These data reflect the most commonly purchased benefits package for each of the health plans in
the year 2000. Coventry/Principal would not supply updated information.
HMO Non-Urgent Care Outside of Service Area
Aetna US Healthcare Excluded.
Blue Cross Blue Shield Covers: Only extended period travelers who enroll in "Guest Membership" before traveling. Terms of coverage under "Guest Membership" will match those for the plan in the destination’s service area.
CIGNA / Healthsource Excluded.
Doctors Health Plan Excludes: Excluded unless the law mandates that the only reasonable treatment is outside the service area or unless a Point of Service rider is purchased.
Generations Excluded.
Optimum Choice Excludes: Non-urgent care outside of service area unless authorized in advance by OCCI or by the member’s PCP.
PARTNERS Excluded
Coventry/Principal Health Care of the Carolinas Excluded.
QualChoice Covers: Under the HMO gatekeeper option (Option 1), treatment received for illness or injury when traveling out of the service area will be covered only if:
  1. You could not have reasonably foreseen the condition.
  2. You could not reasonably return to the service area to receive treatment from your PCP.
  3. Qual Choice’s Medical Director agrees that the treatment was medically necessary.
  4. You contact Qual Choice within 48 hours or by the close of the first business day after receiving care.
  5. You submit all claims and proof of service to Qual Choice in writing within 90 days after the date of service.
The Wellness Plan of North Carolina, Inc. Excluded.
United HealthCare Excluded.
WellPath Excluded.

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