If you need care outside of your plan's Network, follow the steps for Emergency Care or Urgent Care.
If you are planning a long trip outside the Quartz service area, talk to your Primary Care Provider*. Make sure you know how to get medical care while you are away.
All Quartz plans cover out-of-area emergency and urgent care services. Most plans include cost-sharing for emergency room and urgent care visits. Check your Schedule of Benefits, Summary of Benefits and Coverage, or Certificate of Coverage in MyChart for your plan's cost-sharing.
HMO members: Your plan offers benefits for emergency and urgent care obtained from Out-of-Network providers. If you need follow-up visits after receiving emergency care, you must go to an In-Network provider. Routine or preventive visits must also be obtained from an In-Network provider.
POS and PPO members: Your plan offers benefits for most health care obtained from Out-of-Network providers. Please log into MyChart to see your benefits and to make sure you understand your plan. The Choice plans - Choice, Choice Plus, and My Choice - all provide benefits for Out-of-Network health care.
Sometimes you need to pay the full cost for these services at the time you receive them. When this happens, you can fill out a Member Claim Form and include an itemized receipt and proof of payment. For prescriptions, you can fill out a Member Reimbursement Form and include proof of payment. In either case, Quartz will pay its portion of cost-sharing after receiving the your claim.
