Blue Cross and Blue Shield
BlueChoice Opt-Out Plus (POS)

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 is a point-of-service (POS) plan that offers the cost savings of an HMO with the freedom of choice and out-of-pocket savings received through traditional CareFirst BlueCross BlueShield coverage. Members are required to choose a primary care physician (PCP) upon enrollment.

BlueChoice Opt-Out Plus allows the flexibility of choosing health care providers when treatment is needed. When care is received from the PCP, specialists, hospitals and other providers who participate in CareFirst BlueChoice's provider network using written referrals, a lower out-of-pocket cost is incurred. The plan also allows members to receive care outside the CareFirst BlueChoice network from any provider with a higher out-of-pocket cost. This plan is only available to groups.

Advantages:

  • Freedom to choose any doctor, specialist or hospital
  • No claims to file when visiting a participating provider
  • No balance billing for out-of-network services rendered by CareFirst BlueCross BlueShield providers. Members can see a provider who is not in the Blue Cross and Blue Shield network, but they may pay a higher out-of-pocket cost and they 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, with no written referrals required for routine gynecological and obstetrical care
    • 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 the Evidence of Coverage for more information

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:

Routine Vision Benefits:

Frequently Asked Questions:

  • Click here to get answers to Frequently Asked Questions regarding this plan.

Member Handbook:

For more information about this plan, contact our Member Services Department at the phone number on your member ID card.

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