Member Plan Specific FAQs
Enrollment FAQs
If I already have CareFirst Standard HealthyBlue or BlueChoice High Open Access, do I need to do anything during Open Enrollment to keep my coverage?
No, if you wish to keep your existing coverage, you need not take any actions. All benefit changes will be posted to this website.
If I want to pick up CareFirst Standard HealthyBlue or BlueChoice High Open Access for 2012, what do I need to do?
- Active employees can apply thorough their agency.
- If your agency uses an automated enrollment system, changes process more quickly than suing a paper form 2809.
- Annuitants can make a change on line or by phone.
When is the Open Enrollment for 2012 benefits?
Open Season for 2012 benefits is November 14, 2011 through December 12, 2011.
- Federal regulations require an annual Open Season to be held each year from the Monday of the second full workweek in November through the Monday of the second full workweek in December.
- You must submit your Open Season enrollment change before midnight, Eastern Standard Time, on the last day of Open Season for it to be considered as timely filed.
- Open Season enrollment changes take effect the first day of your first full pay period in January of the following year.
When can I re-enroll my dependent child who has "aged off" my policy?
If you have an Self and Family membership, you may send the completed Add a Dependent to a Family Membership 
form to us anytime during Open Enrollment and your child will be effective on January 1, 2012.
How can I enroll or re-enroll my eligible dependent?
Fax the completed Add a Dependent to a Family Membership form to 410-505-6779 or mail it to:
ATTN: Federal Enrollment – RR165
CareFirst BlueChoice, Inc
10802 Red Run Blvd
Owings Mills, Maryland 21117-5157
What if I have a question that is not answered here?
Please refer to your 2012 Plan Information Booklet for your chosen CareFirst health plan.
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Are my family members covered?
Family members eligible for coverage under your family enrollment are your spouse (including a valid common law marriage) and children who are age 26 or younger, including legally adopted children, step-children, and recognized natural (born out of wedlock) children. Your employing office will look at the child's relationship to you as the enrollee to determine whether the child is a covered family member.
- Your foster children are included if they live with you in a regular parent-child relationship.
- An unmarried dependent child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 is also an eligible family member.
- Public Law 104-199, Defense of Marriage Act, states, "the word 'marriage' means only a legal union between one man and one woman as husband and wife, and the word 'spouse' refers only to a person of the opposite sex who is a husband or a wife."
What dependents qualify for coverage under their parents' policy?
Under the new law (Affordable Health Care Act):
- Children do not have to live with the enrolled parent, be financially dependent on the enrolled parent, or be students to remain covered until age 26.
- Children are covered under the enrolled parent's Self and Family enrollment even if they are eligible for or have their own employer-provided health insurance coverage.
- Children are not required to have any form of continuous health insurance, such as Temporary Continuation of Coverage, leading up to the effective date of their eligibility.
- If your child has a spouse and/or children, the spouse and/or children are not eligible family members under your Self and Family enrollment.
- For children who converted to an individual policy, they may no longer need that policy once they resume coverage under your Self and Family enrollment.
If you have an Self Only policy, you will follow the procedures to change to Self and Family coverage during Open Enrollment.
Can my under age 26 dependent child who has enrolled through Temporary Continuation of Coverage (TCC) revert back to my plan?
Children with a TCC FEHB enrollment will receive notice in their Open Season mailing. We advise them that they are again eligible for coverage under your Self and Family enrollment. You may add them to your family policy by completing the Add a Dependent to a Family Membership form. <-->
If my child under the age of 26 loses their own personal or employer-based coverage, can I add the child to my coverage?
If your child loses their personal or employer-based coverage, this would be a qualifying life event, and coverage can be extended. Procedures are the same as during Open Enrollment.
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What is the Affordable Health Care Act?
On March 23, 2010, President Obama signed the Affordable Health Care Act, (AHCA), Public Law 111-148. Beginning January 1, 2011, children, either married or unmarried, are covered under their parent's Self and Family enrollment up to age 26.
How will the Affordable Health Care Act affect me?
Your children between the ages of 22 and 26 or your married children who are currently ineligible for FEHB coverage may be added to your Self and Family enrollment and be covered up to age 26. To add your child to your existing Self and Family policy, please complete the Add a Dependent to a Family Membership form.
Under the new law:
- Children do not have to live with the enrolled parent, be financially dependent on the enrolled parent, or be students to remain covered until age 26.
- Children are covered under the enrolled parent’s Self and Family enrollment even if they are eligible for or have their own employer-provided health insurance coverage.
- Children are not required to have any form of continuous health insurance, such as Temporary Continuation of Coverage, leading up to the effective date of their eligibility.
- If your child has a spouse and/or children, the spouse and/or children are not eligible family members under your Self and Family enrollment.
- For children who converted to an individual policy, they may no longer need that policy once they resume coverage under your Self and Family enrollment.
How does the Affordable Health Care Act (AHCA) impact my Standard HealthyBlue or BlueChoice High Open Access coverage?
This plan is a "non-grandfathered health plan" under the Affordable Care Act. A non-grandfathered plan must meet immediate health care reforms legislated by the Act. Specifically:
- This plan must provide preventive services and screenings to you without any cost sharing.
- You may choose any available primary care provider for adult and pediatric care.
- Visits for obstetrical or gynecological care do not require a referral.
- Emergency services, both in- and out-of-network, are essentially treated the same (i.e., the same cost sharing, no greater limits or requirements for one over the other; and no prior authorizations).
What provisions of AHCA are already incorporated into the Federal Employee Health Benefit Program (FEHBP)?
All FEHBP plans already:
- Have no aggregate lifetime maximums
- Have no pre-existing medical condition exclusions
- Have no provisions to limit or exclude benefits should a member develop a medical problem after coverage goes into effect
How does the ACHA affect preventive care benefit under my Standard HealthyBlue or BlueChoice High Open Access?
Under the act, preventive care will have no copays or coinsurance. Your Standard HealthyBlue or CareFirst BlueChoice High Open Access will now:
- Cover routine physicals and well child care with no office copay
- Cover smoking cessation with no copay
- Cover prenatal vitamins, fluoride, and iron supplements under certain conditions, with no copay at the pharmacy
How does ACHA affect annual maximums under my Standard HealthyBlue or BlueChoice High Open Access?
ACHA indicates that "essential services" should not have annual maximums. This applies to dollar limits, not visit limits. This means that, as of January 1, 2011:
- You will no longer be limited to $1,400 per ear for hearing aids – we will cover up to our allowance
- We will also eliminate the $7,500 limit on Durable Medical Equipment, Medical Supplies and external prostheses
Are there any other changes that are due to ACHA or to the Mental Health Parity law of 2008?
Effective January 1, 2011:
- CareFirst BlueChoice will no longer require pre-authorization for outpatient mental health or substance abuse treatment
- Mental health and substance professional providers will be subject to the primary care office copay rather than the specialist copay.
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