BlueChoice HMO HSA (Open Access)

Note: The information below briefly describes important features about this health care program. It is not a contract. A detailed description of benefits is included in the Evidence of Coverage. Please refer to the Evidence of Coverage for specific terms, conditions, limitations and exclusions.

BlueChoice HMO HSA features the cost savings of an HMO combined with the tax savings of a Health Savings Account (HSA). And, because this is an "Open Access" plan, members have the freedom to see network providers without a referral from a primary care physician.* Members also have the flexibility to choose a provider from a network of over 2,600 primary care physicians (PCPs), specialty care from over 14,000 participating specialists and hospital care from 55 area hospitals.

Members are still required to choose a PCP upon enrollment. The PCP will coordinate routine care and provide treatment for a variety of medical conditions. If more specialized care is required, the PCP can coordinate specialty care using a network of specialists within the CareFirst BlueChoice network. With the Open Access feature, members don't need a referral from their PCP to visit most CareFirst BlueChoice specialists.* When you are outside of the CareFirst BlueChoice service area, benefits are available for emergency or urgent care, only. This plan is only available to groups.

Advantages:

• No referrals needed to see plan specialists*
• 365 days of hospital coverage
• No claim forms to file
• Preventive Care and Wellness Benefits:
  • Annual routine examinations and office visits
  • Well-child care and immunizations
  • Women's health coverage, such as routine mammograms and Pap tests
  • Men's health coverage, including routine prostate cancer screening
• Discount dental program offers BlueChoice members savings of 20% to 40% on dental services.

3-Tier Prescription Drug Plan:

• Tier 1 - Generic drugs (lowest out-of-pocket cost) $
• Tier 2 - Preferred brand name drugs (higher out-of-pocket cost) $$
• Tier 3 - Non-preferred brand name drugs (highest out-of-pocket cost) $$$

Plans typically have some member out-of-pocket costs in the form of copayments, coinsurance, deductibles or annual maximums. Please refer to your Evidence of Coverage for more information.

Advantages of using a Health Savings Account:

• Financial control over how you spend your health care dollars
• An interest accruing, tax-deferred savings account that can be used to pay for your out-of-pocket medical expenses
• HSA earnings grow tax-deferred and qualified withdrawals are tax free.
• No "use it or lose it provision" like a flexible spending account (FSA). Money not used in your health savings account can be rolled over to the following year.
• HSA funds can be used for all qualified medical expenses, including traditional medical coverage, as well as eye glasses, dental procedures, and prescription drug coverage.
• You make the decision on where and how to spend your health care funds, while still benefiting from the Blue Cross and Blue Shield provider discounts.
  

Online Tools and Resources:
My Account - Allows you to:

• Review eligibility and benefits
• Check the status of a claim 
• Request a new ID card

My Care First - Provides health and wellness information along with health risk assessment and health goal-setting tools.

Options Discount Program - Learn about discounts on services such as laser vision correction, fitness club memberships, weight loss programs, cosmetic dentistry and more.

Find a Doctor - This provider directory is updated every two weeks.

Prescription Drug Information - Look up your prescription drug coverage levels and learn how to save money on your prescription drugs.

Additional Features:

• Disease management programs for members with chronic asthma, diabetes, congestive heart failure or coronary heart disease
• Quarterly wellness magazine
• Health education programs
• Great Beginnings program for expectant mothers
• Discounts on alternative therapies: Options provides discounts on alternative therapies including acupuncture, massage therapy and chiropractic care. It also provides discounts for fitness center memberships and weight loss programs.
• 24/7 Advice: FirstHelp gives you 24-hours a day, 7-days a week health care advice from registered nurses who can answer your health care questions and help guide you to the most appropriate care.

*While a referral is not needed to visit plan specialists when receiving services rendered in an office setting, pre-authorization may be needed for certain services such as mental health and substance abuse treatments and non-emergency hospitalizations, among others. Please refer to your benefits booklet (also called Evidence of Coverage) for the specific services that require pre-authorization.