Dependent Children Residing Outside the Service Area

In addition to emergency and urgent care, child dependents enrolled in HMO, POS, and POS+ plans living outside of Massachusetts are eligible to receive in-network coverage for non-emergency medical and behavioral health care, when officially requested by the dependent’s primary care provider (PCP) or out-of-state behavioral health provider.

Eligibility:

  • Dependent children (under the age 26) and
  • Residing outside the service area

For those traveling out of state, standard urgent and emergency coverage applies.

How the process works:

Medical Services

  • The child dependent should contact their HUHS or Atrius PCP and ask for a referral to a provider in their area that has a local BCBS contract agreement in their state
  • The PCP, in collaboration with the member, will need to complete and submit the Managed Care Out-Of-Network Request Form
  • Once a decision has been reached, the dependent will receive a letter regarding the approval of care

Behavioral Health

  • The dependent should contact the out-of-state Behavioral Health provider and ask them to complete the Managed Care Out-Of-Network Request Form for Behavioral Health
  • Once a decision has been reached, the dependent will receive a letter regarding the approval of care

Examples of covered and non-covered services:

Examples of services that are typically allowed:

  • Physical, occupational and speech therapy
  • Outpatient behavioral health
  • Acupuncture and chiropractic services

The intention is to cover services that are time sensitive, not considered urgent in nature or needed to support the member with follow-up care as a result of an urgent or emergency visit.

Examples of services not eligible for coverage outside of Massachusetts:

  • Annual preventive services, including exams, labs, and other tests
  • Infertility treatment
  • Bariatric surgery
  • Arthroscopic surgery
  • Cosmetic/reconstructive surgery
These services would be denied even if an authorization request is received because they can be safely delayed until the member returns to the service area.

Other points:

The dependent child must have a completed Managed Care Out-Of-Network Request Form submitted for each service that they are looking to receive.

Dependents enrolled in the HUGHP HMO Plan

Dependents in the HMO plan must have a HUGHP in-network PCP and obtain an out-of-network request form from their PCP to be eligible to schedule non-urgent care.  

Dependents enrolled in the HUGHP POS or POS Plus Plan 

Dependents in the POS or POS Plus plan that do not have a HUGHP in-network PCP will be not be eligible for non-urgent care at the in-network benefit level. They can utilize their self-referred benefits with higher out-of-pocket costs.  

Find a Doctor

Blue Cross Blue Shield of Massachusetts can help you find a health care provider. They are available 24 hours a day, 7 days a week by calling 800-810-BLUE. When you call, please remember to have your ID card ready. Let the representative know that you are looking for health care providers that participate with the local Blue Cross and/or Blue Shield Plan in your area.  You may also search for providers online using the Blue Finder

Members should be utilizing network providers in the state in which they are receiving their care (e.g., PPO or indemnity).