Common use of Within California Clause in Contracts

Within California. If you are temporarily traveling within California, but are outside of your Primary Care Physician Service Area, if possible you should call Shield Concierge at the number provided on the back page of this booklet for assistance in receiving Ur- gent Services through a Blue Shield of California provider. You may also locate a Blue Shield provider by visiting our web site at xxx.xxxxxxxxxxxx.xxx. However, you are not re- quired to use a Blue Shield of California provider to receive Urgent Services; you may use any Cali- fornia provider. Out-of-Area Follow-up Care is also covered ately use the “911” emergency response system (where available) or seek immediate care from the nearest Hospital. Members should go to the closest Plan Hospital for Emergency Services whenever possible. The Member should notify their Primary Care Physi- cian within 24 hours of receiving Emergency Ser- vices or as soon as reasonably possible following medical stabilization. through a Blue Shield of California provider or from any California provider. Authorization by Blue Shield is required for more than two Out-of- Area Follow-up Care outpatient visits. Blue Shield may direct the patient to receive the additional fol- low-up services from their Primary Care Physi- cian. If services are not received from a Blue Shield of California provider, you may be required to pay the provider for the entire cost of the service and submit a claim to Blue Shield. Claims for Urgent Services obtained outside of your Primary Care Physician Service Area within California will be reviewed retrospectively for coverage. When you receive covered Urgent Services out- side your Primary Care Physician Service Area

Within California. If you are temporarily traveling within California, but are outside of your Primary Care Physician Service Area, if possible you should call Shield Concierge at the number provided on the back page of this booklet for assistance in receiving Ur- gent Services through a Blue Shield of California provider. You may also locate a Blue Shield provider by visiting our web site at xxx.xxxxxxxxxxxx.xxx. However, you are not re- quired to use a Blue Shield of California provider to receive Urgent Services; you may use any Cali- fornia provider. Out-of-Area Follow-up Care is also covered ately use the “911” emergency response system (where available) or seek immediate care from the nearest Hospital. Members should go to the closest Plan Hospital for Emergency Services whenever possible. The Member should notify their Primary Care Physi- cian within 24 hours of receiving Emergency Ser- vices or as soon as reasonably possible following medical stabilization. through a Blue Shield of California provider or from any California provider. Authorization by Blue Shield is required for more than two Out-of- Area Follow-up Care outpatient visits. Blue Shield may direct the patient to receive the additional fol- low-up services from their Primary Care Physi- cian. If services are not received from a Blue Shield of California provider, you may be required to pay the provider for the entire cost of the service and submit a claim to Blue Shield. Claims for Urgent Services obtained outside of your Primary Care Physician Service Area within California will be reviewed retrospectively for coverage. When you receive covered Urgent Services out- side your Primary Care Physician Service AreaArea within California, the amount you pay, if not sub- For information on claims for Emergency or Ur- gent Services received outside of California see the Inter-Plan Arrangements section of the EOC. ject to a flat dollar Copayment, is calculated based on Blue Shield’s Allowed Charges.