Guest Membership
FAQS
1. What is Away From Home Care (AFHC)?
AFHC is a national program sponsored by the Blue Cross and Blue Shield Association that allows eligible HMO members to receive guest membership benefits from another participating Blues plan when living temporarily outside their home plan’s service area.
2. What are the different types of guest membership?
Eligible scenarios include:
- Families Apart (e.g., dependents not residing with the subscriber)
- Long-term Travelers (away for 90–180 consecutive days)
- Students (attending school out of area for 90+ days)
3. What’s the difference between high and low benefit options under Blue KC’s guest coverage?
These tiers reflect differences in coverage and copayments. Blue KC will inform you of which benefit level applies when the guest member is assigned to your practice.
4. What’s the minimum time requirement to qualify for guest membership?
Members must be temporarily residing out of area for at least 90 consecutive days to qualify for a guest membership.
5. How does a member enroll in the Away From Home Care program?
The member must contact their home plan to verify the destination plan participates in AFHC, and then complete a guest application with that home plan.
6. How are Primary Care Physicians (PCPs) assigned under AFHC?
Once enrolled, the host plan assigns a PCP, and the provider will receive membership details and benefit information, including ID cards.
7. Do guest members receive the same benefits as local members?
Yes. Guest members receive the full range of HMO benefits—including inpatient, outpatient, routine, and preventive care—available through the host plan.
8. Are guest members required to get referrals for specialty care?
No. Guest members can self-refer within the Blue-Care HMO network after selecting a PCP.
9. How do I verify eligibility for a guest member?
Check the member ID card for copayment information, the PCP’s name and phone number, and the Blue-Care guest prefix. If in doubt, call the Away From Home Care number listed in the Contact Resource Directory.
10. Where should claims for guest members be submitted?
File claims directly to Blue KC. Payment is made to the provider after processing.
Away From Home Care (AFHC) is an out-of-area program sponsored by the Blue Cross and Blue Shield Association (BCBSA) that is available to select HMO members in specific states.
AFHC enables members to receive guest membership coverage and benefits from other participating Blues plan HMOs, while temporarily residing outside of the service area for at least 90 days.
Members have access to a comprehensive range of benefits, including routine and preventive services.
Coordinators from the two Blues plan work together throughout the duration of a guest enrollment period to ensure all aspects of the program run smoothly.
Blue-Care HMO network members may obtain a guest membership if they plan to stay in the other Blues plan HMO location for 90 or more consecutive days.
Membership Types
Families Apart
When not residing with the subscriber, divorced or separated spouses and other dependents may apply for Families Apart Guest Membership. There is no administrative time limit for members to receive services from their guest HMO.
Long-term Traveler
A long-term traveler are subscribers, spouses or other dependents who are away from home for at least 90 consecutive days (3 months) but not more than 180 days (6 months).
Students
This program is ideal for qualified dependents of the subscriber who are attending school outside of their home HMO area – and not residing with the subscriber for 90 days or more. There is no administrative time limit for a member to receive services from their guest HMO.
Before applying, call to find out if the student will be residing in a covered service area.
Member Enrollment
- This service provides courtesy enrollment in a Blues plan HMO outside the member’s home plan service area. The member must contact his or her home plan to confirm the out of area location participates in the AFHC program.
- Members must complete a guest application with their home plan to be considered for a guest membership.
- Coordination of the AFHC guest enrollment, PCP assignment and Blues plan billing is tracked by AFHC coordinators.
- After a Primary Care Physician (PCP) is selected, the host plan will give participating providers a membership identification card and information on how to access Provider benefits.
Coverage and Benefits
Guest members enjoy the full range of benefits/services offered by another Blues plan HMO. Covered benefits include inpatient and outpatient services and other medical care, including routine and preventive care. Guest members must select a PCP, but are free to self-refer within the Blue-Care HMO specialist Provider network.
When Blue KC functions as a host plan, guests have access to Blue-Care HMO which has high and low benefit options available. These ranges indicate the types of services that are covered. For example, high benefit options may include more services that aren’t covered under the low benefit option. Blue KC will advise providers of any Away From Home Care (AFHC) guest members when they are assigned to providers.
The main Blue KC Provider Reference Guide difference between these options is member copayment amounts.
Eligibility Check
- Copayment information is on the member identification (ID) Card.
- The PCP’s name and phone number is on the member’s ID Card.
- A special prefix, preceding the policy number, is assigned to Blue- Care guest.
Claims
- Claims should be filed to Blue KC and payment is directed to the Provider.
If providers have questions about a patient’s eligibility as a Guest member, call our Away From Home Care number (see Contact Resource Directory).