Foreign Claims

• Plan Provisions
• Foreign Claim Submissions
• Retired Members
• Specific Provider Information
• Exceptions

The medical plan provisions apply to all Members, including Members traveling or employed in a foreign country.

When a Member receives care in a foreign country, the Member does not need to obtain Preauthorization before receiving services with the exception of air transportation. The Plan does require that transfer by air ambulance for acute care is approved by the Administrator of the Plan.

In most circumstances, the Member must pay for services at the time Benefits are provided.

For claims incurred outside of the United States, the Member must complete a Blue Cross Blue Shield Worldwide Claim Form and obtain an itemized statement from the foreign provider. The statement must contain the patient's name, the date of service, a description of the service provided, the cost of the service and the diagnosis as of the service date. Prescription drug charges must contain the name of the drug and its strength. The Plan can no longer accept receipts in lieu of itemized statements.

This statement, along with the BCBS Worldwide Claim Form, should then be mailed to the WELS Benefit Plans Office at the following address:

Upon receipt, the Benefit Plans Office will forward the claim to the appropriate processing center.

Retired Members will be reimbursed only for the charges, which are addressed as benefits of WELS VEBA. Medicare will not reimburse most foreign claims; therefore, if Medicare does not provide coverage, WELS VEBA will pay 80% of the UCM charges.

A Member should have specific contact information for any foreign provider. WELS VEBA may require additional information to process your claim.

Special rules will apply when a Member is filling a prescription before going abroad for a call by, or as a volunteer, for a Sponsoring Organization:

• The Member must pay for the prescription(s) and submit a completed drug company claim form to the WELS Benefit Plans Office.
• WELS VEBA will notify the prescription drug company to override the 34-day limitation.
• The prescription drug company will reimburse 75% of UCM charges.