What is the BlueCard Program?

BlueCard is a national program that allows members to obtain health care services when traveling or living outside their Blue Plan’s service area. Your ID card gives you access to providers throughout the United States. For example, when Blue Cross and Blue Shield members travel or live outside their home plan’s service area, they’ll continue to have the same benefits.

More than 90 percent of all hospitals and 80 percent of physicians in the United States contract with BCBS plans. Outside the United States, members have access to doctors and hospitals in more than 200 countries and territories around the world through the Blue Cross and Blue Shield Global Core® Program.

The program links participating health care providers with the independent Blue Plans across the country and in more than 200 countries and territories worldwide through a single electronic network for claims processing and reimbursement. The program lets you submit claims for patients from other Blue Plans, domestic and international, to your local Blue Plan.

Products Included in BlueCard

A variety of products and claim types are eligible to be delivered via BlueCard, however not all Blue Plans offer all of these products to their members. Currently, BCBSIL offers products indicated by the asterisk below, however you may see members from other Blue Plans who are enrolled in the other products:

 Traditional* (indemnity insurance)
 PPO* (Preferred Provider Organization)
 EPO* (Exclusive Provider Organization)
 POS (Point-of-Service)
 HMO* (Health Maintenance Organization)
 Medigap
 Medicaid: payment is limited to the member’s Plan’s state Medicaid reimbursement rates. These cards will not have a suitcase logo.
 SCHIP (State Children’s Health Insurance Plan) if administered as part of Medicaid. Payment is limited to the member’s Plan’s state Medicaid reimbursement rates. These member ID cards also do not have a suitcase logo. Stand-alone SCHIP programs will have a suitcase logo.
 Stand-alone vision*
 Stand-alone prescription drugs*
NOTE: Stand-alone vision and stand-alone self-administered prescription drugs programs are eligible to be
processed through BlueCard when such products are not delivered using a vendor. Consult claim filing instructions on the back of the member’s ID card.

Products Excluded from the BlueCard Program

The following claims are excluded from the BlueCard Program:
 Stand-alone dental
 Vision delivered through an intermediary model (using a vendor)
 Self-administered prescription drugs delivered through an intermediary model (using a vendor)
 Medicaid and SCHIP that is part of the Medicaid program
 Medicare Advantage*
 The Federal Employee Program® (FEP)

In an emergency, where do members go to receive emergency medical care if they are traveling or living outside of their home Blue Plan service area?

In an emergency, members should go directly to the nearest hospital. To find a doctor or hospital outside your home plan service area, call 9-1-1. Benefits for ambulance and emergency room care will vary depending on your health plan.

What do members pay for services?

Members have the same benefits for covered services received outside of their Blue Cross and Blue Shield plan service area when they are covered under a “host” Blue Plan. For example, if a copayment is $25 under your BCBS plan, it will be $25 wherever you are visiting or temporarily living. Limitations and exclusions are the same as your BCBS plan. For more information about your coverage, check your benefit information or call the customer service number on the back of your ID card before traveling.

PPO members will not need to file claims or handle paperwork. Simply present your ID card and remind the provider that you are on the PPO plan. After treating you, the provider will file your claim with the local Blue Cross and Blue Shield Plan with whom he or she contracts.

Do all members have access to the BlueCard Program?

Most PPO plan members have access to BlueCard when traveling or living outside their service area. However, PPO members are responsible for calling their local Blue Cross and Blue Shield plan for precertification, when necessary. The precertification phone number on the back of the member ID. 

• HMO plan members who are traveling only have access to BlueCard for emergency and urgent care. When temporarily living outside their service area, HMO members can use the Away From Home Care® Program. 
• Medicare Advantage and Medicare Part D plan members do NOT have access to BlueCard. 

To verify if your plan has access to BlueCard, call Member Customer Service at the toll-free number listed on the back of your member ID card.

How the BlueCard Program Works?

1. Identify BlueCard Members – The main identifiers are:

• PPO in a suitcase logo, for eligible PPO members
• Empty suitcase logo, for Traditional, POS or HMO members
• A three-character prefix (the first three positions of the identification number)
• The three-character prefix correctly routes BlueCard claims for processing

Three-character prefixes are assigned to every BCBS Plan and start with X, Y, Z, or Q:

• First Character – X, Y, Z or Q
• Second character – A-Z
• Third character – A-Z 

National Account Prefixes:

• Begin with letters other than X,Y, Z or Q
• Typically relate to the name of the group, as in UAL for United Airlines. 

2. Check Eligibility and Benefits

Telephone: Call the Blue Card Eligibility^® line at 800-676-BLUE (2583). Enter only the three-character prefix on the member’s ID number and your call will be routed to the member’s home plan.

Electronic: Submit an electronic eligibility and benefits inquiry (270 transaction) to BCBSIL via the Availity^® Provider Portal or your preferred web vendor. Electronic eligibility and benefits (270/271) transactions may be conducted almost continuously, with the exception of Sunday, 8 p.m. to midnight, CT.

3. Obtain Pre-certification/Preauthorization for BlueCard Members, When Applicable

Telephone: Call the BlueCard Eligibility line at 800-676-2583 and ask to be transferred to the Medical Management Department.

Electronic: Use the Pre-Cert/Pre-auth Router (out-of-area members) to view the applicable Blue Plan’s medical policy or general pre-certification/preauthorization information. If pre-certification/preauthorization is required, submit an electronic request (278 transaction) through Availity or your preferred web vendor portal.                  

4. Submit all BlueCard claims electronically to BCBSIL, for faster service.