| 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. |
BluePreferred Open Enrollment is a preferred provider organization (PPO) health care plan that is available regardless of your health condition. The plan offers the flexibility to choose your own doctor or hospital and control health care costs. You save money when you obtain your health care from our large Preferred Provider network, and you can self-refer to any physician or provider in the network.
If you choose to have medical care provided by a physician or hospital outside of the preferred provider network, out-of-network benefits are available for covered services, but you will incur higher out-of-pocket expenses.
Advantages:
- Members do not need to choose a Primary Care Physician (PCP) and will never need a referral.
- Freedom to visit any doctor or hospital outside the network and still be covered. You will just share more of the cost. *
- Access to one of the largest PPO provider networks in Maryland, D.C., and Northern Virginia area, with more than 1,700 provider locations.
- Fewer paperwork hassles than traditional plans. All Select Preferred Providers and Participating Providers will typically file claims for members.
- No balance billing** when using participating hospitals or providers.
- Travel coverage. The BlueCard® PPO Program allows BluePreferred members to receive in-network benefits while they live or travel outside our service area.
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
Medical Benefits:
- Surgery
- Hospitalization/inpatient services up to 365 days
- Outpatient hospital services
- Emergency care for injury and illness
- Office visits for illness
- Diagnostic tests and X-rays
- Allergy testing and injections
- Home health care
- Hospice care
- Durable medical equipment
- Medical supplies
3-Tier Prescription Drug Plan:
- $100 Deductible
- $10 Generic copay
- $25 Preferred brand copay
- $45 Non-preferred brand copay
- $1500 annual benefit maximum
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
- 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 offers health care 24-hours a day, 7-days a week. Registered nurses are available to answer health care questions and help guide members to the most appropriate care.
Member Handbook:
Purchasing this Plan:
For information about purchasing this plan, call us at 443-394-6691 or toll-free at 1-866-241-6442.
A Dental Plan May Be Purchased Separately:
BluePreferred Open Enrollment members may purchase separate dental HMO coverage through CareFirst BlueCross BlueShield (CareFirst). The plan, administered by The Dental Network, Inc. (TDN), offers dental benefits for the price of a copay through a network of primary care dentists. Orthodontia coverage for adults and children is included.
Routine Vision Benefits:
BluePreferred Open Enrollment members receive vision coverage through BlueCross BlueShield (CareFirst). The plan, BlueVision, is administered by Davis Vision, Inc., a national provider of vision care services. For a $10 copayment, members receive an annual routine examination and discounts on frames and lenses or contact lenses.
*If you choose to have medical care provided by a physician or hospital outside of the preferred provider network, out-of-network benefits are available for covered services, but you will incur higher out-of-pocket costs and be responsible for filing the claim.
** 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.
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