2023 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services
Page 93
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services
Page 93
Benefit Description
Ambulance (cont.)
Standard Option - You Pay
All charges
Basic Option - You Pay
All charges
Ambulance (cont.)
- Ambulance transport that is requested, beyond the nearest facility adequately equipped to treat the member’s condition, by patient or physician for continuity of care or other reason
- Commercial air flights
- Repatriation from an international location back to the United States. See definition of repatriation in Section 10. Members traveling overseas should consider purchasing a travel insurance policy that covers repatriation to your home country.
- Costs associated with overseas air or sea transportation to other than the closest hospital equipped to adequately treat your condition.
Standard Option - You Pay
All charges
Basic Option - You Pay
All charges