Transcript Open Enrollment for 2013 Benefits
A A C P S
Introduction to the BlueChoice HMO Plan
CareFirst BlueCross BlueShield is an independent licensee of the Blue Cross and Blue Shield Association.
® Registered trademark of the Blue Cross and Blue Shield Association. ® ’ Registered trademark of CareFirst, Inc.
Open Enrollment for 2013 Benefits
A A C P S
BlueChoice HMO
Benefit Network PCP Required Referrals Required Copays
BlueChoice Yes Yes
Independent Lab
$5 PCP $10 Specialist LabCorp – No charge
Preventive Services
No copay
Plan Highlights Benefit Urgent Care Center Emergency Room
$10 copay $50 copay; waived if admitted No charge
Inpatient Hospitalization Occupational, Physical, Speech Therapy
Combined 30 visits per condition/per yr
Open Enrollment for 2013 Benefits
A A C P S
BlueChoice HMO
Primary Care Physician At time of enrollment, you select a Primary Care Physician (PCP). Your PCP will be listed on your ID card. The PCP can be changed at any time, simply contact Member Services (800-628-8549).
Dependents may select their own PCP. Each member will have their own personalized ID card with PCP information
Open Enrollment for 2013 Benefits
A A C P S
BlueChoice HMO
Access to care through your Primary Care Physician or Specialist with referral You pay a $5 PCP or $10 Specialist co-pay No Deductible No coinsurance No need to file claim forms Independent Lab - Lab Corp
Open Enrollment for 2013 Benefits
A A C P S
BlueChoice HMO
Over 32,000 Providers in the MD, DC, Northern VA area Full 3 Year NCQA Accreditation BlueChoice Customer Service - 800-628-8549
Medical / Vision
will be on the same ID Card.
Dental
will be on a separate ID Card. Visit our website at
carefirst.com
to find a doctor, PCP or Specialist. You can also find information about our
Options
discount program, in addition to other services and resources CareFirst offers.
Open Enrollment for 2013 Benefits
A A C P S
Away From Home Care
Members who live in another part of the country for at least 90 consecutive days may be eligible for “
Away From Home Care
”.
Contact Member Services to enroll (telephone number is on the back of your ID card) and ask for the Away From Home Care Coordinator.
Once enrolled, you have access to routine and urgent care through an affiliated BCBS HMO.
Great program for out-of-state college students.
Open Enrollment for 2013 Benefits
A A C P S
BlueChoice HMO
Questions & Answers
Open Enrollment for 2013 Benefits
A A C P S
Open Enrollment for 2013 Benefits
A A C P S
The Benefits of Changing to the Triple Option Plan
CareFirst BlueCross BlueShield is an independent licensee of the Blue Cross and Blue Shield Association.
® Registered trademark of the Blue Cross and Blue Shield Association. ® ’ Registered trademark of CareFirst, Inc.
Open Enrollment for 2013 Benefits
A A C P S
BlueChoice Triple Option Plan 3 Health Care Plans in 1
Annual Deductible Individual Family Out-of-Pocket Individual Family Lifetime Maximum Co-pays Primary Specialist Coinsurance Triple Option Plan Level 1 Level 2 Level 3
N/A $200 $300 N/A $400 $600 N/A $500 $1,000 N/A $1,000 $2,000 Unlimited Unlimited Unlimited $10 $15 N/A $10 $15 N/A 100% 90% 80%
Open Enrollment for 2013 Benefits
A A C P S
BlueChoice Triple Option Plan 3 Health Care Plans in 1
Primary Care Physician At time of enrollment, you select a Primary Care Physician (PCP). Your PCP will be listed on your ID card. The PCP can be changed at any time, simply contact Member Services (800-628-8549).
Dependents may select their own PCP. Each member will have their own personalized ID card with PCP information
Open Enrollment for 2013 Benefits
A A C P S
BlueChoice Triple Option Plan 3 Health Care Plans in 1
Level 1 (BlueChoice HMO) Access to care through your Primary Care Physician or Specialist with referral You pay a $10 PCP or Specialist co-pay No Deductible No coinsurance No need to file claim forms Independent Lab - Lab Corp
Open Enrollment for 2013 Benefits
A A C P S
BlueChoice Triple Option Plan 3 Health Care Plans in 1
Level 2 (PPO Providers, Local and National) Access to care through a PPO Provider – no referral required You pay a $15 co-pay for office visits After you meet $200 individual deductible, services are covered at 90% AB up to the $500 maximum out-of pocket.
No need to file claim forms
Open Enrollment for 2013 Benefits
A A C P S
BlueChoice Triple Option Plan 3 Health Care Plans in 1
Level 3 (Participating and Non-Participating Providers) Direct access to care through participating or non participating providers After you meet your annual $300 individual deductible, services are covered at 80% of the allowed benefit up to the $1,000 maximum out-of-pocket.
Participating Providers may not balance bill, however, Non-Participating Providers may balance bill the difference between the allowed benefit and total charge
Open Enrollment for 2013 Benefits
A A C P S
Away From Home Care
Members who live in another part of the country for at least 90 consecutive days may be eligible for “
Away From Home Care
” Contact Member Services to enroll (telephone number is on the back of your ID card) and ask for the Away From Home Care Coordinator.
Once enrolled, you have access to routine and urgent care through an affiliated BCBS HMO.
Great program for out-of-state college students
Open Enrollment for 2013 Benefits
A A C P S
BlueChoice Triple Option Helpful Reminders
Select PCP at time of enrollment. You may change your PCP at any time during the year.
When accessing Level 1 Benefits, remember to get a referral for specialty care from your PCP. Level 2 does not require a referral. Remember to use Lab Corp for Level 1 Benefits. Quest Diagnostic will be processed under Level 2.
Medical / Vision
will be on the same ID Card.
Dental
will be on a separate ID Card.
Open Enrollment for 2013 Benefits
A A C P S
BlueChoice Triple Option Helpful Reminders
Visit our website at
carefirst.com
to find a doctor, PCP or Specialist. You can also find information about our
Options
discount program, in addition to other services and resources CareFirst offers.
Open Enrollment for 2013 Benefits
A A C P S
BlueChoice Triple Option
Questions & Answers
Open Enrollment for 2013 Benefits