Emergency Coverage

The BCBS PPO provides benefits for emergency medical services whether you are in or outside of Massachusetts. These emergency medical services may include inpatient or outpatient services by providers qualified to furnish emergency medical care and that are needed to evaluate or stabilize your emergency medical condition.

In an emergency, such as a suspected heart attack, stroke, or poisoning, you should go directly to the nearest medical facility or call 911 (or the local emergency phone number). You pay a $100 copayment for in-network or out-of-network emergency room services. This copayment is waived if you are admitted to the hospital or for an observation stay. The out-of-network deductible does not apply.

Within the Enrollment Area
You will receive full coverage after a $100 copayment per person per visit for hospital emergency room treatment you receive at a hospital in the plan network. This copayment will be waived, however, if you are immediately admitted to the hospital.

Outside the Enrollment Area
When you are temporarily outside the enrollment area, the BCBS PPO will cover emergency room treatment in full after a $100 copayment if the illness or injury is sudden and life-threatening. Emergency treatment received at a physician’s office outside the enrollment area will be covered in full after a $20 copayment per person per visit.