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, My Choice, and Senior 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.
