If you have an HMO contract and are traveling out of state and need to seek treatment for non-emergency care, we request that you call the number on the back of your ID card 1.800.4HMO.USA to obtain information on local providers in that area. Follow-up care should be received from an HMOLA network provider.
If you have an HMO contract and are traveling out of the country and need emergency medical care, you should go to the nearest hospital available. If possible, you should call the number on the back of your ID card 1.800.4HMO.USA to obtain information on local hospitals in that area. HMOLA must be notified of the emergency medical service within forty-eight  hours after receiving treatment or as soon as medical circumstances permit.
If your Individual HMO contract provides coverage for Pregnancy Care benefits and the pregnancy is not pre-existing, you will be responsible for payment of a Pregnancy Care co-pay if covered services are performed by a Network Provider. You will also be responsible for an Inpatient Hospital Admission co-pay. Of course with respect to the Individual HMO/POS product covered services rendered out of network are subject to a deductible and coinsurance.
You are allowed two (2) routine visits to a network OB/GYN per benefit period. You do not need a referral for these services. You may also schedule follow-up visits within 60 days of a routine gynecological exam without a referral from your PCP for treatment of a condition that was diagnosed or treated during a routine gynecological exam. All other situations would require a referral from your PCP.
Unless you are receiving emergency medical services, a referral is normally needed whenever services are going to be performed at a location other than your primary care physician's office in order to receive benefits or the highest level of benefits. A streamline referral is the expedited process by which your PCP is allowed to refer you to a network specialist or other providers by completing the Physician Referral Authorization Form. A plan-approved referral is used for services performed in an outpatient or inpatient setting. This referral is also used for targeted procedures referred to in your schedule of benefits as "outpatient pre-service authorization" services.
Call FEP Customer Service at 1.800.272.3029 to receive a benefit brochure and summary or to speak to a customer service representative.
*CVS Caremark is an independent company that serves as the pharmacy benefit manager for the Blue Cross and Blue Shield Service Benefit Program.
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