Blue Shield Abortion Travel Reimbursement Benefit

Blue Shield of California has announced that they are expanding their travel expense benefit to include pregnancy terminations or abortions. The expanded travel reimbursement benefit will apply to women covered by a Blue Shield of California group plan and residing in a state that has banned or severely restricted abortion services.

Blue Shield of California will reimburse the travel expenses to receive an abortion

In California, pregnancy termination is a covered health care benefit in most health insurance plans. Whenever a covered health care service cannot be accommodated locally for the member, there can be provisions within the health plan to cover travel expenses to obtain the medical service.

Because the U.S. Supreme Court overturned Roe v. Wade, the decision that legalized abortion, many states have or will seek to ban any and all pregnancy termination services. This means that women with Blue Shield of California coverage, residing in a state with no abortion services, will have to travel out-of-state to receive the pregnancy termination health care benefit.

Pregnancy Termination Travel Expense Reimbursement Program

Blue Shield of California has outlined several conditions for the pregnancy termination travel reimbursement program. First, the Blue Shield of California member must reside in a state that has banned or restricted abortions. As of June 24, 2022, that includes the states of Oklahoma, South Dakota, Tennessee, Texas, Utah, and Wyoming. Other states may be added or removed as states change their laws regarding pregnancy termination.

While prior authorization is not required, Blue Shield of California members should become familiar with all of the conditions of the program for proper reimbursement. The abortion services must be provided by a licensed practitioner in a state other than the member’s residence where pregnancy termination can be lawfully provided. The pregnancy termination benefit will be processed through the member’s BlueCard benefit or an out-of-network provider if the member’s plan covers out-of-network benefits.

The travel reimbursement is limited to pregnancy termination and for costs incurred and paid by the member and not also reimbursed or paid by another party. In other words, if someone else, such as a nonprofit or employer pays the travel expenses related to the travel for the abortion, Blue Shield won’t reimburse those entities.

The travel reimbursement is capped at $2,000 per event. The reimbursement may cover transportation, hotel accommodations, and meals. If it is necessary for the woman to have a companion on the trip, such as a minor child or caregiver, the companion’s expenses may also be covered. Members with a High Deductible Health Plan, Health Savings Account compliant, may have to satisfy the plan deductible.

Not all plans cover abortion and deductibles may apply

The pregnancy travel reimbursement program is separate from any costs associated for the health care service billed by the provider under the health plan’s benefit structure. Blue Shield of California members should refer to their plan’s Summary or Benefits or Evidence of Coverage document if pregnancy termination is a covered benefit and how member cost sharing is applied.

Not all group plans offered by Blue Shield of California include a pregnancy termination benefit. Consequently, it is necessary to review the Summary of Benefits or Evidence of Coverage for the health plan. In addition, some groups may opt out of the pregnancy termination travel reimbursement program. Blue Shield states that there is no impact to group premiums as a result of the program. Contracts and plan documents will not be amended as then travel reimbursement program is not a change to any plan design or benefit change.

Blue Shield of California, an independent member of the Blue Shield Association, is a nonprofit health plan operating in California. Blue Shield offers group health insurance plans that may cover employees in other states.