November 7, 2019
The benefits of each plan vary by contract, but you can verify a member’s eligibility and benefits in several ways:
- Provider website: Verify member eligibility and benefits, basic demographic information, deductible, benefit limit accumulators, and claim status.
- Interactive Voice Response (IVR): Self-service specific information is available 24 hours a day, 7 days a week. Contact IVR at 800-722-4714, option 2. IVR isn’t available for service related to the Federal Employee Program or BlueCard.
- Limitations and exclusions: Benefit plans typically have exclusions and limitations-services and supplies that plans do not cover. A list is available in the Provider Reference Info section.
- Emergency care: Members should call 911 or seek care immediately if they have a medical emergency. Our plans cover emergency care 24 hours a day, anywhere in the world. If a member is treated in the emergency department, the member’s physician or other provider needs to provide any necessary follow-up care (e.g., suture removal).
Actual payment is subject to the subscriber’s contract and eligibility at the time of service. For more information about member eligibility and coverage, member appeals, and member responsibilities, visit the Provider Reference Library.