Standard HealthyBlue

Introducing Standard HealthyBlue, the next generation of health benefits from the CareFirst BlueCross BlueShield family of health care plans. A new and positive approach to health care that rewards you for being healthy.

• Standard HealthyBlue gives members more flexibility in choosing their medical care and provides Healthy Rewards incentives to living a healthy lifestyle.
• Access to out-of-network providers.
• Pay nothing for preventive and sick office visits at your PCP, X-rays, lab tests, and generic prescriptions – not even a copay.
• Work toward the same goal as your doctor – getting you healthy and keeping you healthy while giving you a great opportunity to reduce your future health care costs.
• Partner with one doctor who knows and understands you – and all of your health care needs.
• Save money when you're healthy and stay healthy.

BlueChoice High Open Access

Here's what is new for 2012:

• The copay for Inpatient Hospital admissions will change from $150 per day with a $450 maximum per admission to $200 per admission.
• Generic drugs will no longer have a copay from a pharmacy or through mail order.
• We no longer cover infertility drugs that are associated with a non-covered fertility procedure.
• When you get a prescription for a brand name drug that is also available in a generic form, and your provider does not indicate "Dispense as written" (DAW), you will be responsible for the cost difference between the brand and the generic drug as well as the appropriate copay.
• BlueChoice Hich Open Access will cover infertility procedures only for couples in a spousal relationship as defined by the Office of Personnel Management.

Special Features

Your Standard HealthyBlue and/or BlueChoice High Open Access health plans include several additional benefits and services designed to help you live a healthy lifestyle and make choices about your health care options. Some of these include:

• First Help™ 24 hour nurse line, a 24/7 toll free number where you can talk to a Registered Nurse about your health concerns.
• CareEssentials, a care management program that focuses on your specific needs to promote prevention, identify health risks, and manage care to avoid costly treatments.
• National (Blue365) and local (Options Discount Program) programs that give you discounts on products and services in the areas of health and wellness, family care, health-focused financial services, and travel.

Go Green with CareFirst

This website is one way that you can find plan information quickly and easily, while helping preserve the environment. By accessing information, brochures, and forms online instead of on printed paper, we can reduce our impact and waste.

This website enables you to find your claims history and to review your benefit statements electronically. We have forms you may need, as well as copies of your 2012 CareFirst Plan Information Booklets and our supplemental literature. You can e-mail us directly with questions through My Account.

 

Medical Coverage

Program Details	BlueChoice	HealthyBlue
	In Network Only	In Network	Out-of-Network
Network	BlueChoice	BlueChoice	RPN (no balance billing) Out-of-Network (balance billing)
PCP Selection	Yes	Yes	Yes
Referrals	No	No	No
Member Liability
Individual Deductible	None	$500 per contract	$1,000 per contract
Family Deductible	None	$1,000 per contract	$2,000 per contract
Individual OOP Max – By member	$1,900 per member	$1,900 per contract	$3,600 per contract
Family OOP Maximum - By member	$5,500 family maximum	$5,500 per contract	$7,200 per contract
Preventive Care
Routine Adult Physical - includes exams and tests	No charge	No charge	Deductible, then no charge
Well Child Care(Includes exams and tests)	No charge	No charge	Deductible, then no charge
Cancer Screening - prostate and colorectal screening	No charge	No charge	Deductible, then no charge
Screening Mammograms and routine pap tests	No charge	No charge	No charge
Medical Care
Office Visits	$25 PCP copay $35 Specialist copay	No charge PC $35 Specialist	Deductible, then $70 per visit copay
Office visits for PT., OT, Speech - 60 visits per condition per calendar year	$35 per visit copay	Specialist - $35 Copay	Deductible, then $70 per visit copay
Office visits for Chiropractic - 20 visits per year for spinal manipulation	$35 per visit copay	Specialist - $35 Copay	Deductible, then $70 per visit copay
Diagnostic/Lab tests	No charge	No charge	Deductible, then $70 per visit copay
X-ray	No charge	No charge	Deductible, then $70 copay
Maternity Services
Office Visits - Pre and Post Natal Care	No charge after $35 for initial visit	No charge	Deductible, then no charge
Delivery	No charge for Physician, hospital admission copay applies	Deductible, then $200 hospital copay per admission	Deductible, then $500 hospital copay per admission
AI/IVF
AI	$35 copay for office visit	Deductible and 50%	Deductible and 50%
IVF	Not covered	Not covered	Not covered
Emergency and Urgent Care
Emergency Room (waived if admitted)	$100 copay	No charge	Deductible, then $70 copay (non-standard)
Urgent Care Center (participating)	$35 copay per participating urgent care center/$100 per non-participating center	$100 copay	$100 copay
Ambulance - medically necessary	No charge	$50 copay	$50 copay
Care while in a Facility
Inpatient Facility Services	$200 per admission	Deductible, then $200 copay per admission	Deductible, then $500 copay per admission
Inpatient Physician Services	No charge	Deductible, then no charge	Deductible than $70 copay
Outpatient Facility Services - Medical and Maternity	$50 copay	Deductible, then $35 copay per admission	Deductible, then $70 copay per admission
Outpatient Physician Services - medical and maternity	$35 copay	Deductible, then no copay	Deductible than $70 copay

Additional Coverage

Program Details	BlueChoice	HealthyBlue
	In Network Only	In Network	Out-of-Network
Mental Health
Office Visits	PCP - $25 per visit copay	No charge	Deductible, then $70 per visit copay
Inpatient Physician Services	No charge	No charge	Deductible, then $70 per visit copay
Inpatient Facility Services	$200 per admission	Deductible, then $200 copay per admission	Deductible, then $500 copay per admission
Outpatient Facility Services	$50 copay	No charge	Deductible, then $70 copay per admission
Outpatient Physician Services - medical and maternity	$35 copay	No charge	Deductible than $70 copay
Hearing Aids - Medically necessary hearing aids. One hearing aid per ear every 36 months covered up to the BlueChoice allowed benefit.	Provider can bill for amount over our allowance if written notification is provided to the member	Covered after Deductible. Provider can bill for amount over our allowed benefit if written notification is provided to the member	Covered after Deductible. Provider can bill for amount over our allowed benefit
Durable Medical Equipment (DME)	Member pays 25% of our allowance	Deductible than $35 copay	Deductible than $70 copay
Pharmacy Benefits
Generic	No copay	No copay	No copay
Brand Tier 2	$30	$30	$30
Brand Tier 3	$50	$50	$50
Mail Order Maintenance Drugs	Two copays for 90 day supply	Two copays for 90 day supply	Two copays for 90 day supply
Standard Diabetic Supplies	No copay	No copay	No copay
Brand/Generic Differential when generic is available	If doctor does not specify "Dispense As Written (DAW)", member pays difference between brand and generic in addition to copay	Member pay difference between brand and generic in addition to copay	Member pay difference between brand and generic in addition to copay
AI/IVF drugs	Covered only for AI	Covered only for AI	Covered only for AI
Tobacco Cessation - with a prescription, all FDA approved medications to include those that could otherwise considered OTC	No charge	No charge	No charge
Special Benefits
Annual Eye Exam	$10 from Davis provider	$10 from Davis provider $35 Specialist copay	Plan pays $33 and member pays balance
Glasses ad contacts	Discounts at Davis providers	Discounts at Davis providers	N/A
Dental	Dental Discount Program	Dental Discount Program	N/A

Payroll Deductions

2012 CareFirst Blue Choice Payroll Deductions
	High Open Access		Standard HealthyBlue
Premiums	Self - Plan 2G1	Self & Family - Plan 2G2	Self - Plan 2G4	Self & Family - Plan 2G5
Biweekly	$64.61	$148.87	$59.64	$133.76
Monthly	$139.99	$322.55	$128.83	$289.82
Postal - Category 1	$43.98	$102.83	$39.25	$88.28
Postal - Category 2	$41.40	$97.07	$36.87	$82.93

 

Plan Highlights

• No referrals, more flexibility.
• In-network and out-of-network benefits.
• Healthy Reward earned simply by completing 3 easy steps
• Preventive care visits with your in-network PCP at no charge - no deductible, not even a copay.
• Multiple plan offerings with all generic drugs offered at no cost.

 

In Network	Out of Network
No referrals necessary	No referrals necessary
Deductible $500 Indiv / $1,000 Family	Deductible $1,000 Indiv / $2,000 Family
Catastrophic coverage (most you'll spend in a calendar year) for individuals is $1,900; $5,500 for families.	Catastrophic coverage (most you'll spend in a calendar year) for individuals is $3,600; $7,200 for families.
No deductible or copay for annual adult physicals, well baby and child care, routine GYN visits, mammograms, or cancer screenings.	No copay after deductible for annual adult physicals, well baby and child care, routine GYN visits, mammograms, or cancer screenings.
$0 PCP / $35 Specialist copays for office visits for illness and physician office services.	Deductible, then $70 copays for office visits for illness and physician office services.
Inpatient facility copay of $200 per admission after deductible for all inpatient facility care to include mental health admissions.	Inpatient facility copay of $500 per admission after deductible for all inpatient facility care to include mental health admissions.
No charge for pre and post-natal maternity care. Deductible, then no-charge for delivery.	Deductible, then no charge for pre and post-natal maternity care and delivery up to allowed benefit.
Prescription copay of $0 generic, $30 tier 2 brand name drugs and $50 tier 3 brand name drugs for up to a 30 day supply.	Prescription copay of $0 generic, $30 tier 2 brand name drugs and $50 tier 3 brand name drugs for up to a 30 day supply.
Mail Order copay for up to a 90-day supply: $0 generic, $60 tier 2 brand named drugs and $100 for tier 3 brand name drugs.	Mail Order copay for up to a 90-day supply: $0 generic, $60 tier 2 brand named drugs and $100 for tier 3 brand name drugs.

For a more complete summary of your benefits, please see your 2012 Plan Information Booklet.

*Viewing & printing these forms requires Adobe Acrobat Reader. Download it free from the Adobe site.

 

Healthy Rewards

Standard HealthyBlue members can save money, in a few simple steps, when they partner with their Primary Care Physician (PCP) and get a Healthy Reward:

• Select a PCP
• Complete your Health Assessment and provide consent to allow it to be shared with your PCP (adults 18+)
• Have your PCP complete your Health and Wellness Evaluation Form
• Submit completed Health and Wellness Evaluation Form to CareFirst
• Submit online through My Account 
• Mail or fax form to CareFirst.
• Visit CareFirst.com > Healthy Rewards for more information.

Selecting a Primary Care Physician (PCP)

• Select a PCP for yourself and each of your covered dependents.
• Using in network physicians, offers you greater cost savings. Selecting an out of network physician increases the cost but gives you greater flexibility to choose any physician to provide the care you are seeking.
• Access http://www.carefirst.com/fedhmo for the most current listing of BlueChoice High Open Access PCPs from our online provider directory.
• Your plan will pay for covered services, when visiting participating CareFirst BlueChoice High Open Access providers and facilities.
• You may have to pay a copay or deductible for some services when you receive care or for out-of-network providers.

Out-of-area Coverage

• Limited to emergency or urgent care only.
• Members and their covered dependents planning to be out of the service area for at least 90 consecutive days are eligible for Away from Home Care®.

Discount Dental Coverage

• 20% - 40% on dental procedures, including routine office visits, x-rays, exams, fillings, root canals and even orthodontics.
• No claim forms, no maximums, no exclusions for pre-existing conditions and no deductibles.
• More than 700 participating General Dentists and Specialist in Maryland, Washington, DC, and Northern Virginia.

BlueVision Plan Highlights

• $10 copay for in-network routine eye examination with dilation (per benefit period).
• $40 copay for frames priced up to $70 retail.
• $40 copay, plus 90% of the amount over $70 for frames priced above $70 retail.
• $35 copay for single vision spectacle lenses.

Mail Service Pharmacy

Once you register with Walgreens Mail Service, you will have access to:

• Consulting pharmacists available 24 hours a day by phone.
• Refill options online, by mail, or phone.
• Automated phone system to check account balances and make payments.
• Email notification of order status.
• Multilingual pharmacists.

For a more details summary of your benefits, please see your 2012 Plan Information Booklet.

*Viewing & printing these forms requires Adobe Acrobat Reader. Download it free from the Adobe site.

 

Plan Benefits Highlights

• Your primary care physician (PCP) provides preventive care.
• Open Access feature - no referrals from your PCP to visit specialists.
• No deductible. No lifetime maximum.
• Catastrophic coverage (most you'll spend in a calendar year) for individuals is $1,900; $5,500 for families.
• No copay for adult physicals, routine GYN visits, mammograms, or cancer screenings.
• $25 PCP / $35 Specialist copays for office visits for illness, to include diagnostic services.
• No copay for x-rays or lab tests or inpatient physician services.
• Inpatient facility copay of $200 per admission on all inpatient facility care to include maternity/delivery and mental health admissions.
• No prescription copay for generic drugs through a pharmacy or mail order.
• Prescription copay of $30 for tier 2 brand name drugs and $50 for tier 3 brand name drugs for up to a 30 day supply.
• Mail Order copay for up to a 90-day supply: $60 tier 2 brand named drugs and $100 for tier 3 brand name drugs.

For a more complete summary of your benefits, please see your 2012 Plan Information Booklet.

*Viewing & printing these forms requires Adobe Acrobat Reader. Download it free from the Adobe site.

 

Selecting a Primary Care Physician (PCP)

• Select a PCP for yourself and each of your family members as well.
• PCPs must participate in the CareFirst BlueChoice High Open Access provider network and must specialize in family practice, general practice, pediatrics or internal medicine.
• Your plan will pay for covered services, as long as you visit participating CareFirst BlueChoice High Open Access providers and facilities.
• You may have to pay a copay or coinsurance when you receive care.

Out-of-area Coverage

• Limited to emergency or urgent care only.
• Members and their covered dependents planning to be out of the service area for at least 90 consecutive days are eligible for Away from Home Care®.

Discount Dental Coverage

• 20% - 40% on dental procedures, including routine office visits, x-rays, exams, fillings, root canals and even orthodontics.
• No claim forms, no maximums, no exclusions for pre-existing conditions and no deductibles.
• More than 700 participating General Dentists and Specialist in Maryland, Washington, DC, and Northern Virginia.

BlueVision Plan Highlights

• $10 copay for in-network routine eye examination with dilation (per benefit period).
• $40 copay for frames priced up to $70 retail.
• $40 copay, plus 90% of the amount over $70 for frames priced above $70 retail.
• $35 copay for single vision spectacle lenses.

Mail Service Pharmacy

Once you register with Walgreens Mail Service, you will have access to:

• Consulting pharmacists available 24 hours a day by phone.
• Refill options online, by mail, or phone.
• Automated phone system to check account balances and make payments.
• Email notification of order status.
• Multilingual pharmacists.

For a more details summary of your vision benefits, please see your 2012 Plan Information Booklet.

*Viewing & printing these forms requires Adobe Acrobat Reader. Download it free from the Adobe site.

 

Flexible Benefits Option

Under the flexible benefits option, we determine the most effective way to provide services.

• We may identify medically appropriate alternatives to traditional care and coordinate other benefits as a less costly alternative benefit.
• Alternative benefits are subject to our ongoing review
• By approving an alternative benefit, we cannot guarantee you will get it in the future
• The decision to offer an alternative benefit is solely ours, and we may withdraw it at any time and resume regular contract benefits
• Our decision to offer or withdraw alternative benefits is not subject to OPM review under the disputed claims process.

Please call us at (888) 789-9065 for more information about this program.