Network Access Travel Reimbursement Policy

Reimbursement for eligible travel, lodging, and food expenses (“Travel Expenses”) may be available to Blue Cross & Blue Shield of Mississippi Members when access to a Provider specialty is limited in the county in which the Member resides and when the requirements of this Network Access Travel Reimbursement Policy are met.

Policy Statement

Travel Expenses are eligible for reimbursement only when the following criteria are met:

• Reimbursement of Travel Expenses is available to the Member under state law.
• The Member resides in Mississippi.
• Access* to a Blue Cross Blue Shield Network specialty Provider is not available to a Member in the county in which the Member resides. Access is considered to be not available when:
• • The Member must travel more than 100 miles one-way to reach the specialty Provider; or,
  • The Member must travel one-way more than the network adequacy distance standard set by Mississippi law for the specialty Provider, as set forth in Exhibit A - Access Standards for Specific Provider Specialties by County, whichever distance is greater.
• The travel is to the closest available Blue Cross Blue Shield Network Provider of the appropriate specialty.
• The services rendered by the Blue Cross Blue Shield Network specialty Provider are Covered Services under the Member’s Health and Wellness Benefit Plan.
• Reimbursement of Travel Expenses is available for travel by private vehicle only. Expenses related to public transportation are not reimbursable.

*Access is available when a Blue Cross Blue Shield Network Provider is available within the distance standards through the BlueCard Network in a bordering state(s).

Reimbursement Policy

• Travel by vehicle shall be reimbursed at the current Internal Revenue Service mileage standard for total miles driven as published at www.irs.gov.
• Reimbursement for mileage will be based on the distance between the Member’s residential address and the Provider’s address, as reported on the Network Access Travel Reimbursement Form.
• Mileage will be calculated using publicly available tools for calculating mileage (e.g. Waze or Google Maps).
• Lodging reimbursement is available only when reasonably necessary based on the miles traveled, the time of the appointment and the nature of the services. Lodging reimbursement is available for a maximum of one night for a provider visit.
• Food and lodging reimbursement will be at the federal per diem rates in effect at the time of travel as set by the U.S. General Services Administration, unless actual expenses, based on receipts provided, are lower than the federal per diem rates, in which case reimbursement will be limited to actual expenses.
• Travel Expenses are limited to $10,000 per Member per calendar year.
• Itemized receipts are required to be submitted for lodging and food expenses.
• The Member must contact Blue Cross & Blue Shield of Mississippi Customer Support at 601-664-4590 or 800-942-0278 at least two (2) days prior to the travel to allow for verification of network access.
• A completed Network Access Travel Reimbursement Form (link above), including receipts, must be submitted to Blue Cross & Blue Shield of Mississippi.
• Member cost-sharing (copay/coinsurance/deductible) does not apply to reimbursement of Travel Expenses.
• If a Member does not comply with the requirements of this Network Access Travel Reimbursement Policy and/or elects to incur Travel Expenses which are ineligible for reimbursement, the Member shall be responsible for the Travel Expenses.

Reimbursement Process

To be reimbursed for eligible Travel Expenses, the Member must notify Blue Cross & Blue Shield of Mississippi prior to the travel. Please contact Customer Support at 601-664-4590 or 800-942-0278 and have the following information available:

• Member Name
• Member Mobile Number
• Member I.D. Number
• Member Date of Birth
• Member Street Address
• Provider Name
• Provider Address
• Provider Phone Number
• Provider Specialty

All requests for reimbursement of Travel Expenses, along with the required itemized receipts, must be submitted within 90 days of the date the Travel Expenses were incurred using the Network Access Travel Reimbursement Form.

Exhibit A - Access Standards for Specific Provider Specialties by County