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Note: The information below briefly describes important features about this health care program. It is not a contract. A detailed description of the benefits is included in the Evidence of Coverage. Please refer to the Evidence of Coverage for specific terms, conditions, limitations and exclusions.
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BlueChoice Advantage: CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc now offer a “tiered network” plan, called BlueChoice Advantage - designed to assist members in controlling the cost of health care.
These tiered network plans offer the cost savings and the freedom for members to visit any network doctor whenever they wish – with no gatekeeper and no referrals necessary.
BlueChoice Advantage allows members the flexibility to choose a health care provider when treatment is needed. When care is received from a BlueChoice network provider, specialist, hospital or other provider who participates in CareFirst BlueChoice's provider network, a lower out-of-pocket cost is incurred. However, this plan also allows members to receive care outside of the CareFirst BlueChoice network - from any provider – in exchange for a higher out-of-pocket cost.
Advantages:
- No PCP selection required
- No referrals needed to see a plan specialist+
- Freedom to choose any doctor, specialist or hospital - anytime you wish
- No claims to file when visiting a plan provider
- No balance billing for out-of-network services by CareFirst BlueCross BlueShield participating providers. Members can see a provider who is not in the Blue Cross Blue Shield network, but may pay a higher out-of-pocket cost and members typically must file their 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 all BlueChoice members a savings of between 20% to 40% on dental services.
3-Tier Prescription Drug Plan:
- Tier 1 - Generic copays offer the lowest cost to the member
- Tier 2 - Copays for formulary/preferred brand name drugs are higher than for generic drugs
- Tier 3 - Copays for nonformulary/nonpreferred brand name drugs have the highest level of copay
- Option may require prescription deductible and/or annual maximum
Additional Features:
- Care Essentials 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 24-hours a day, 7-days a week health care advice from registered nurses who can answer your employees' health care questions and help guide them to the most appropriate care.
Dental Plans May Be Purchased Separately:
Routine Vision Benefits:
- BlueVision provides vision coverage for members of the CareFirst BlueChoice medical plan and requires only a copayment for a routine examination and contact lens fittings and provides discounts on frames, lenses and contact lenses.
- BlueVision Plus is an enhanced vision plan that may be purchased separately. BlueVision Plus provides a routine eye examination and the opportunity to receive one pair of eyeglasses or a supply of contact lenses for a single copayment during each benefit period.
+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 the benefits booklet (also called Evidence of Coverage) for the specific services that require pre-authorization.
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