| 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. |
BlueChoice Opt-Out Open Access is a plan that offers the cost savings of an HMO and the freedom to visit any provider without a referral from a primary care physician (PCP). Members are required to choose a PCP upon enrollment.
With BlueChoice Opt-Out Open Access, members will pay a lower out-of-pocket cost when they receive care from providers who participate in CareFirst BlueChoice's network. They may also receive care outside the BlueChoice network, from any provider, but they will pay a higher out-of-pocket cost. With the Open Access feature, members do not need a referral from their PCP to receive most in- or out-of-network care. + This plan is only available to groups.
Advantages:
- Freedom to choose any doctor, specialist or hospital - anytime members wish
- 365 Days of Hospital Coverage
- No referrals needed to see plan specialists+
- No claims to file when visiting a BlueChoice provider
- Preventive Care and Wellness Benefits
- 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
- Family planning services
- Discount dental program offers BlueChoice members savings of 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
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 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:
- National Capital Area:
- Maryland:
Routine Vision Benefits*:
Frequently Asked Questions:
- Click here to get answers to Frequently Asked Questions regarding this plan.
Member Handbook:
*Out-of-Network benefits are not available for this service for Groups based
in the District of Columbia.
+While a referral is not needed to visit plan specialists, pre-authorization
may be needed for certain services. Also, speech, physical, and occupational
therapy services may require a recommendation for treatment from a PCP or specialist.
Please refer to the benefits booklet (also called Evidence of Coverage) for
the specific services that require pre-authorization.
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