providers/policies_guidelines/medical_policy.html
Notice of Nondiscrimination (PDF)
Language Assistance Service (PDF)

Product Disclosures by State

Connecticut

Anthem Blue Cross Blue Shield of Connecticut

Network Adequacy and Accessibility
While in Connecticut, GeoBlue members have access to Anthem Blue Cross Blue Shield of Connecticut’s network of doctors, hospitals and facilities throughout the state via the BlueCard® Program. To review Frequently Asked Questions about their network, please click on the link below Anthem Blue Cross Blue Shield of Connecticut FAQs

To review how Anthem Blue Cross Blue Shield of Connecticut chooses providers and facilities for their network, please see this document available on Anthem’s website describing the criteria used to build their network, including quality of care, the member experience, accessibility and cost.
Anthem Blue Cross Blue Shield of Connecticut Doctor/Facility Selection Criteria
Anthem Blue Cross Blue Shield of Connecticut/How we choose doctors and hospitals for our plans (PDF)

Provider Access Notice
You may select primary and specialty providers via electronic access using the provider search tool known as Find-a-Doc. Log on to www.geo-blue.com anytime you’re on the web to browse our online provider directory or directly link to the Blue National Doctor and Hospital Finder, which is updated weekly. You can search by languages spoken, specialty, hospital association, and more. Additionally, you can request a copy of the provider directory through a toll-free number (1-855-282-3517).

When you need medical attention when you’re traveling, or if you live in another Blue Cross Blue Shield area, you can get a list of doctors and hospitals across or outside the U.S. by calling 1-800-810-BLUE (2583), or by visiting the Blue National Doctor and Hospital Finder.

Service Area
In the event that you cannot find a primary or specialty provider without unreasonable travel or delay from your Connecticut residence, or if the services is not available through a Participating Provider, Covered Expenses for the services of a Non-Participating Provider will be paid according to the in network benefit schedule. Please call Customer Service at 1.888.412.6403 to notify us in advance, so we can ensure the claim is processed correctly. In the event the claim is not processed correctly, please contact customer service to inform us and we will adjust the claim.

Pharmacy Availability & Accessibility Table
Individuals enrolled in a Blue Cross Blue Shield Global Expat plan have access to a pharmacy network while residing in or visiting Connecticut. The adequacy of the pharmacy network in terms of the number of pharmacies and the time in minutes and distance in miles for current insured residents of Connecticut is shown by county in this pharmacy time and distance table.

Minnesota

Provider Networks
For any GeoBlue members in Minnesota, GeoBlue members have access to a large network of medical providers in Minnesota established by Blue Cross Blue Shield of Minnesota and available to GeoBlue members insured under a Blue Cross Blue Shield Global product through the BlueCard® program. For a list of providers, which is updated at least monthly, please go to Blue Cross Blue Shield Provider Finder.

Although we strive to have a broad network available to you, if you live in Minnesota and you are unable to find a primary care physician, mental health services or general hospital services within 30 miles or 30 minutes of your residence, or for other health services within 60 miles or 60 minutes, you are eligible to have your out-of-network services paid at the in-network rate.

In the event a network provider is not accessible, please Contact Customer Service at 1.888.412.6403 or +1.610.254.5830, or by email at customerservice@geo-blue.com, to let them know and to ensure that your claims, when submitted, will be paid at the in-network rate.

Ohio

State of Emergency for Ohio Counties Impacted by Severe Weather Event and Tornadoes
For any GeoBlue members in the Ohio counties of Greene, Mercer and Montgomery and other Ohio counties that subsequently declared an emergency due to dangerous and damaging conditions resulting from the severe weather event and tornadoes that began May 27–28, 2019, you are offered the option to defer premium payments coming due, interest free, for up to 60 calendar days from the original premium due date. Further, as to any policy provision that imposes a time limit on an insured or claimant to perform any act, including the transmittal of information or funds, with respect to a contract for insurance, companies are to extend such time limits by at least 60 calendar days from the last day allowed under the terms of the contract, or any longer period that may be deemed reasonable under the specific circumstances related to that insured or claimant. This 60-calendar day period is not to extend past July 28, 2019.

To take advantage of this offer, please Contact Customer Service at 1.888.412.6403 or +1.610.254.5830, or by email at customerservice@geo-blue.com.

Texas

You have the right to an adequate network of preferred providers (also known as “Blue Choice PPO Network”). If you believe that the network is inadequate, you may file a complaint with the Texas Department of Insurance.

You have the right, in most cases, to obtain estimates in advance:
– from out-of-network providers of what they will charge for their services; and
– from your insurer of what it will pay for the services.

You may obtain a current directory of preferred providers at the following website: www.geo-blue.com or by calling Customer Service at 1.888.412.6403 or +1.610.254.5830 or by email at customerservice@geo-blue.com for assistance in finding available preferred providers.

If you are treated by a provider or facility that is not a preferred provider, you may be billed for anything not paid by the insurer.

If the amount you owe to an out‐of‐network hospital‐based radiologist, anesthesiologist, pathologist, emergency department physician, neonatologist, or assistant surgeon, including the amount unpaid by the administrator or insurer, is greater than $500 (not including your copayment, coinsurance, and deductible responsibilities) for services received in a network hospital, you may be entitled to have the parties participate in a teleconference, and, if the result is not to your satisfaction, in a mandatory mediation at no cost to you. You can learn more about mediation at the Texas Department of Insurance website: www.tdi.texas.gov/consumer/cpmmediation.html.

If directory information is materially inaccurate and you rely on it, you may be entitled to have an out-of-network claim paid at the in‐network percentage level of reimbursement and your out-of-pocket expenses counted toward your in‐network deductible and out‐of‐pocket maximum.

Telehealth Medical Service and Telemedicine Medical Services for Texas based Group Plans
In accordance with Chapter 1455 of the Texas Insurance Code, Blue Cross Blue Shield Global Expatriate Health plans provides benefits for covered services that are appropriately provided through Telehealth Medical Service and Telemedicine Medical Services, subject to the terms and conditions of the Plan. In-person contact between a health care Provider and the patient is not required for these services, and the type of setting where these services are provided is not limited. Telehealth Medical Service and Telemedicine Medical Services does not include consultations between the patient and the health care Provider, or between health care Providers, by telephone, facsimile machine, or electronic mail.

Equipment costs and transmission costs associated with Telehealth Medical Service and Telemedicine Medical Services are not reimbursable.

Customer Service

Need additional assistance with GeoBlue product?
Contact Customer Service at 1.888.412.6403 or +1.610.254.5830, or by email at customerservice@geo-blue.com.