In an effort to offer the highest level of customer satisfaction and product plans, the State of Maryland has added the following benefit enhancements to the product plans offered to State employees.
What's Happening – Effective July 1, 2012:
- POS members no longer need referrals to receive care from an in-network Specialist.
- New ID cards will be issued to all members regardless of product.
- $30 copayments for Specialists and Urgent Care Centers.
- $75 copayment for Emergency Room facility plus $75 Emergency Room physician.
- No change to Primary Care copayment.
- PPO and POS plans pay 90% of allowed benefit in-network and 70% of allowed benefit out-of-network for services not associated with a copayment.
- Annual out-of-pocket maximums added to in-network services to protect you from financial hardship (see the Benefit Chart in your Health Care Options Booklet for details).
Benefit Highlights and Enrollment Booklet (July 1, 2012 – June 30, 2013)
CareFirst BlueCross BlueShield's Preferred Provider Network (PPO) is offered to all active State of Maryland employees as well as all retirees, with or without Medicare, regardless of their place of residence.
Plan Highlights:
Medical Plan Benefits
By selecting CareFirst's PPO, you have the freedom to choose your own doctor or specialist, every time you need care.
- No referrals needed. You have direct access to any specialist.
- No primary care physician needed.
- Vision included with medical benefits.
- Out-of-network benefits available – subject to deductible and coinsurance.
- Unlimited lifetime maximum.
- Office visits are covered for minimal copay.
- In-network well child visits, physicals, and annual GYN exams are covered at 100% with no copay.
- No paper work for you. Our PPO physicians submit claims directly to us.
- Out-of-Area Coverage – You will receive one of the most widely recognized and accepted health care identification cards in the United States – BlueCard. So now, you can take your health care benefits with you – across the country and around the world.
- Advice Line – A 24-hour nurse-line, called FirstHelp, when all you need is a little advice.
- Options Discount Program – As a BlueChoice member, you will also receive access to our Options Discount Program, which provides you with discounts alternative therapies such as acupuncture, chiropractic services, yoga and much more.
Vision Benefits
- $45 allowance on frames
- $45 allowance on exam
- Set fee allowance for lenses and contacts
- Member balance billed at time of service
For answers to common questions, please review the Frequently Asked Questions.
For detailed information about your plan, please see your Evidence of Coverage PPO Benefit Guide.
Benefit Highlights and Enrollment Booklet (July 1, 2012 – June 30, 2013)
CareFirst BlueCross BlueShield's Point of Service (POS) is offered to all active State of Maryland employees as well as all retirees, with or without Medicare. When you enroll, you must select a primary care physician (PCP) within our regional network (Maryland, DC, northern Virginia).
Plan Highlights:
A POS plan offers:
- New! No referrals required for in-network specialists effective July 1, 2012.
- The flexibility to select any doctor you wish.
- When you need medical care, you can choose to see your PCP or you can go "out-of-network" to see any doctor you choose.
- When you see your PCP, you save money by paying fewer out-of-pocket costs.
- Each family member must select a primary care physician. Each member will receive an individual ID card identifying the PCP he or she selected.
- Two levels of benefits in one health plan. At the time you need care, you can visit your PCP or go "out-of-network" and visit any doctor you wish.
- Office visits are covered for a minimal copay when care is provided by your PCP or a referred specialist.
- In-network well child visits, physicals, and annual GYN exams are covered at 100% with no copay.
- Vision coverage included with medical benefits.
- Women's health coverage such as PAP tests and mammograms and men's health coverage including routine prostate screenings.
- No paper work for you. If you receive care from an POS doctor, he or she will submit claims directly to us.
- Out-of-Area Coverage is subject to "out-of-network" deductibles and coinsurance.
- Advice Line – A 24-hour nurse-line, called FirstHelp, when all you need is a little advice.
- Options Discount Program – As a BlueChoice member, you will also receive access to our Options Discount Program, which provides you with discounts alternative therapies such as acupuncture, chiropractic services, yoga and much more.
- Unlimited lifetime maximum.
Select a Primary Care Physician (PCP)
When you enroll in POS, you must select a PCP or your claims may be denied. Selecting a PCP is easy, just follow these steps:
- Find a Doctor online
- Inform CareFirst of your selection by:
- Calling Member Services at 1-800-225-0131, or
- Downloading, completing and returning the PCP Selection Form (34KB, 2 pgs.)
Vision Benefits
- $45 allowance on frames
- $45 allowance on exam
- Set fee allowance for lenses and contacts
- Member balance billed at time of service
For answers to common questions, please review the Frequently Asked Questions.
For detailed information about your plan please see your Evidence of Coverage POS Benefit Guide.
Benefit Highlights and Enrollment Booklet (July 1, 2012 – June 30, 2013)
CareFirst BlueCross BlueShield's Exclusive Provider Organization (EPO) is offered to all active State of Maryland employees as well as all retirees, with or without Medicare, regardless of their place of residence.
Plan Highlights
Medical Plan Benefits
By selecting the CareFirst EPO, you drive your own health care decisions by enjoying many hassle-free benefits with this plan.
Members selecting the EPO plan must select their providers from a National network and must stay in-network to receive coverage benefits.
- No referrals needed. You have direct access to any specialist.
- No primary care provider (PCP) needed.
- No paper work for you. Our participating physicians (with the PPO network) submit claims directly to us.
- Vision benefits included with medical benefits.
- No out-of-network coverage.
- Unlimited lifetime maximum.
- Advice Line – A 24-hour nurse-line, called FirstHelp, when all you need is a little advice.
- Options Discount Program – As a BlueChoice member, you will also receive access to our Options Discount Program, which provides you with discounts alternative therapies such as acupuncture, chiropractic services, yoga and much more.
Mental Health Benefits
- Mental Health Services – provided through CareFirst/Magellan Health Services.
- Inpatient treatment is covered at 100% of the allowed benefit. Preauthorization is required.
- Outpatient treatment is covered at 100% of the allowed benefit after a $15 co-pay.
Vision Benefits
- $45 allowance on frames
- $45 allowance on exam
- Set fee allowance for lenses and contacts
- Member balance billed at time of service
For answers to common questions, please review the Frequently Asked Questions.
For detailed information about your plan please see your Evidence of Coverage EPO Benefit Guide.
Benefit Highlights and Enrollment Booklet (July 1, 2012 – June 30, 2013)
*Note: PPO and POS mental health benefits are available through APS Healthcare.
