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About CareFirst
Profiles
The following characters are fictional and designed to represent individuals, couples and families who have different needs, but are all looking for one thing: health insurance.
"Andy" -- Single, renter, age 24, earning $30,000, no children
 Andy is single and in his mid-twenties. A recent college grad, he rents a small apartment and just bought a sports car to celebrate his first-year anniversary as an accountant for a mid-size company. He has no children and his income is approximately $30,000. Andy is young and busy with no time for claims and paperwork. Also, he is seeing the same doctor as when he was under his parents' plan as a college student.
- Medical needs: Few. Andy mostly goes to the doctor's office for preventive visits such as his annual physical.
- Goal: To have health coverage without spending a lot.
- Best fit : Since Andy's doctor is in the BlueChoice and MPOS network, an HMO or a POS plan is a good choice for him. HMO and POS plans typically have the least expensive premium and he most likely won't have any claims to file. Another good choice would be a BlueFund Consumer Directed Health Plan (CDH) which rolls over unused funds, which will benefit Andy down the road in case of emergency.
CareFirst plans that fit this scenario:
"Carole" - Single parent, homeowner, age 38, earning $50,000, one child
 Carole is 38 years old, divorced and mother of Sasha, age 7. Carole owns a modest Cape Cod-style home in the suburbs. She is a real estate agent and enjoys a flexible schedule, mainly to be available for her daughter, Sasha, who suffers from asthma. Carole takes Sasha to a specialist who is closely involved in guiding her medical needs.
- Medical needs: Above-average. Because Sasha's asthma flares up from time-to-time, she needs direct access to a specialist to help manage her asthma. Also, in case of an emergency, it is important to have access to a 24-hour nurseline.
- Goal: To stabilize Sasha's condition and put her on an asthma management plan. Also, Carole is looking to continue the visits with Sasha's specialist while keeping costs down. Plus, she wants access to a help line in case of emergency.
- Best fit: Since Carole wants direct access to Sasha's specialist while keeping costs down, the best fit is an HMO or POS plan that doesn't require PCP referrals. This plan is cost-effective and she'll have a broad range of specialists available in-network, and if she chooses the POS plan, access to out-of-network providers, too. Also, Carole can get 24-hour, seven day-a-week medical advice for her daughter through FirstHelp, a toll-free medical phone service staffed by nurses. This feature is unique to CareFirst's BlueChoice medical products.
CareFirst plan that fits this scenario:
"Jason and Cynthia" -- Married, homeowners, mid-30's, household income of $97,000, no children
 Jason and Cynthia have been married for two years and have no children. They work downtown, own a three-bedroom townhouse in the city and have one car. Their household income is approximately $97,000. They would like to begin having children.
- Medical needs: They plan on starting a family within the year.
- Goal: Jason and Cynthia are young professionals, living comfortably, with plans of starting a family. They would like medical coverage that allows them to access any kind of specialist without needing a PCP referral. In addition, they are from the Midwest and plan on visiting their families often. Therefore, they will need medical coverage across the U.S.
- Best fit: A Preferred Provider Organization plan (PPO) will give them the biggest network with the most flexibility in choosing a doctor. PCP referrals are not necessary and preferred providers usually handle the paperwork. PPO's tend to be more expensive than HMO and Point-of-Service plans (POS), but Jason and Cynthia will have the most flexibility in choosing the doctor they want. In addition, they will have access to providers nationwide through the BlueCard PPO program. Another good choice is a BlueFund Consumer Directed Health plan (CDH) where they can plan for future health expenses by putting pretax money aside and having it build year-after-year. Also, once Cynthia is pregnant, she should enroll in CareFirst's Great Beginnings, which is a free prenatal care program for members.
CareFirst plans that fit this scenario:
"Mike and Karen" - Married, homeowners, early 50's, household income of $160,000, two college-age children
 Mike and Karen are in their early 50's, have owned their home for 25 years and are on the verge of becoming empty-nesters since one child (Ryan, 20) is a sophomore in college and another is just starting (Chris, 18). Both children go to out-of-state colleges. Mike is partner in a major law firm and Karen works part-time as a dental hygienist. Since their children are out of the house, they are eager to start traveling more.
- Medical needs: Mike and Karen are heading into the second 50 years of their lives and their children are active (downhill skiing, surfing) and attend out-of-state colleges.
- Goal: Mike and Karen want their children to have good coverage while they're away at school. They also want flexible coverage for themselves in case of unforeseen health issues. They plan on traveling more, so coverage that is attainable across the country is important to them.
- Best fit: A plan that offers out-of-state coverage is the best fit for all since the children are out-of-state and Mike and Karen plan on traveling more.
CareFirst plan that fits this scenario:
- BluePreferred (PPO) - This plan offers the BlueCard PPO program, which allows members to receive in-network benefits while they live or travel outside our service area.
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