CurrentBlue Cross Blue Shield - IowaPolicy H5900-001; H5900-004; H5900-006; H5900-007; H5900-008

Worldwide Coverage - Emergency and Urgent Care

Governs coverage, reimbursement, member cost sharing, and claims submission for emergency and urgent medical services provided outside the United States for specified Blue Medicare Advantage plans in Iowa and South Dakota.

Policy Summary

PayerBlue Cross Blue Shield - Iowa

PolicyWorldwide Coverage - Emergency and Urgent Care

Policy CodePolicy H5900-001; H5900-004; H5900-006; H5900-007; H5900-008

Change TypeNo material change

Effective DateJan 1, 2022

Next Review Date

Key ActionSubmit claims for services requiring interpretation or currency conversion through Blue Cross Blue Shield Global Core using the International Claim Form; cruise ship services without those requirements may be submitted directly to WMAHP.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

$50,000combined lifetime maximum

IA, SDstates applied

Itemized billsrequired documentation

Worldwide Emergency and Urgent Care Coverage Criteria

Worldwide emergency/urgent care coverage criteria

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Service is an emergency or urgent medical service rendered while the member was physically located outside the United States or its territories.

Original Medicare exceptions (any of the following)

Emergency inpatient hospital services that occurred while the beneficiary was physically present in the United States or in Canada when traveling without reasonable delay and by the most direct route between Alaska and another State.
Emergency or nonemergency inpatient hospital services furnished by a hospital located outside the United States if that hospital was closer to, or substantially more accessible from, the beneficiary's United States residence than the nearest participating United States hospital adequately equipped and available to treat the condition.
Physician and ambulance services furnished in connection with, and during a period of, covered foreign hospitalization.

Services rendered on board a ship in a United States port, or within 6 hours of when the ship arrived at, or departed from, a United States port, are considered furnished in United States territorial waters and follow U.S. coverage rules; services provided outside those parameters are treated as furnished outside United States territorial waters.

Because Original Medicare excludes many foreign emergent/urgent services, WMAHP determines the scope of benefit, reimbursement methodology, maximum payment amounts, and member cost sharing for services furnished outside the U.S.

Reimbursement will be determined by WMAHP based on reasonable charges and currency exchange when required, and assigned to the applicable benefit category.

Member liability: Payment represents WMAHP's payment in full; the member may be held liable for amounts in excess of WMAHP's payment and is responsible for full charge for any non‑covered services; refer to the member's Evidence of Coverage or Summary of Benefits for specific cost share amounts.

Combined lifetime limit: Worldwide emergency, worldwide urgent care, and worldwide transportation care are subject to a combined lifetime maximum benefit of $50,000.

Claims and documentation: Services rendered in a foreign land and services on a cruise ship that require interpretation or currency conversion must be submitted through BCBS Global Core using the International Claim Form; cruise ship services not requiring interpretation or currency conversion may be submitted directly to WMAHP. Members must provide required documentation including member information, itemized bills with dates, diagnosis and charges, and receipts as applicable.

Claims Submission and Provider Requirements

Documentation Required

Claim submission pathways for international services

Services rendered in a foreign land and services rendered on a cruise ship that require interpretation or currency conversion must be submitted through Blue Cross Blue Shield Global Core (BCBSGC) using invoices and a BCBSGC International Claim Form; follow the directions on the form and send to the BCBSGC Service Center address listed on the form. Cruise ship services that do not require interpretation or currency conversion may be submitted directly to WMAHP using the medical claim form obtained by calling Customer Service at 1-855-716-2544 (TTY:711). The member must provide member name, WMAHP contract and group numbers, member address, itemized bills with provider name/address, specific dates of service, diagnosis, descriptive itemized services, charges per service, and paid receipts.

Submit international claims (interpretation/currency conversion required) via BCBS Global Core International Claim Form with invoices to the BCBSGC Service Center.
Obtain BCBSGC forms and access via customer service or https://www.bcbsglobalcore.com (user agreement and login required).
Submit cruise ship services that do not require interpretation/currency conversion directly to WMAHP using its medical claim form (call 1-855-716-2544; TTY:711).
Members must include: member name, WMAHP contract & group numbers, member address, itemized bills with provider name/address, dates of service, diagnosis, descriptive itemized services, charges per service, and paid receipts.

Key Definitions

Emergency medical condition

DefinitionA medical condition manifesting by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson could reasonably expect the absence of immediate medical attention to result in serious jeopardy to health, serious impairment to bodily functions, or serious dysfunction of any bodily part.

Standard appliedPrudent layperson with average knowledge of health and medicine determines need for immediate attention.

Examples of consequencesSerious jeopardy to health, impairment of bodily functions, or dysfunction of any bodily part (including risks to a pregnant woman or her unborn child).