BlueChoice Opt Out Plus 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 Opt-Out Plus HSA is a point-of-service (POS) plan that provides the cost savings of an HMO with the flexibility to choose any provider - even those outside the CareFirst BlueChoice network. In addition, this plan also features the tax savings advantages of a Health Savings Account (HSA). And, because this is an "Open Access" plan, members also have the freedom to see network providers without a referral from a primary care physician (PCP).

While members are still required to identify a PCP upon enrollment, BlueChoice Opt-Out Plus HSA offers members the flexibility to choose their health care providers each time treatment is needed. When care is received from the PCP, specialists, hospitals and other providers who participate in the CareFirst BlueChoice provider network, a lower out-of-pocket cost is incurred. For a higher out-of-pocket cost, members also have the freedom to choose a health care provider outside the CareFirst BlueChoice network. It's their choice.

Advantages:

• Freedom to choose any doctor, specialist or hospital - anytime you wish
• 365 days of hospital coverage
• No referrals needed to see a plan specialist+
• No claims to file when visiting a CareFirst BlueChoice or a CareFirst BlueCross BlueShield participating provider
• No balance billing for out-of-network services by CareFirst BlueCross BlueShield providers. You can see a provider who is not in the Blue Cross and Blue Shield network, but you may pay a higher out-of-pocket cost and you typically must file your own claims.
• 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:

Member self-service site - Allows you to:

• Check the status of a claim 
• See your eligibility
• 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, coronary heart disease and chronic obstructive pulmonary disease (COPD)
• 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 health care 24-hours a day, 7-days a week 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.