As a Harvard University Group Health Plan member, you are covered for urgent and emergency care at home and while traveling. Members with the HMO plan must contact their primary care physician within 48 hours of receiving urgent care. Members with the POS and HDHP plans have the option of receiving care from providers who are not in their plan network—this will result in higher out-of-pocket costs. Learn more
What is urgent care?
Urgent care is care that you need to prevent serious deterioration of your health when an unforeseen illness or injury occurs. In most cases, urgent care will be brief diagnostic care and treatment to stabilize your condition. A sprained ankle, an earache, and a fever are examples of illnesses and injuries that may require urgent care.
What is emergency care?
Emergency care is care that you need due to the sudden onset of a condition with acute symptoms, including severe pain. A suspected heart attack, stroke, poisoning, loss of consciousness, convulsion, and a suicide attempt are examples of medical emergencies.
How to access urgent or emergency care?
If you are traveling outside the service area or outside of Massachusetts and you need urgent care, you should go to the nearest appropriate health care facility. After you receive urgent care, members must call BCBSMA at 800-257-8141 within 48 hours to request an out-of-the-area/out-of-state urgent care referral.
When you have an emergency medical condition, you should go to the nearest medical facility or call 911 (or the local emergency number). You do not need a referral for emergency room visits, but all follow-up care must be coordinated by your primary care physician.
Need help finding a provider?
Contact Member Services at 617-495-2008 or Blue Cross Blue Shield at 800-810-BLUE (available 24/7) for assistance in locating a health care provider. When you call, you should have your ID card ready. You may also search for a provider online through the Blue Cross Blue Shield National Doctor and Hospital Finder.
Planned or Foreseen Care Outside of Massachusetts
Examples of planned care include having your cholesterol checked, receiving a chemotherapy treatment, or receiving pregnancy care.
Planned or foreseen care is not covered outside of Massachusetts.
POS and POS Plus Members
Members with the POS and POS Plus plans are covered for planned or foreseen care outside of Massachusetts—this will result in higher out-of-pocket costs. You will be subject to the annual deductible and coinsurance, and you may be billed the difference between the provider’s actual charge and the Blue Cross Blue Shield of Massachusetts allowed amount.
Members with the HDHP plan that use the PPO network are covered nationwide at the in-network benefit level. HDHP members also have the option of using out-of-network benefits at a higher out-of-pocket cost. You will be subject to the annual deductible and coinsurance and may be billed the difference between the provider’s actual charge and the Blue Cross Blue Shield of Massachusetts allowed amount.