HealthyBlue 2.0/HealthyBlue Advantage Member ... - CareFirst

HealthyBlue 2.0 / HealthyBlue AdvantageBOK5448-1S (5/12)CareFirst BlueChoice, Inc.your member handbook

Welcome to HealthyBlueThank you for choosing HealthyBlue, the next generation of health benefits from theCareFirst 1 family of health care plans. Enrolling in HealthyBlue is an important step towardtaking control of your health care. This handbook covers the HealthyBlue 2.0, HealthyBlue2.0 HRA, HealthyBlue 2.0 HSA, HealthyBlue Advantage, HealthyBlue Advantage HRA andHealthyBlue Advantage HSA health care plans.With the HealthyBlue plans, you now have access to a new health care solution with theflexibility to change as your needs change, along with the opportunity to earn a reward forliving a healthy life. HealthyBlue Advantage members also have the flexibility of receivingIn-Network benefits by using BlueCard ® PPO network providers when needing care outsideof MD, DC and Northern VA.HealthyBlue is a health care plan focused on you:➤ Pay nothing for preventive office visits - not even a copay when you use anIn-Network provider. 2➤ Get rewarded when you complete 3 simple steps➤ Work toward the same goal as your doctor – getting you healthy & keepingyou healthy while giving you a great opportunity to reduce your futurehealth care costs.➤ Partner with one doctor who knows and understands you – and all of yourhealth care needs.➤ Choose how you will get your care, each time you need care – it’s up to you.1All references to CareFirst refer to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. collectively.2If a member accesses care from out-of-network providers, there will be out-of-pocket expenses for the services mentioned.We’re committed to providing our memberswith the highest level of service possible. Theinformation included in this handbook willprovide you with an overview that describessome important features to help you manageyour health care.Please take a moment to review thisinformation and keep it in a safe place forfuture reference. This handbook, along withyour Summary of Benefits and enrollmentmaterials, gives you tips on how to receive thehighest level of health care benefits. However,this isn’t a contract. A detailed description ofspecific terms, as well as the conditions andlimitations of your coverage, is included inyour Evidence of Coverage/Agreement.As always, please contact Member Servicesat the phone number listed on the back of yourmember ID card if you have any questionsregarding your coverage.We appreciate your business and lookforward to serving you in the future.Focused on you.Keep in a safe place for future reference.➤ You may also view this handbook online atwww.carefirst.com in the Members & Visitors section.HealthyBlue Member Handbook1

Important InformationEmergency Assistance and Medical AdviceKnowing when to get the right care, at the right time and at the right place isimportant in managing your health care.➤ If you or a family member is experiencing a medical emergency, call 911 orgo to the emergency room.➤ If you need routine care or have a health problem you should call yourpersonal, primary care provider (PCP).➤ If you can’t reach your PCP and have questions about your health, anillness, or an urgent medical condition, call FirstHelp . Registerednurses are available to help you make a decision concerning the mostappropriate level of care.McKesson, Inc. is an independent company that provides 24-hour health care advice services under the name FirstHelp .McKesson, Inc. does not provide CareFirst BlueChoice products or services. FirstHelp is solely responsible for the advice services.FirstHelp : 24-Hour Health Care Advice LineToll-free: (800) 535-9700Hospital Authorization/Utilization ManagementYour HealthyBlue provider should obtain any necessary admissionauthorizations for covered services.Toll-free: (866) PREAUTH (773-2884)Mental Health/Substance Abuse Care – 24 Hours a day, 7 days a weekCall the phone number on your member ID card under the Mental Health/Substance Abuse Service and Authorization section.AdditionalTelephone NumbersPharmacy Benefits(CVS Caremark)*(800) 241-3371Vision Benefits(Davis Vision)**(800) 783-5602Away From Home Care ®(888) 452-6403BlueCard Worldwide ® ServiceCenter (inside the U.S.)(800) 810-BLUE (2583)BlueCard Worldwide ® ServiceCenter (outside the U.S.)(804) 673-1177Member ServicesPlease call the Member Services phone numberlisted on your member ID card.TTY Telephone NumbersMaryland Relay Program (toll-free)(800) 735-2285National Capital Area TTY(202) 479-3546Multi-lingual translators are available forassistance through Member Services.Contact Member Services for benefit andcontract information. When writing to CareFirstBlueChoice, Inc. (CareFirst BlueChoice), alwaysinclude your Member Identification Number.Please address your correspondence to:Mail AdministratorP.O. Box 14114Lexington, KY 40512-41142 HealthyBlue Member Handbook* CVS Caremark is an independent company that provides pharmacy benefitmanagement services to CareFirst BlueChoice members.** Davis Vision, Inc. is an independent company and administers the vision benefitsfor CareFirst BlueChoice.

ContentsYour HealthyBlue 2.0 Member ID Card 4Your HealthyBlue Advantage Member ID Card 5HealthyBlue — The Basics 6Your PCPYour Healthy RewardGet Your Healthy RewardHealthyBlue Prescription BenefitsCareFirst BlueChoice &CareFirst PPO Network Providers 10Frequently Asked Questions 12Emergency and Urgent Care 15Urgent Care CentersFollow-Up CareMedical EmergenciesCoverage Outside the Area 17BlueCard ® Network — Across the Country and WorldwideAway From Home Care ® ProgramSeeing Mental Health/ Substance Abuse Specialists 19How to Obtain In-Network Mental Health/Substance Abuse CareHow to Obtain Out-of-Network Mental Health/Substance Abuse CareAdditional Benefits 20Dental BenefitsVision BenefitsHealth + Wellness 22Staying HealthyHealth AssessmentGetting HealthyDealing with the UnexpectedLiving with a ConditionHealth and Wellness ToolsAdministration of Your Plan 25Personal & Enrollment ChangesFiling a Claim for ReimbursementProvider ReimbursementEnding or ContinuingYour Coverage 28Ending Your CoverageContinuing Your CoveragePortability (HIPAA)Member’s Rights andResponsibilities 30Rights of MembersNew Technology AssessmentHSA and HRA Plans 31Definition of Terms 38Index 40HealthyBlue Member Handbook3

Your HealthyBlue 2.0 Member ID CardTIP: Alwayscarry yourmember IDcard with youat all times andpresent yourcard when youreceive care.Your member ID card identifies you as a HealthyBlue 2.0 member and containsimportant information about you, your personal primary care provider (PCP), andsome of your eligible benefits. This is the card you present to your PCP, specialistor hospital to receive care. Always carry your member ID card with you.The diagram to the right explainsthe information on your member IDcard. Please take a moment to reviewyour card. If any of the information isincorrect, please contact the MemberServices phone number on yourmember ID card immediately, so theycan assist with correcting any errors.This is a sample HealthyBlue 2.0 IDcard. Please review your personal card,and the cards of your dependents thatare covered members, for your IDnumber and information specific toyour coverage. Remember to destroyany old cards and always presentyour current member ID card whenreceiving services from a provider.The back of your member ID cardincludes medical emergency assistanceand mental health/substance abusephone numbers, instructions and anaddress for filing claims and sendingcorrespondence. If your member IDcard is lost or stolen, please contactMember Services immediately for areplacement.Empty suitcase means you have accessto other Blue Cross and Blue Shieldplan providers outside the CareFirstBlueChoice Service Area, but will becovered out of network1236Member NameJOHN DOEMember IDJHA999999999GroupXXXXRx Bin: 004336 PCN: ADVBCBS Plan 080/580Local CareFirst providers mail to:Mail AdministratorPO Box 14116 (for claims)Lexington, KY 40512-4116PO Box 14114 (for correspondence)Lexington, KY 40512-4114CareFirst BlueChoice, Inc. and CareFirst BlueCrossBlueShield are both independent licensees of theBlue Cross and Blue Shield Association.XXXX-1S (9/11)12345678Member NameOPEN ACCESSPCP NameSmith, JoeYour Member ID card NumberYour Group ID NumberCopayCD0000 P00 S00 ER000 RX DHwww.carefirst.comMember Services: 866-452-2217Your Primary Care Provider’s nameCopays and CoinsuranceProvider Claims and Benefits: 800-842-5975Hospital Precert: 866-773-2884Mental Health/Substance Abuse: 800-245-701324hr FirstHelp: 800-535-9700To locate Participating Providers outside theCareFirst BlueCross BlueShield service area,call 800-810-2583DH - 888-833-8464DN - Refer to Member Services numberClaims and Correspondence AddressesMember Services and other importantphone numbersSuitcase45784 HealthyBlue 2.0 Member Handbook

Your HealthyBlue Advantage Member ID CardYour member ID card identifies you as a HealthyBlue Advantage member andcontains important information about you, your personal primary care provider(PCP), and some of your eligible benefits. This is the card you present to your PCP,specialist or hospital to receive care. Always carry your member ID card with you.The diagram to the right explainsthe information on your member IDcard. Please take a moment to reviewyour card. If any of the information isincorrect, please contact the MemberServices phone number on yourmember ID card immediately, so theycan assist with correcting any errors.This is a sample HealthyBlueAdvantage ID card. Please review yourpersonal card, and the cards of yourdependents that are covered members,for your ID number and informationspecific to your coverage. Rememberto destroy any old cards and alwayspresent your current member IDcard when receiving services from aprovider.The back of your member ID cardincludes medical emergency assistanceand mental health/substance abusephone numbers, instructions and anaddress for filing claims and sendingcorrespondence. If your member IDcard is lost or stolen, please contactMember Services immediately for areplacement.Suitcase with PPO written insidemeans you have access to other BlueCross and Blue Shield plan providersoutside the CareFirst BlueChoiceService Area through In-Networkbenefits.1236Member NameMember JOHN DOE NameJOHN Member DOE IDMember JHA999999999 IDJHA999999999GroupGroup XXXXXXXXRx Bin: 004336 PCN: ADVRx BCBS Bin: Plan 004336 080/580 PCN: ADVBCBS Plan 080/580Local CareFirst providers mail to:Mail AdministratorLocal PO Box CareFirst 14116 providers (for claims) mail to:Mail Lexington, Administrator KY 40512-4116PO PO Box 14116 14114 (for (for claims) correspondence)Lexington, KY KY 40512-4116 40512-4114PO Box 14114 (for correspondence)Lexington, KY 40512-4114CareFirst BlueChoice, Inc. and CareFirst BlueCrossBlueShield are both independent licensees of theCareFirst Blue Cross BlueChoice, and Inc. Shield and Association. CareFirst BlueCrossBlueShield are both independent licensees of theBlue XXXX-1S Cross (9/11) and Blue Shield Association.XXXX-1S (9/11)12345678Member NameOPEN ACCESSOPEN ACCESSPCP NamePCP Smith, Name JoeSmith, JoeYour Member ID card NumberYour Group ID NumberYour Primary Care Provider’s nameCopays and CoinsuranceCopayCopay CD0000 P00 S00 ER000 RX DHCD0000 P00 S00 ER000 RX DHwww.carefirst.comMember Services: 866-452-2217www.carefirst.comMember Services: 866-452-2217Provider Claims and Benefits: 800-842-5975Provider Hospital Claims Precert: and 866-773-2884Benefits: 800-842-5975Mental Health/Substance Abuse: 800-245-7013Hospital 24hr FirstHelp: Precert: 800-535-9700866-773-2884Mental Health/Substance Abuse: 800-245-701324hr To locate FirstHelp: Participating 800-535-9700 Providers outside theCareFirst BlueCross BlueShield service area,To call locate 800-810-2583 Participating Providers outside theCareFirst BlueCross BlueShield service area,call DH 800-810-2583- 888-833-8464DN - Refer to Member Services numberDH - 888-833-8464DN - Refer to Member Services numberClaims and Correspondence AddressesMember Services and other importantphone numbersSuitcase4578HealthyBlue Member Handbook5

HealthyBlue — The BasicsAs a HealthyBlue member, you’re now part of the health care program that brings together the healthbenefits you want and the cost savings you need, with the goal of keeping you healthy. And, as youwould expect from CareFirst BlueChoice, you have access to a large network of quality providers withwhich to partner.HealthyBlue enables you to choose when, how and by whom your health care is administered. To ensureyou receive the highest level of benefit, both in your health and in your wallet, select an In-Networkprovider when you need care. You may also receive your care from out-of-network providers, but youmay have to pay higher costs for this added flexibility.HealthyBlue 2.0 PlansYou have the freedom to visit any doctorwith any HealthyBlue 2.0 plan, regardless ofwhether they participate in one of CareFirst’sprovider networks. However, greater flexibilitycomes with higher costs to you, so be sure youunderstand the difference between a CareFirstBlueChoice network provider and an out-ofnetworkprovider.HealthyBlue 2.0In-Networkyou pay: $Visit any CareFirst BlueChoice provider.No referrals required.CareFirst BlueChoice Provider NetworkOut-of-Networkyou pay: $$Visit any CareFirst PPO NetworkProviderVisit a Non-Participating Provider.Balance billing may apply.CareFirst Preferred ProviderOrganization (PPO) NetworkNon-Participating ProviderHealthyBlue Advantage PlansRemember, with the HealthyBlue Advantageplans, you have choices and control. Keep inmind that members who receive care outside theCareFirst service area should use the BlueCard ®PPO network to obtain In-Network benefits.Note: Your out-of-network coverage allows you andyour family members to seek treatment from anycovered provider of your choice. At the time youreceive treatment from a provider who does notparticipate with CareFirst BlueChoice or anotherBlue Cross and Blue Shield plan, you may need toprovide payment in full to the hospital, doctor orother covered provider.HealthyBlue Advantage6 HealthyBlue Member Handbook

HealthyBlue: The BasicsYour Out-of-Pocket MaximumYour out-of-pocket maximum is the maximumamount you’ll pay for covered services duringyour benefit period. Should you reach yourout-of-pocket maximum, you will no longer berequired to pay copayments or your share of thecoinsurance for the remainder of that benefitperiod. Most amounts you pay towards yourcopays and/or coinsurance will count towardsyour out-of-pocket maximum.*You’ll have a different out-of-pocket maximumfor In-Network vs. Out-of-Network benefits.If more than one person is covered under yourplan, once the family out-of-pocket maximum issatisfied, no copays or coinsurance amounts willbe required for anyone covered under your plan.Out-of-pocket maximum requirements vary basedon your coverage level (e.g. individual, family) aswell as the specific plan selected. Members shouldrefer to their Evidence of Coverage/Agreement fordetailed out-of-pocket maximum information.*The deductible, coinsurance and copayments formost services may be used to meet out-of-pocketmaximum. Review your Evidence of Coverage/Agreement for more details on what applies to yourout-of-pocket maximum.Your PCPBetter health begins when you select yourCareFirst BlueChoice PCP and begin to develop arelationship, so choose a PCP if you haven’t already.You, and each of your covered family members,will need to select a PCP or nurse practitioner ifenrolled in any of the HealthyBlue 2.0 plans. ThePCP must participate in the CareFirst BlueChoiceprovider network as a PCP.If you are enrolled in any HealthyBlueAdvantage plan, you are not required to selecta PCP. However, you will need to select a PCP toqualify for the Healthy Reward. If you are locatedin the CareFirst BlueChoice Service Area, youwill need to select a PCP who participates in theCareFirst BlueChoice network as a PCP. If youreside outside the CareFirst BlueChoice ServiceArea you will need to select a BlueCard® PPOprovider specializing in family practice, pediatrics,internal medicine or geriatrics.HealthyBlue was designed to encourage greaterinteraction between you and your PCP as you bothwork toward the goal of a healthier you.Your PCP:➤ Knows and understands all your healthcare needs.➤ Is informed about your medical history.➤ Provides basic medical care.➤ Prescribes medications.➤ Works with you to complete your Healthand Wellness Evaluation.➤ Coordinates care and treatment, withhigh quality CareFirst BlueChoice specialistsand centers of excellence.Your Healthy RewardYour path to good health and a Healthy Rewardbegins as soon as you enroll in HealthyBlue. Thesooner you begin, the sooner you’ll qualify foryour reward. All steps must be completed within180 days of your effective date.You can qualify for your reward in 3 easy steps!Step 1: Select a PCP (this is requiredfor members in all HealthyBlueproducts)➤ If you or your family members didn’t select aPCP when you enrolled, select one by visitingwww.carefirst.com/myaccount or call theMember Service phone number listed on yourmember ID card.Steps 2 & 3: Complete the HealthAssessment and the Health &Wellness Evaluation Form. These stepscan be completed in any order within180 days from your effective date.➤ To qualify for the Healthy Reward, you mustcomplete the Health Assessment-online(HealthyBlue members 18+ only) and consentto sharing the information with your PCP.➤ Register online for My Account atwww.carefirst.com/myaccount. Have yourmember ID card number handy and click“Register now,” to create your usernameand password. From the My Accounthome page, choose the Manage My Healthtab and under “Health Assessment,” click“Begin Assessment. Then, simply answersome health and lifestyle questions.Remember to check the consent box toshare the information with your PCP.➤ If you don’t have internet access, call (866)454-5375 to request a paper copy of theHealth Assessment.Tip: You maychange your PCPany time online atwww.carefirst.com/myaccount.HealthyBlue Member Handbook7

HealthyBlue: The Basics➤ Work with Your PCP to Complete the Healthand Wellness Evaluation – then submit it toCareFirst BlueChoice! Make sure to submitthe completed form within 180 days of youreffective date using one of the followingmethods:➤ Login to My Account at www.carefirst.com. Click on “My HealthyBlue Rewards”under the Manage My Health tab andselect “Qualification.” Click on “BeginEvaluation” to enter all of the informationthat your Provider wrote on your form; or➤ Scan and save the form in JPG, PDFor TIFF format. Login to My Accountat www.carefirst.com and click on “MyHealthyBlue Rewards” under the ManageMy Health tab. Click on “Upload yourHealth and Wellness Evaluation Form” tobrowse for your document and upload it; or➤ Fax it to (800)354-8205; or➤ Mail the form to:CareFirst BlueChoice, Inc.Mail AdministratorP.O. Box 14116Lexington, KY 40512-4116When you go for the Health and WellnessEvaluation visit with your PCP, be sure to bringthe Health and Wellness Evaluation Form withyou. You can download a copy from www.carefirst.com/healthyblue. Your PCP can’t complete yourevaluation without this important form.So that you’re familiar with what the formlooks like, below is a snapshot:Get Your Healthy RewardOnce CareFirst BlueChoice receives your Healthand Wellness Evaluation Form and your onlineHealth Assessment is complete (with the consentportion signed).For more information about the Healthy Reward,please visit www.carefirst.com/healthyblue.Please note: Children under 2 are not eligible to earnthe reward.Remember: You have 180 days to qualifyfor your Healthy Reward.HealthyBlue Prescription BenefitsYour coverage may include benefits for prescriptiondrugs. Please review your Evidence of Coverage/Agreement to determine whether or not you havebenefits for your prescription medications underyour CareFirst BlueChoice plan.CareFirst BlueChoice uses a Preferred Drug Listwhich is a list of Generic certain Preferred Branddrugs. Drugs that aren’t on the Preferred Drug Listmay be covered as part of your plan, although youmay have to pay higher out‐of‐pocket costs forthese drugs.If you’re prescribed a drug that is not on thePreferred Drug List, discuss with your doctorsome lower‐cost alternatives.You can rest easy knowing your medicationshave been reviewed for quality, effectiveness,safety and cost by a committee of doctors andpharmacists who serve in the CareFirst BlueChoiceregion. The Preferred Drug List changes frequentlyin response to the Food and Drug Administration(FDA) requirements and is also adjusted when aGeneric drug is introduced for a brand name drug.When that happens, the Generic will be added tothe Preferred Drug List.8 HealthyBlue Member Handbook

HealthyBlue: The BasicsPrior authorizationSome prescriptions require advanced approvalbefore they can be filled. As a result, a priorauthorization is used to ensure you meet thenecessary medical criteria to obtain a particulardrug.For the most up-to-date prior authorizationlist, visit www.carefirst.com/rx.Should you require a prescription for one ofthese drugs, please explain to your doctor thatprior authorization is needed before benefits willbe available to you and they must call to begin theprocess. Without proper authorization, you’ll paythe full price of the prescription, rather than onlyyour copay or coinsurance amount.QuestionsIf you have any questions about your prescriptiondrug coverage, please call CareFirst PharmacyMember Services at (800) 241-3371 or visitthe Prescription Drug section in the Members&Visitors area of www.carefirst.com.How to manage medication costsYour prescription drug benefit already saves youmoney because CareFirst BlueChoice negotiatesdiscount rates with pharmacies in our network.However, you may have alternatives to lower yourcosts even more while getting medicines that treatyour condition. Here are simple steps you can take:1. Ask your doctor. Talk to your doctor to see ifthere are generic options available for yourmedication(s). And, if the drug your doctoris prescribing is brand name only, ask if thereare other Generics in the same class or lessexpensive alternatives that work the same way.2. Ask your pharmacist. When you fill yourprescription, ask the pharmacist if there is aGeneric alternative. Your doctor may not beaware of other available options.3. Check the Preferred Drug List atwww.carefirst.com/rx and click on“Prescription Drug Tools.” Bring a copy ofthe list to your doctor or pharmacist and askthem to help you find generics that can saveyou money.4. Use a participating pharmacy. There aremore than 60,000 participating pharmaciesnationwide, so you can choose one that’sconvenient, but remember to shop around. Youcan find one at www.carefirst.com/rx under“Prescription Drug Tools.” Some pharmaciescharge more than others and if you haven’t metyour deductible yet, you could pay more-outpocketcosts at one pharmacy over another.5. Don’t forget your member ID card. Tohelp ensure you receive proper service, thepharmacist will need your member ID card anda prescription from your doctor.HealthyBlue Member Handbook9

CareFirst BlueChoice &CareFirst PPO Network ProvidersChanging Your PCP—CareFirst BlueChoiceNetwork ProvidersIf you are enrolled in any of the HealthyBlue 2.0plans, you must select a PCP at enrollment. Youcan change your PCP during at any time—just visitMy Account.To get started, visit www.carefirst.com/myaccount. If you haven’t already registeredwith My Account, just click on “Register now” tofollow the easy steps for creating your user nameand password. Make sure you have your memberID card number handy, which is located on yourHealthyBlue ID card.If you don’t have access to the Internet, pleasecontact Member Services at the phone number onyour member ID card and give the representativethe name of the PCP you’d like to see.If the change is requested prior to the 20th ofthe current month, it will be effective on the 1st ofthe following month. Requests received after the20th of the current month will be effective on the1st day of the 2nd month following your request.For example, a request received on January 10would be effective February 1. A request receivedon January 21 would be effective March 1.Once your PCP change request has beenmade, you’ll soon receive a new member ID cardwith your new PCP’s name. Please destroy yourold member ID card once the change becomeseffective.Note: If you are enrolled in any of theHealthyBlue Advantage plans, then you do notneed to select a PCP at enrollment. However, toqualify for the Healthy Reward you will needto work with a CareFirst BlueChoice PCP. If youreside outside the CareFirst BlueChoice ServiceArea, you must work with a BlueCard ® PPOprovider to receive In-Network benefits as well asqualify for the Healthy Reward. The BlueCard ®PPO provider must specialize in general internalmedicine, general pediatrics or geriatrics.CareFirst PPO providers are out-of-network.Scheduling Appointments with a CareFirstBlueChoice or CareFirst PPO ProviderCareFirst BlueChoice and CareFirst PPO doctorssee patients in their own offices. Always call foran appointment before visiting your providerand identify yourself as a HealthyBlue member.Don’t forget to bring your member ID card toyour appointment and present the card to thereceptionist. You should always present yourmember ID card whenever you seek care.CareFirst has set goals for providers in ourparticipating networks regarding appointmentavailability and office waiting times. For nonsymptomaticvisits, such as preventive careor routine wellness, we expect the provider toschedule the appointment within 4 weeks.If you have an urgent problem, call your PCPas soon as possible, and the office staff will arrangean appropriate time for you to be seen. For asymptomatic (acute) problem, most offices try toschedule you within 24-72 hours or less, dependingon the urgency of the problem. The nurse or theappointment staff at your PCP’s office will help youdetermine how quickly you need to be seen.Canceling Appointments with a CareFirstBlueChoice or CareFirst PPO ProviderIf you’re unable to keep a scheduled appointment,call the provider’s office as soon as possible.Our CareFirst BlueChoice and CareFirst PPOproviders prefer at least 24 hours notice so they canoffer your appointment time to another patient.Some providers may charge a fee if you miss anappointment and have not called to cancel.Blue Cross and Blue Shield ParticipatingProvidersIf you use a practitioner, specialist, or hospitalthat participates in the Blue Cross and Blue Shieldnetwork, the provider will file the claim for you.Once the claim is processed, we will send paymentdirectly to the participating provider. You willreceive an Explanation of Benefits form showinghow much the provider was paid and how muchyou owe the provider.10 HealthyBlue Member Handbook

CareFirst BlueChoice and PPO Network ProvidersAt the time of the service, the provider maycollect any amount of your deductible that youhave not yet satisfied, any applicable copay orcoinsurance, as well as those charges specificallyexcluded under your contract (e.g., cosmeticsurgery). Participating providers cannot bill youfor balances above the Allowed Benefit. Also,participating providers cannot bill you or collectfor services that are, in the judgment of CareFirst,not medically necessary.Non-CareFirst Participating ProviderYour out-of-network coverage allows you andyour family members to seek treatment from anycovered provider of your choice. At the time youreceive treatment from a provider who does notparticipate with CareFirst BlueChoice or anotherBlue Cross and Blue Shield plan, you may needto provide payment in full to the hospital, doctoror other covered provider. Non-participatingproviders based outside of Maryland may bill youfor balances above the Allowed Benefit.When accessing your out-of-network benefits,you are responsible for obtaining authorizationfor certain services. Failure to do so may result in areduction or denial of benefits.Your Medical RecordsEach provider’s office keeps a copy of yourmedical records. If you’re a new member, weencourage you to transfer your previous medicalrecords to your PCP’s office. Transferring yourrecords to your PCP’s office will give yourprovider easier access to your medical history.Your previous provider may charge you a fee forthis transfer of records. Your medical records arekept in confidence and will only be released asauthorized by law.➤ Please refer to the “Confidentiality” section on page30 of this handbook for our guidelines on the releaseof medical information.HealthyBlue Member Handbook11

Frequently Asked QuestionsWhy is my member ID card important?Your card is important in getting the most outof your health plan. Your card identifies you andinformation about your HealthyBlue plan to yourprovider. You should carry your member ID cardwith you at all times and present your card whenyou receive care.How can I find out if my provider isa primary care provider (PCP) withCareFirst BlueChoice?You can access our CareFirst BlueChoiceProvider Directory on our website atwww.carefirst.com/doctor.You can also call Member Services at thetelephone number on your member ID card torequest a CareFirst BlueChoice Provider Directoryor have a Member Services Representative accessthis information for you. Remember, if you haveany of the HealthyBlue Advantage plans, youalso have access to In-Network benefits throughBlueCard ® PPO. You can also search the BlueCard ®PPO Provider Directory at www.carefirst.com/doctor. Simply click on PPO Providers outside ofMD, DC and Northern VA to launch the BlueCard ®directory.➤ For more information, see the “Your PCP” section onpage 7 of this handbook.How do I obtain In-Network specialtycare?Your PCP can recommend specialists whoparticipate in the CareFirst BlueChoicenetwork—no referrals are needed. You can alsoeasily find an In-Network specialist by going towww.carefirst.com/doctor. Our online providerdirectory is updated weekly. To be considered“In-Network,” the specialist must participate inthe CareFirst BlueChoice provider network if youare enrolled in any of the HealthyBlue 2.0. In theHealthyBlue Advantage plans, you have access to theBlueCard ® PPO providers for In-Network benefits ifyou receive care outside of the CareFirst BlueChoiceService Area (MD, DC or Northern VA).➤ For more information, see the “CareFirst BlueChoice& PPO Network Providers” section on page 10 of thishandbook.Do I need to select a primary careprovider (PCP)?If you are enrolled in any of the HealthyBlue 2.0plans, then you are required to select a PCP atenrollment. You can change your primary careprovider (PCP) at any time. The quickest way tochange your PCP is online at www.carefirst.com/myaccount. Once logged in, you can search for andselect a PCP and a new member ID card containingyour new PCP’s name will be sent to you. Enrollingin MyAccount is quick and easy. All you’ll need isyour member ID card for the registration process.If you don’t have access to the Internet, just callMember Services and a representative will assist youwith changing your PCP. CareFirst BlueChoice mustbe notified and must process the PCP change priorto the time you receive care from the new PCP.➤ For more information, see the “Changing Your PCP”section on page 10 of this handbook.If you are enrolled in a HealthyBlue Advantageplan, you are not required to select a PCP. However,to qualify for the Healthy Reward, you will needto work with a PCP. For more information on theHealthy Reward see page 8.How can I find out if I have a particularbenefit?Your benefits are detailed in your Evidence ofCoverage/Agreement. You may also contactMember Services to obtain specific information oncontract benefits such as medical care, vision care,dental care, prescription benefits, etc.If you have a group plan through your employer,you should contact your Human ResourcesDepartment to find out details on a particular benefit.I will be traveling out of town. Whatcoverage do I have?If you are enrolled in any of the HealthyBlue2.0 plans, when you are outside the CareFirstBlueChoice Service Area (MD, DC or NorthernVA), In-Network benefits are available foremergency or urgent care only. If you are travelingand need non-emergency or non-urgent treatment,you’ll only have out-of-network benefits availableto you.12 HealthyBlue Member Handbook

Frequently Asked QuestionsIf you or a covered dependent will be livingaway from home for more than 90 days, you may beeligible for the Away From Home Care ® Program.If you enrolled in any of the HealthyBlueAdvantage plans, when you are outside theCareFirst BlueChoice Service Area (MD, DC orNorthern VA), In-Network benefits are availablewhen care is rendered by a BlueCard ® PPOprovider. If you choose to use a provider who is nota BlueCard PPO provider, you will receive out-ofnetworkbenefits➤ For more information, see the sections “Emergencyand Urgent Care” on pages 15 , “The Away From HomeCare® Program” on page 18 and “Filing a Claim forReimbursement” on page 26 of this handbook.If I need emergency care, what shouldI do?If your situation is a medical emergency, call 911 orseek help immediately at the nearest emergency orurgent care facility.In an urgent situation, we recommend thatyou contact your PCP for advice. If you are unableto reach your PCP, you may contact FirstHelp,our 24-Hour Emergency Assistance and MedicalAdvice Service at (800) 535-9700.➤ For more information, see the “Emergency andUrgent Care” section on page 15 of this handbook.I have a dependent who will be goingaway to college. What coverage doeshe or she have?If you are enrolled in any of the HealthyBlue 2.0plans, students who will be out of the area for 90 ormore days may be eligible for the Away From HomeCare ® Program. All other services will be coveredat the out-of-network level. For more information,see the “Away From Home Care ® ” section on page18 of this handbook.If the college is outside of the CareFirstBlueChoice Service Area and an HMO provider isnot available near the college, or the student is notout of the area for more than 90 days, In-Networkcoverage is limited to emergency or urgent careonly. For more information, see the section“Emergency and Urgent Care” on page 15 of thishandbook.If you are enrolled in any of the HealthyBlueAdvantage plans and if the college is outside of theCareFirst BlueChoice Service Area, In-Networkcoverage is provided when your dependent usesBlueCard ® PPO providers. If your dependent doesnot use a BlueCard ® PPO provider, he/she willreceive out-of-network benefits.Where should I go for coveredlaboratory services?No matter which HealthyBlue plan you areenrolled in, to receive In-Network benefits whilein Maryland, DC or Northern VA you mustgo to LabCorp ® for any laboratory services.LabCorp ® is contracted to provide services forCareFirst BlueChoice members throughout theCareFirst BlueChoice Service Area. To locate aLabCorp ® near you, call (888)-LAB-CORP or visitwww.labcorp.com.If you are enrolled in any of the HealthyBlue2.0 plans, obtaining laboratory services from alaboratory other than LabCorp ® will result incoverage at the out-of-network level and will costyou more out-of-pocket.If you are enrolled in any of the HealthyBlueAdvantage plans and laboratory services areobtained outside of CareFirst BlueChoice ServiceArea, In-Network benefits will be provided aslong as you use a BlueCard ® PPO participatinglaboratory. Otherwise, laboratory services will becovered at the out-of-network level.What can I do to ensure I pay thelowest copay for my prescriptions?To ensure you are paying the lowest copay for aprescription, you should check the status of the drugon the CareFirst BlueChoice Preferred Drug List:➤ Talk with your doctor about a refill or achange in your medication.➤ Call the pharmacy to order a refill.➤ Order a prescription through mail order.➤ For more information on how to cut prescriptiondrug costs, see the “HealthyBlue PrescriptionBenefits” section on page 8 of this handbook.What is Health + Wellness?Health + Wellness is CareFirst BlueChoice’s wellnessprogram that provides you with the tools andresources to help you stay healthy or make you well.Our prevention tools are designed to help youstay strong and healthy. Utilization Managementhelps ensure you receive the right care at the righttime in the right place. Case Management providessupport to members when it is needed most.➤ For more information and to learn how Health +Wellness can work for you, see pages 22-24 in thishandbook.HealthyBlue Member Handbook13

Emergency and Urgent CareWhen you have a medical emergency, your healthcare coverage isn’t the first thought that comesto mind. We encourage you to become familiarwith this section so you’ll know how to get themaximum benefits available under the plan ifyou should have a medical emergency.All medically necessary emergency and urgentcare will be covered at the In-Network benefitlevel regardless of the provider.MEDICAL EMERGENCIESIf the situation is a medical emergency:Call 911orGo directly to the nearestemergency facilityEmergency Services means, with respect toan Emergency Medical Condition:A. A medical screening examination (asrequired under section 1867 of the SocialSecurity Act, 42 U.S.C. 1395dd) that iswithin the capability of the emergencydepartment of a hospital, includingancillary services routinely available tothe emergency department to evaluatesuch Emergency Medical Condition; andB. Such further medical examination andtreatment, to the extent they are withinthe capability of the staff and facilitiesavailable at the hospital, as are requiredunder section 1867 of the Social SecurityAct (42 U.S.C. 1395dd(e)(3)).Emergency Medical Condition means thesudden and unexpected onset of a medicalcondition of sufficient severity, including severepain, when the absence of immediate medicalattention could reasonably be expected by aprudent layperson who possesses an averageknowledge of health and medicine to result in:➤ Serious jeopardy to the mental orphysical health of the individual; or➤ Danger of serious impairment of theindividual’s bodily functions; or➤ Serious dysfunction of any of theindividual’s bodily organs or parts; or➤ In the case of a pregnant woman,serious jeopardy to the health ofthe fetus.URGENT CAREAn “Urgent Condition” is a condition thatis not a threat to life or limb, but doesrequire prompt medical attention. If thesituation is urgent:➤ Contact your PCP. If your PCP isunavailable or if you are unsure aboutthe meaning or seriousness of thesymptoms, you can call FirstHelp at(800) 535-9700 for medical advice.➤ Go directly to an urgent care center.A list of participating CareFirstBlueChoice Urgent Care Centers canbe found in the CareFirst BlueChoiceProvider Directory or on our website atwww.carefirst.com/doctor. Additionally,if you have any of the HealthyBlueAdvantage plans, you have access toBlueCard ® PPO urgent care facilitiesoutside of the CareFirst BlueChoiceService Area (MD, DC and No. VA).Urgent Care CentersUrgent care centers are walk-in medical facilitiesequipped to handle minor emergencies. Mosturgent care centers have evening and weekendhours if a condition requires immediate attentionand you’re unable to reach your PCP. Urgent carecenters are typically more conveniently locatedand often allow you to be seen more quickly thanin an emergency room. You may refer to the list ofurgent care centers in your CareFirst BlueChoiceProvider Directory or call FirstHelp , toll-freeat (800) 535-9700 for a participating urgent carecenter near you.Follow-Up CareIf your condition requires follow-up care after yourinitial visit to an urgent care center or hospitalemergency room, you should contact your PCP.In-Network benefits may not be available forfollow-up care performed in an urgent care centeror hospital emergency related to the initialcondition.You can always refer to your Evidence ofCoverage/Agreement or contact Member Servicesto determine whether you’re following the correctprocedures to receive the highest level of benefits.REMEMBER:Prior authorizationis not needed foremergency roomservices.Urgent care centersdo not take theplace of your PCP.Your PCP should beyour first contactwhenever you needmedical care.HealthyBlue Member Handbook15

Emergency and Urgent CareFirstHelp : 24-HourHealth Care Advice Line(800) 535-9700You can speak with a FirstHelp nurse anytime,day or night. Registered nurses are available toanswer your health care questions and help guideyou to the most appropriate care.If you believe a situation is a medical emergency,call 911 immediately or go to the nearest emergencyfacility.In an urgent situation, contact your PCPfor advice. If your PCP isn’t available, you havesymptoms and don’t know exactly what they meanor how serious they are, CareFirst BlueChoiceprovides you with FirstHelp .Here’s how it works:1. Call FirstHelp at (800) 535-9700. The phonenumber is also listed on the back of yourmember ID card. Your call will be answeredpromptly by an experienced registered nurse.2. If the nurse determines your situation is amedical emergency, he or she will advise you toseek immediate medical care. NOTE: If takingthe time to call FirstHelp would seriouslyjeopardize your health, call 911 or go to anemergency facility immediately.3. If your condition isn’t an emergency situation,you’ll be asked about your symptoms. Thenurse will make recommendations to help youdecide the safest and most appropriate courseof action, whether it’s a participating urgentcare center, an appointment at your PCP’soffice, or self-care.4. If the nurse recommends self-care, he or shewill educate you about your condition, explainwhat to do for pain or symptom relief, tell youwhat to expect or watch to for. You may becalled by the nurse the next day to check onyour condition.Now you have the option to securely contactFirstHelp about less urgent medical issues onthe Internet. Simply log on to My Account atwww.carefirst.com/myaccount and click on “AskOur Nurses” to submit your question. Within 24hours, you will receive an e-mail stating that aresponse from a registered nurse is available at MyAccount.FirstHelp nurses won’t be able to answerquestions about the following:➤ Your benefits and what is covered by yourHealthyBlue plan➤ Information on your claims➤ Pre-authorizationsIf you have questions about your benefitsor claims, please call the Member Servicesnumber listed on your member ID card. If youneed authorization for a service, please call theappropriate number listed on the back of yourmember ID card.➤ If your urgent condition is related to mental healthor substance abuse, see the section on “Seeing MentalHealth/ Substance Abuse Specialists” on page 19 inthis handbook.Emergency & Urgent Care When TravelingSeek medical attention immediately in the case of emergencies and urgent conditions.If you’re unsure about the meaning or seriousness of the symptoms, call FirstHelp formedical advice.For assistance in locating Blue Cross and Blue Shield providers and hospitals when outsideof the CareFirst BlueChoice Service Area, call BlueCard ® Access at (800) 810-BLUE (2583).The BlueCard ® program allows members who receive care outside of the CareFirst ServiceArea to benefit from most claims-filing and hold-harmless agreements that other BlueCrossand BlueShield plans have with their local participating providers.16 HealthyBlue Member Handbook

Coverage Outside the AreaBlueCard ® Network — Across theCountry and WorldwideYou can take your health care benefits with you – across thecountry and around the world* with BlueCard ® , a programfrom the Blue Cross and Blue Shield Association.Your member ID card enables you and your family membersto receive inpatient and outpatient hospital care and physicianservices when you’re outside the CareFirst BlueChoice ServiceArea. The BlueCard ® network program includes medicalassistance services and an expanded network of health careproviders throughout the world.If you are enrolled in any of the HealthyBlue 2.0 plans, whenyou visit a provider outside the CareFirst BlueChoice servicearea, only emergency and urgent care services are available In-Network. All non-emergency services will be covered as Outof-Network.Members in any of the HealthyBlue Advantageplans have access to In-Network benefits in emergency andnon-emergency situations outside the CareFirst BlueChoiceService Area when they visit a BlueCard ® PPO Provider.The BlueCard ® network includes more than 6,100 hospitalsand 600,000 providers nationally. While you can see anyprovider in the BlueCard ® network, this may be an out-ofnetworkprogram. So, make sure you understand your levelof coverage and the out-of-pocket expenses associated withvisiting an out-of-network provider.For more information on BlueCard ® network, call the MemberServices phone number on your member ID card.How BlueCard ® Network Works1. When you leave for your next trip outside of the CareFirstBlueChoice service area, be sure to take your HealthyBluemember ID card with you.2. To locate information on the availability of local providersand hospitals in your travel destination, use yourHealthyBlue ID card and call the BlueCard ® Access line at800-810-BLUE (2583). (You can use the toll-free numberoutside of the U.S. by using an AT&T Direct ® AccessNumber.) You can also visit http://www.bcbs.com/coverage/bluecard/bluecard-when-traveling.html forinformation on BlueCard ® network when traveling insidethe U.S.3. If you require medical attention while you’re traveling orliving outside the U.S., show your HealthyBlue memberID card and call BlueCard ® Access at (800) 810-BLUE(2583). A medical assistance coordinator, in conjunctionwith a nurse, will arrange hospitalization, if necessary, ormake an appointment with a physician. In an emergency,you should bypass this step and go directly to the nearesthospital. You can also visit www.bcbs.com/coverage/bluecard/bluecard-worldwide.html for information onBlueCard ® network when traveling outside the U.S.4. Once you arrive at the hospital, show them yourHealthyBlue member ID card. By providing your memberID card to the hospital staff, you can avoid paying upfrontfor your inpatient participating hospital services,other than any out-of-pocket expenses (deductibles,copayments, coinsurance and non-covered services). Youalso won’t need to complete a claim form; the hospital willdo that for you. For outpatient hospital care or physicianservices, you will pay the hospital or physician, completean international claim form (if you’re outside of the U.S.)and send it to the BlueCard Worldwide ® Service Center. Toreceive an international claim form, call(800) 810-BLUE (2583).5. If you are admitted to the hospital, your care will bemonitored throughout your hospital stay.If you are in a HealthyBlue 2.0 plan, non-emergencyservices from a BlueCard® PPO Provider are covered asOut-of-Network. If you are in a HealthyBlue AdvantagePlan, services from a BlueCard® PPO Provider will becovered as In-Network.For more information on BlueCard Worldwide®, call ourMember Services department at the telephone numberon your member ID card. AT&T Direct is a registeredtrademark of AT&T. BlueCard® and BlueCard Worldwide®are registered service marks of the Blue Cross and Blue ShieldAssociation, an association of independent, locally-ownedBlue Cross and Blue Shield Plans.* Please note: certain plans only cover emergency serviceswhen traveling outside the United States. Please refer to yourEvidence of Coverage/Agreement for more details.HealthyBlue Member Handbook17

Additional BenefitsDental BenefitsYour benefits may include dental coverage. Detailsabout your dental coverage are located in yourEvidence of Coverage/Agreement.If you have dental benefits, you may have accessto the following services:➤ Preventive care➤ X-rays➤ Fillings and restorative services➤ Oral surgery and periodontal care➤ Emergency careYour dental coverage may also include orthodontia.For information on dental coverage, pleasecall the Member Services or the Dental MemberServices number on your member ID card.Vision BenefitsBlueVision and BlueVision PlusCareFirst BlueChoice is pleased to offer BlueVisionand BlueVision Plus to meet your vision needs.These vision plans are administered by DavisVision, Inc., a national provider of vision careservices.Your coverage includes benefits for visioncare under BlueVision or BlueVision Plus. Pleasereview your Evidence of Coverage/Agreement todetermine which vision plan you have.BlueVision PlusBlueVision Plus provides an extended benefit thatincludes an eye examination (including dilation)and coverage for eyeglasses or contact lenses onceper benefit period. Eyeglass frames are coveredin full when you choose from the Davis VisionCollection of approximately 400 frames or you canreceive an allowance toward any other frame.You can also receive full coverage for contactlenses in lieu of eyeglasses if collection contactlenses are dispensed or you can receive anallowance towards other contact lenses. Thechoice is yours! Additionally, Davis Vision offersdiscounts on laser vision correction surgery,additional lens treatments and coatings. Refer toyour Evidence of Coverage/Agreement to find outwhat benefits you have under your plan.With BlueVision Plus you may receive servicesfrom out-of-network providers in addition to In-Network providers, although you will receive thegreatest value and maximize your benefit dollarsif you select a provider who participates in thenetwork.BlueVisionBlueVision provides a routine vision examination(including dilation) once per benefit period for a$10 copay when you visit a participating DavisVision provider. Through Davis Vision, you alsoreceive discounts on eyeglass lenses and framesor contact lenses, as well as laser vision correctionsurgery. Refer to your Evidence of Coverage/Agreement to find out what benefits you haveunder your plan.20 HealthyBlue Member Handbook

Additional BenefitsHow to Access In-Network Vision Care➤ Call (800) 783-5602 for a list of providersnearest you, or access the network throughwww.carefirst.com/doctor then select theVision tab.➤ Call the Davis Vision provider of your choiceand schedule an appointment.➤ Identify yourself as a CareFirst BlueChoicemember and a Davis Vision plan participant.➤ Provide the office with the member’s IDnumber and the year of birth of any covereddependents needing services.➤ The provider’s office will verify your eligibilityfor services and no claim forms are required.How to Access Out-of-Network Vision CareOut-of-Network care varies according to plan.Some plans allow out-of-network care whileothers don’t. Refer to your Evidence of Coverage/Agreement to find out what benefits you haveunder your plan.If you choose an out-of-network provider,you’ll be required to pay the provider directlyfor all charges and then submit a claim forreimbursement to:Vision Care Processing UnitP.O. Box 1525Latham, NY 12110Only one claim per service may be submitted for reimbursement each benefit cycle. To print claim forms,visit the “Members” section of www.carefirst.com and click on “Forms” or call (800) 783-5602 to request claimforms.HealthyBlue Member Handbook21

Health + WellnessWhether you’re looking for health and wellnesstips, discounts on health and wellness services,or support to manage a health condition, we havethe resources to help you get on the path to goodhealth.With our Health + WellnessProgram, you can:➤ Stay healthy by identifying habitsthat could put your healthat risk.➤ Get healthy with programs thattarget specific health or lifestyleissues.➤ Deal with unexpected health issuesor medical emergencies withhelp from our case managementprogram.➤ Live with a condition with thesupport of a coordinated health careteam, by participating in our Patient-Centered Medical Home program.➤ Access online tools and servicesto help you get healthy and stayhealthy.Health and wellnessprograms and resourceshelp you and your familylive a healthy life.Staying HealthyHealth AssessmentGet an immediate picture of your health statuswith our confidential, online questionnaire.You’ll be asked about lifestyle choices includingnutrition, physical activity and tobacco use.The survey takes about 15 minutes to completeand, based on your health status, you’ll receiverecommendations for improving your health. Totake the Health Assessment, log into My Accountat www.carefirst.com, click on the tab Manage MyHealth and then click on the Health Assessment andCoaching.Getting HealthyHealth AdvisingAfter completing the Health Assessment, a HealthAdvisor may contact you to discuss your results.The Health Advisor will refer you to theappropriate resources, tools, care managementand Health Coaching programs that can guide youtoward better health.Online Health CoachingYou may participate in a variety of free, confidentialOnline Health Coaching programs to help improveyour health in the following areas:➤ Weight management➤ Stress management➤ Smoking cessation➤ Physical activity➤ Overcoming depression➤ Care for your backThese programs include access to an onlinehealth library, healthy recipes, exercise planners,enhanced goal-setting capabilities, quizzes, videosand links to relevant health information. You canalso download most of the tools to an iPod .22 HealthyBlue Member Handbook

Health + WellnessUtilization ManagementOur program ensures you’ll receive the mostappropriate care when you need it. If you have to behospitalized, or need therapy, our team will reviewyour case, help coordinate care with your providerand assist with discharge planning. If necessary,our team will also approve additional inpatienthospital days.Dealing with the UnexpectedDon’t forget to take your HealthAssessment to get an immediate pictureof your health.Telephonic Health CoachingDepending on your Health Assessment results, youmay also qualify for Telephonic Health Coachingprograms related to physical activity, healthyeating, smoking cessation, or stress management.You may interact with your coach through aprivate, secure Web-based message board or byphone.You’ll work together to develop a personalhealth action plan and your coach will monitoryour progress and provide guidance and supportas needed.Case ManagementIf you have a serious illness or injury, our CaseManagement program can help you navigate throughthe health care system and provide support alongthe way.Our Case Managers, who are registered nurses,will:➤ Work closely with you and your doctors todevelop a personalized treatment plan.➤ Coordinate necessary services.➤ Contact you regularly to see how you’re doing.➤ Answer any of your questions.➤ Suggest available community resources.Our Case Management program is voluntaryand confidential. To enroll or for more information,call (888) 264-8648.Living with a ConditionPatient-Centered Medical Home (PCMH)Our PCMH program promotes higher qualityhealth care, while striving to control health carecosts over time. PCMH was designed to provideyour PCP with a more complete view of yourhealth needs, as well as the care you receive fromother providers. This enables the PCP to bettermanage your health risks, while encouraging youto maintain better health and ultimately producebetter outcomes. To participate in PCMH, talk toyour PCP.HealthyBlue Member Handbook23

Health + WellnessHealth and Wellness ToolsHealth EducationTake an active role in managing your health byvisiting My Care First at www.mycarefirst.com.Find nearly 300 interactive health-related tools, amulti-media section with more than 400 podcasts,and recipes to search by food group or dietaryrestrictions. Plus, there are videos and tutorialson chronic diseases and an encyclopedia withinformation on more than 3,000 conditions.FirstHelpSpeak with a FirstHelp nurse any time, day ornight. Registered nurses are available to answeryour health care questions and help guide youto the most appropriate care. Simply call (800)535‐9700 and a registered nurse will ask about yoursymptoms and help you decide on the best sourceof care.Ask Our NursesOur Ask Our Nurses program lets you emailquestions about conditions, symptoms, treatmentsor diagnostic tests to our registered nurses througha secure and confidential email system. Simplylog on to My Account at www.carefirst.com andclick on “Ask Our Nurses” to submit your question.You’ll receive a personalized response within 24hours.Vitality MagazineOur member magazine has the tools to help youachieve a healthier lifestyle. Vitality providesyou with updates to your health care plan and avariety of health and wellness topics, includingfood and nutrition, physical fitness andpreventive health. All issues are available online atwww.carefirst.com/vitality.Support During Your PregnancyOur Case Managers strive to help you and yourbaby stay healthy during pregnancy. Onceenrolled, the Case Manager will provide educationand information on prenatal care and pregnancy.For more information, call (888) 264-8648.Wellness Discount ProgramYou have access to discounts on fitness centers,acupuncture, massages, chiropractic care,nutritional counseling, and more. To learn more,visit www.carefirst.com/options.Health NewsGet the latest information to help you, and yourfamily, maintain a healthy lifestyle. Sign up for ourmonthly electronic member newsletter by visitingwww.carefirst.com/healthnews to receive healthrelatedarticles and recipes.Symptom Checker AppFind out when to manage symptoms at homeand when to seek medical care, locate the nearestemergency room, or look up the prescribeddosage of common over-the-counter medicines.This free iPhone app can be downloaded atwww.carefirst.com/socialmedia.Pedometer AppCount your steps, distance traveled, and caloriesburned for each workout with the CareFirst Ready,Step, Go! app. This free app is available to anyonewho has an iPhone, iPod Touch, or Androidsmartphone. Visit your favorite app store andsearch for “Ready, Step, Go!”.24 HealthyBlue Member Handbook

Administration of Your PlanPersonal & Enrollment ChangesIf you change your name, address or phonenumber, please contact Member Services andwe’ll update our records or advise you of anyforms you need to submit. Remember, we needyour correct address to keep you informed aboutcritical program information including policies,procedures and benefit changes.If you have group coverage and wish to enrollor disenroll a dependent (including newborns)or change your marital status, you must notifyyour employer within the timeframe specified inyour Evidence of Coverage/Agreement.Individual contract members may fill out aMembership Change Request form found onwww.carefirst.com make enrollment changes.Filing a Claim for ReimbursementTypically, when you see a non-participating provider,you’ll be responsible for filing your own claims.All CareFirst BlueChoice providers, andCareFirst PPO providers based in Maryland, arerequired to submit claims. All you have to do ispay any necessary copayment and/or deductibleat the time of the visit. If you need to submit aclaim for services rendered by a provider whodoesn’t participate in the CareFirst BlueChoice orCareFirst PPO network (such as emergency carereceived outside the Service Area), you may contactMember Services for a CareFirst BlueChoiceHealth Benefits Claim Form or print one from ourwebsite at www.carefirst.com.Be sure to attach a complete itemized bill preparedby the provider of service that includes the chargesfor each service along with the medical conditionfor which the treatment was performed. Submit thecompleted claim form and attachments to:Mail AdministratorP.O. Box 14114Lexington, KY 40512-4114Provider ReimbursementCareFirst BlueChoice providers are paid on a feefor-servicebasis meaning they receive paymentsaccording to a fee schedule for covered servicesthey perform. CareFirst PPO Network providersare paid the Allowed Benefit for services rendered.You may contact Member Services to obtainadditional information about provider paymentarrangements.Other insuranceWhen you or your dependents have additionalcoverage under another health plan or insuranceprogram (for example, a plan through yourspouse’s employer or Medicare) coordinationof benefits (COB) may apply. COB eliminatesduplicate payments for the same expense and playsan important role in controlling the price you payfor your health care coverage.While it’s important that you receive the healthbenefits you’re eligible for, it’s also importantthat payments are properly coordinated so thatone health insurance carrier does not exceed itspayment responsibility for your bill. The combinedpayment by CareFirst BlueChoice and the otherplan should not be more than the total amount ofthe bill.We update our COB information periodically,so make sure we have your most currentinformation or if your other insurance changed.When our records are up-to-date we’re able to payyour claims as quickly and accurately as possible.Even if you don’t have other insurance, it’simportant you provide that information to us sowe may keep your records current. To supply thisinformation, you may call our COB departmentat (866) 285-2611, or download a COB formin the “Forms” section of our website at www.carefirst.com. Rules to determine how benefitsare coordinated are outlined in your Evidence ofCoverage/Agreement.All claims must be filed within the time limit specifiedin your Evidence of Coverage/Agreement.HealthyBlue Member Handbook25

Administration of Your PlanHow to voice a complaintCareFirst BlueChoice wants to hear your concernsand/or complaints so they may be resolved. Wehave procedures to address medical and nonmedicalissues. If a situation should occur forwhich there is any question or difficulty, here’swhat to do:➤ If your comment or concern is regarding thequality of service received from a CareFirstBlueChoice representative or administrativeproblems (e.g., enrollment, claims, bills, etc.),you should contact Member Services. To writeto us directly with a quality of care or serviceconcern, you can:n Send an email to:quality.care.complaints@carefirst.comn Fax a written complaint to (301) 470-5866n Write to:CareFirst BlueCross BlueShieldQuality of Care DepartmentP.O. Box 17636Baltimore, MD 21297If you send your comments to us in writing,please include your ID number and provide uswith as much detail as possible. Please include yourdaytime phone number so we may contact youdirectly if we need additional information.➤ For concerns or complaints about the qualityof care or quality of service received from aspecific provider, contact Member Service at thephone number listed or your member ID card. Arepresentative will record your concern and mayrequest a written summary of the issues. You canalso submit a complaint by sending an e-mailto quality.care.complaints@carefirst.com.A written complaint can be faxed to (301) 470-5866. Please include your ID number and provideus with as much detail as possible regardingany events. Please include your daytime phonenumber so we may contact you directly if we needadditional information. The substance of thecomplaint will be investigated as appropriate andthe action taken will be thoroughly documented.These procedures are also outlined in your Evidenceof Coverage/Agreement.If you wish, you may also contactthe appropriate jurisdiction’sregulatory department regardingyour concern:Virginia:Office of the Managed CareOmbudsmanBureau of InsurancePO Box 1157Richmond,VA 23218(877) 310-6560 or(804) 371-9032ombudsman@scc.virginia.govOffice of Licensure andCertification Complaint IntakeVirginia Department of Health9960 Mayland Drive, Suite 401Richmond, VA 23233-1463Phone: (800) 955-1819(804) 367-2106District of Columbia:Office of Health CareOmbudsman and Bill of RightsOne Judiciary Square441 4th Street, NW, 9th FloorWashington, DC 20001Phone: (877) 685-6391Fax: (202) 535-1216Maryland:Maryland InsuranceAdministration Inquiry andInvestigation, Life and Health200 St. Paul Place, Suite 2700Baltimore, MD 21202-2272(410) 468-2244 or (800) 492-6116Fax: (410) 468-2270www.mdinsurance.state.md.usOffice of Health Care QualitySpring Grove CenterBland-Bryant Building55 Wade AvenueCatonsville, MD 21228(877) 402-8218Fax: (410) 402-8215www.dhmh.state.md.us/ohcqFor assistance in resolving abilling or payment disputewith the health plan ora health care provider,contact the Health Educationand Advocacy Unit ofthe Consumer ProtectionDivision of the Office of theAttorney General at:Health Education andAdvocacy UnitConsumer ProtectionDivisionOffice of the AttorneyGeneral200 St. Paul PlaceBaltimore, MD 21202(410) 528-1840 or(887) 261-8807Fax: (410) 576-6571www.oag.state.md.us26 HealthyBlue Member Handbook

CareFirst BlueChoice’s appeal procedure is designedto enable you to have your concerns regarding a denialor reduction of benefits or a denial of authorization forservices heard and resolved. By following the stepsoutlined below, you can ensure your appeal is quickly andresponsively addressed.Please note that state mandates may alter the stepsbelow. Refer to your Evidence of Coverage/Agreement formore specific information regarding the appeals process.The procedure for filing an appeal is also located on ourwebsite at www.carefirst.com. In the Members & Visitorssection, click on “Frequently Asked Questions” in theSolution Center. If you would like a paper copy of theappeals process, you may also contact CareFirst BlueChoiceMember Services at the phone number located on yourmember ID card.Step 1:Inquiry and discussion of theproblemOften, Member concerns can be most effectivelyhandled and resolved through informal discussionsand information gathering. If your question orconcern is regarding our handling of a claim orother administrative action, the member or themember’s authorized representative should discussthe matter with the CareFirst BlueChoice MemberServices Department. The CareFirst BlueChoiceMember Services Department Customer ServiceRepresentative will contact the appropriateindividuals and gather information needed toanswer the question. In many instances, the mattercan be quickly resolved.Step 2:Appeal processIf your concern is not resolved through an informaldiscussion with a CareFirst BlueChoice CustomerService Representative, you or your authorizedrepresentative may make a formal request for anappeal.This appeal request should be in writing,addressed to our Member Services Department andstate the reason(s) for the request. In the event themember or the member’s authorized representativecannot put the request in writing, a CustomerService representative can assist you. The requestfor an appeal must be made within six (6) monthsor at least 180 days from the date of the notificationof denial of benefits. A decision by the Plan shallbe made within 30 calendar days for a pre-serviceappeal, or 45 working days for a post service appeal.The appeal of a medical necessity decision shallbe reviewed, as appropriate, by a physician of thesame or similar specialty as the treatment underreview. The physician review of the appeal will beperformed by a physician who was not part of theoriginal denial.An expedited appeal process has been establishedin the event that a delay in a decision would beseriously detrimental to your health or the healthof a covered family member. Expedited appealsinvolve care that has not yet occurred or is currentlyoccurring (pre-service or concurrent care). In anexpedited appeal, a decision shall be made within 24hours of receipt. The physician review of the appealwill be performed by a physician who was not part ofthe original denial decision.The expedited appeal review will be, asappropriate, reviewed by a physician in the same orsimilar specialty as the treatment under review.All appeal decisions will be communicatedin writing to the member, and include a detailedexplanation as to the reason for the decision, andany supporting documentation to show how thedecision was made. If the decision remains a denialof the benefits, a detailed explanation that referencesthe rule, policy or guideline used in making theappeal decision will be included. Also included inthis written appeal decision will be an explanationof the appropriate next steps a member or theauthorized member representative may take if theyare not satisfied with the appeal decision.Members have a right to an independent externalreview of any final appeal determination.If you wish, you may contact the insuranceregulatory department in your area to file acomplaint or an appeal regarding a denial orreduction of benefits. Refer to your Evidence ofCoverage/Agreement for more specific informationregarding initiating an external review of a finalappeal determination or a complaint.HealthyBlue Member Handbook27

Ending or ContinuingYour CoverageEnding Your CoverageYour coverage or your dependents’ coverage withCareFirst BlueChoice may automatically end forcertain reasons. These reasons may include but arenot limited to:➤ You are no longer employed by the companythat carries your CareFirst BlueChoicecoverage;➤ Your employer cancels coverage with CareFirstBlueChoice;➤ Divorce from a policyholder; or➤ A covered dependent turned 26 years of age.Please refer to your Evidence of Coverage/Agreementor contact Member Services for more information.Continuing Your CoverageIf you have group coverage and are changing jobsor your dependents’ status changes, please speakto your employer, your payroll office or MemberServices about the options available to you andyour eligible dependents to continue health carebenefits. The options available are specified inyour Evidence of Coverage/Agreement.If your group coverage ends, you and yourdependents may be eligible under federal laws tocontinue your coverage with CareFirst BlueChoice atyour own expense under the Consolidated OmnibusBudget Reconciliation Act of 1985 (COBRA) orsimilar state program. Your former employer isresponsible for supplying eligible beneficiaries withthe details about COBRA coverage.You and your dependents may also be eligibleunder state laws to continue your coverage withCareFirst BlueChoice at your own expense.Contact your employer or Member Services foradditional information.Another option may be a CareFirst BlueChoiceconversion policy. See your Evidence of Coverage/Agreement for information. A conversion policyis a non-group policy offered to members whoare losing their group benefits under certainconditions. A conversion policy is a contract thatprovides individual or family medical coverage.Dental, vision and prescription plans cannot beadded to the conversion policy.Eligible members can enroll for conversioncoverage after their eligibility for group coverageends. You should check with your employer to seehow soon you must enroll after your coverage ends.Members who end or lose their group coverage maybe entitled to a conversion policy in the followingsituations:➤ The policyholder’s eligibility for his or hercurrent group coverage ends;➤ Termination of spouse’s and dependents’eligibility due to the policyholder’s death;➤ Termination of marriage to the policyholder;➤ Termination of the group agreement if thegroup has not provided for continued coveragethrough another plan, and termination is not aresult of the group’s failure to pay premiums;or➤ Termination of dependent’s eligibility due toreaching the age limit or marriage.If you are interested in receiving a conversionpolicy application, please contact MemberServices at the telephone number on yourmember ID card.Portability (HIPAA)The Health Insurance Portability and AccountabilityAct of 1996 (HIPAA) ensures that individuals whohave health insurance do not experience a gap incoverage due to termination or departure fromtheir current job. A member terminating coveragewith an insurance carrier will receive a Certificateof Creditable Coverage indicating the length oftime they have had health insurance coverage. ThisCertificate of Creditable Coverage is used to reduceany waiting time for pre-existing conditions thatmay be part of subsequent health insurance coverage,as long as there has not been a break in coverage formore than 63 days.When a member terminates with CareFirstBlueChoice, they receive a Certificate of HealthPlan Coverage that indicates how long the memberwas covered. The member should then present thecertificate to the new insurance carrier. This willreduce or eliminate waiting periods for pre-existingconditions under the member’s new policy.REMEMBER:HIPAA is designedto help you keepand maintainhealth insurancecoverage due totermination ordeparture fromyour current job.28 HealthyBlue Member Handbook

All health plans and providers mustprovide information to membersand patients regarding how theirinformation is protected. You willreceive a notice of privacy practicesfrom CareFirst BlueChoice or yourHealth Plan, and from your providersas well, when you visit their office.CareFirst BlueChoice has policies andprocedures in place to protect theconfidentiality of member information.Your confidential information includesProtected Health Information (PHI) andother nonpublic financial information.Because we are responsible for yourinsurance coverage, making sure yourclaims are paid, and you can obtainany important services related toyour health care, we are permittedto use and disclose (give out) yourinformation. Sometimes we are evenrequired by law to disclose yourinformation in certain situations. Youalso have certain rights to your ownprotected health information, and thereare some requirements you will have tofollow to allow other people to obtainyour information on your behalf.HealthyBlue Member Handbook29

Member’s Rights andResponsibilitiesRights of MembersCareFirst BlueChoice promotes members’ rightsby providing mechanisms to ensure:➤ Protection of confidential information;➤ Accurate and understandable informationabout benefit plans, customer service andaccessing health care services;➤ Continuity and coordination of medicaland/or mental health or substance abuse careby participating providers;➤ Professional and responsive customer service;and➤ Timely and complete resolution of customercomplaints and appeals.Members have a right to:➤ Be treated with respect and recognition oftheir dignity and right to privacy;➤ Receive information about the Health Plan,its services, its practitioners and providers, andmembers’ rights and responsibilities;➤ Participate with practitioners in decisionmaking regarding their health care;➤ Participate in a candid discussion ofappropriate or medically necessary treatmentoptions for their conditions, regardless of costor benefit coverage;➤ Make recommendations regardingthe organization’s members’ rights andresponsibilities; and➤ Voice complaints or appeals about the HealthPlan or the care provided.Responsibilities of MembersMembers have a responsibility to:➤ Provide, to the extent possible, informationthat the Health Plan and its practitioners andproviders need in order to care for them;➤ Understand their health problems andparticipate in developing mutually agreedupon treatment goals to the degree possible;➤ Follow the plans and instructions for care thatthey have agreed on with their practitioners;➤ Pay copayments or coinsurance at the time ofservice; and➤ Be on time for appointments and to notifypractitioners/providers when an appointmentmust be canceled.Eligible Individuals’ RightsStatement Wellness andHealth Promotion Services1. Eligible individuals have a right to receiveinformation about the organization,including wellness and health promotionservices provided on behalf of the employeror plan sponsors; organization staff andstaff qualifications; and any contractualrelationships.2. Eligible individuals have a right to declineparticipation or disenroll from wellness andhealth promotion services offered by theorganization.3. Eligible individuals have a right to betreated courteously and respectfully by theorganization’s staff.4. Eligible individuals have a right tocommunicate complaints to the organizationand receive instructions on how to usethe complaint process that includes theorganization’s standards of timeliness forresponding to and resolving complaints andquality issues.New Technology AssessmentTo ensure that our members have access to safe andeffective care, CareFirst BlueChoice has a formalprocess to review and make decisions regarding newdevelopments in medical technology. We evaluatenew medical technologies and the use of existingtechnologies for inclusion as a covered benefitthrough a formal review process. We refer to medicalpersonnel, governmental agencies and publishedarticles about scientific studies in this process.30 HealthyBlue Member Handbook

HSA and HRA PlansThis section is specifically for members of CareFirst’s HealthyBlue BlueFundHSA, BlueFund HRA, Compatible HSA and Compatible HRA Plans. Please notethat all HealthyBlue Advantage plans offered to members who purchase theircoverage directly from CareFirst are HSA compatible. This information is intendedto provide an overview and doesn’t represent your specific HealthyBlue benefits,whether you’re a group or individual member. If you’re unsure whether thisinformation applies to you and your benefits please refer to your Evidence ofCoverage/Agreement.Health Savings Account (HSA)Certain members enrolled in CareFirst BlueChoice’sHealthyBlue BlueFund or Compatible HSAhealth plans have the option to participate ina Health Savings Account to pay for qualifiedmedical expenses with tax-free dollars. If you areenrolled in a HealthyBlue BlueFund HSA plan,you employer will arrange for your HSA to beopened through the BlueFund program. If you areenrolled in a Compatible HSA plan, you may needto open your HSA on your own. HSA health plansare always high deductible health plans (HDHPs)with a deductible that applies to both your medicaland drug benefits.For all services other than the ones mentionedearlier in this section at no cost, you’ll first needto meet your plan year deductible, before yourfull HealthyBlue HSA coverage begins. You thenpay a copayment or coinsurance for all coveredservices, including prescription drugs. The fundsin your HSA can also be used to pay for these outof-pocketexpenses.How your HSA worksA Health Savings Account is a tax-exempt medicalsavings account that can be used to pay for youreligible medical expenses. HSAs enable you to payfor current health expenses and save for futurequalified medical and retiree health expenses on atax-free basis. You own and control the money inyour HSA. Unlike a Flexible Spending Account,there is no “use it or lose it rule.” Funds that arenot used for current health expenses are saved forfuture use. The funds in your HSA earn interest,and when a certain balance is reached, can even beinvested in a wide variety of investment options.Each year you, your employer (if applicable) orboth make a contribution toward your HSA. Youthen use the money in your account to pay thefull or discounted cost of covered services untilyou reach your benefit year deductible.HealthyBlue Member Handbook31

HSA and HRA PlansThe money in the HSA alwaysbelongs to youYour HSA is your personal account and is entirelyportable. If you are a member of an employerbasedplan, this means that, should you leaveyour current employer, you can take the moneywith you. An HSA can be an excellent way toput money aside for any qualified health careexpenses that might not be covered by your plantoday. And if you don’t spend it, it’s also a tax-freeway to prepare for future expenses – such as theneed to cover retiree health premiums (excludingMedicare Supplement plans) or to pay for futurenon-covered health care expenses.While your HSA was designed to fund yourhealth care, now and in the future, HSA funds canbe “cashed out” at any time. The money will besubject to income tax and a penalty if you closethe account before you turn 65. Of course, youcan always use the money for qualified health careexpenses with no penalty and no taxes.How your deductible worksWhile HealthyBlue covers you at no cost forcertain care, all other services are subject to anannual deductible that you must satisfy beforeyou health coverage begins. This means that, ifyour plan includes a $1,500 annual deductible, forexample, you will be required to meet the $1,500deductible each year before your full health carebenefits begin.Until you reach your annual deductible, youmay use the money in your medical savings accountto pay for the eligible health care expenses. Forexample, if you go to the doctor because you aresick, the cost of that visit will contribute towardsyour deductible and you can use your HSA fundsto pay for that service. Be sure your doctor’s officesubmits a claim to CareFirst so the claim can becounted toward your deductible.Note: Preventive services are not subject to thedeductible.Funds rollover from year to yearDepending on the amount of qualified health careexpenses you incur in a given year, you may notneed to use all of the funds in your HSA. In thisevent, the remaining balance in your HSA willautomatically roll over to the following benefityear. HSAs are available to members of employerbasedhealth plans, as well as members whopurchase a qualifying high deductible health planon their own.32 HealthyBlue Member Handbook

HSA and HRA PlansHSA Plan Questions and AnswersHow do I contribute to my HSA?If you are a member of an employer group planand your employer has arranged for you to opena HSA, your HSA contributions are normallymade through pre-tax payroll deductions. If youpurchased your health plan on your own and haveset-up your own HSA, you can make contributionsto your HSA at anytime, up to the allowableamount determined by the IRS.Are there limits to how much can becontributed to my HSA?The IRS stipulates that your HSA funding cannotexceed $3,300* if you have individual coverage, and$6,550* if you have family coverage in a tax-year.For additional information, you can visit the IRSweb site at: www.IRS.gov or call (800) 829-3676.*This amount applies to year 2014 only.How are my medical and prescription drugclaims paid?When visiting your doctor, lab or urgent carefacility, you’ll likely be charged your normal per visitcopay or any portion of your benefit year deductiblethat has not yet been satisfied. Your provider willthen submit a claim to CareFirst BlueChoice forbenefits consideration. If you haven’t already metyour benefit year deductible, the claim will beprocessed and a benefit determination will be sentto you and to the provider. The provider will in turnseek any remaining payments from you. You willbe responsible for the cost of your medical servicesuntil you meet your deductible. These expenses canbe paid out of your HSA by using your HSA debitcard or HSA fund checks (if applicable).Your pharmacist will charge you CareFirstBlueChoice’s discounted cost for prescription drugsuntil you reach your benefit year deductible exceptfor the certain generic drugs that are no charge.These expenses can also be paid directly from yourHSA using your debit card or HSA fund checks.Since prescription deductible information isautomatically transmitted to CareFirst BlueChoiceso that we may efficiently track your deductiblebalances, it is important for you to pick up yourprescription drugs from the pharmacy as soon aspossible. Pharmacies have their own guidelinesfor returning medications to their inventory stock.If the pharmacy returns your prescription drugsto their inventory stock, any applicable deductiblewill be retracted. Each of these deductible andretracted deductible transactions will be recordedon your HSA account.What happens when HSA funds have beenexhausted before the annual deductible’sbeen met?If you use all the money in your HSA before meetingyour annual deductible, you’ll then be responsiblefor a limited out-of-pocket amount, called the“bridge.” The bridge is the difference between theamount in your HSA and your deductible.The amount of money you and/or youremployer have contributed to your HSA willdetermine how much of a “bridge” you have beforeyour HealthyBlue HSA coverage becomes available.You can use future funds that go into yourHSA to reimburse yourself for expenses during thebridge period, as long as the HSA was opened at thetime the expenses were incurred.Who administers the Health SavingsAccount?Your HSA plan can be administered differentlyfrom someone else’s plan, so it all depends on thetype of coverage that you have. There are threepossible scenarios:1. You are a member of an employer groupand your employer has chosen the CareFirstBlueFund program to administer your HealthSavings Account. In this case, you will receiveyour HSA information, as well as your HSAdebit card and personal checks (if applicable)directly from BlueFund and CareFirst’spreferred HSA custodian.2. You are a member of an employer group andyour employer has chosen another financialinstitution to administer your HealthSavings Account. In this case, you will receiveinformation regarding your HSA directly fromyour employer or your employer’s preferredfinancial institution.3. You have purchased an HSA compatible healthplan on your own and you have chosen to setup your HSA with a financial institution ofyour choosing. In this case, you will receiveinformation regarding your HSA directly fromthe bank you have chosen.HealthyBlue Member Handbook33

HSA and HRA PlansWho’s eligible to participate in an HSA?To be eligible to enroll in a Health Savings Account,you must be covered one of the HealthyBlue HSAcompatible high deductible health plans (HDHPs).To enroll in a health savings account youcannot be:➤ Covered by any medical plan other than anIRS-qualified high deductible health plan(dental and vision are not included in thisrestriction).➤ Enrolled in Medicare Part A or Part B.➤ Claimed as a dependent on anotherindividual’s tax return.How can I track my health benefits?The more you know, the better you can manageyour health care needs. With HealthyBlueAdvantage, you can tap into the power of theInternet to help you manage your benefits.CareFirst online tools, available atwww.carefirst.com, allow you to:➤ Keep track of your HSA balance if you are agroup member and have a BlueFund HSA➤ Check the status of a claim➤ Compare hospitals➤ Compare prescription drug costs➤ Request a member ID card➤ Confirm or review eligibility➤ Find a doctor➤ Access health and wellness informationYour HSA funds are available to pay forqualified health care expenses covered under yourCareFirst BlueChoice HealthyBlue coverage.What is the definition of a “QualifiedMedical Expense”?Qualified expenses are those permitted by Section213(d) of the Internal Revenue Tax Code andthat are otherwise permissible under the IRSregulations. When you use the account to pay forqualified expenses, you pay with tax-free dollars.Qualified expenses include but are not limited to:➤ Prescription Drugs➤ Non-Prescription Drugs that are prescribed byyour doctor➤ Doctor’s visits, lab, X-ray and other diagnosticand treatment services➤ Routine health care, including prenatalcare, smoking cessation, obesity weight lossprograms➤ Qualified long-term care services andqualified long-term care insurance➤ COBRA premiums➤ Health insurance for those on unemploymentcompensation➤ Medicare Part A and B premiums, MedicareHMO or Medicare Advantage premiums (butnot premiums for Medicare Supplementalpolicies)For a complete list of qualified andunqualified HSA expenses, visit theIRS web site at:www.IRS.gov orcall (800) 829-3676Please Note: HSA funds can also be spent onqualified expenses that are not covered by yourHealthyBlue plan. These expenses will not beapplied toward your benefit year deductible. Onlycovered expenses will be applied toward your benefityear deductible.34HealthyBlue Member Handbook

HSA and HRA PlansHealth Reimbursement Arrangement (HRA)(Group plan members only)Members of CareFirst BlueChoice’s HealthyBlue BlueFund HRA and HRA Compatibleplans may have the option to participate in a Health Reimbursement Arrangement,where your employer deposits funds into your spending account to pay for qualifiedmedical expenses.How your HRA worksA Health Reimbursement Arrangement (HRA)is an employer-funded medical savings accountthat provides funds to help pay for eligible healthcare expenses.Each year, your employer will fund your HRA.You may then use the money in your HRA to paythe full or discounted cost of covered services thatare subject to your plans’ deductible, copays orcoinsurance. Since an HRA is funded with exclusivelyby your employer, your employer can determine theexpenses that are covered by the HRA.Funds rollover from year to yearIn many cases, the money your employer allocates toyour HRA plan may be more than you’ll use on healthcare during the plan year. Unlike other medicalsavings accounts, (such as a Flexible SpendingAccount) any money you don’t spend may stay inyour account for future use, as long as the programis offered and you remain enrolled. Because eachfunding arrangement is different, please check withyour company’s HR representative for specific detailsabout your HRA plan’s rollover rules.Available to members ofemployer-based group plansBecause HRAs are funded by the employer, HRAsare only available to members of employer-basedhealth plans. HRAs are not available to memberswho wish to purchase this health plan on their own.How your deductible worksSome HRA plans have a medical-only deductiblewhile others have a combined or integrated medicaland prescription drug deductible. This meansthat until your medical-only or your integratedbenefit year deductible has been met, you will beresponsible for covered expenses associated withyour health care services and prescription drugs.You can use the funds allocated to your HRAtowards covering these expenses. See your contract,benefit summary or contact Member Services if youare unsure of the type of deductible in your plan.If you have a combined deductible, you also havea combined out-of-pocket maximum. This meansyour eligible health care and prescription drugout-of-pocket expenses will be applied towardsmeeting your out-of-pocket maximum. Shouldyou reach your out-of-pocket maximum, CareFirstBlueChoice will pay 100% of the applicable planAllowed Benefit for most covered services for theremainder of the benefit year.HealthyBlue Member Handbook35

HSA and HRA PlansHRA Plan Questions andAnswersHow do I contribute to my HRA?Funds in your HRA account can only be depositedby your employer. You are not eligible to make anyadditional contributions toward your HRA.What happens when HRA funds havebeen exhausted?If you use all the money in your HRA beforemeeting your annual deductible, you will then beresponsible for a limited out-of-pocket amount,called the “bridge.” The bridge is the differencebetween the amount in your HRA and yourdeductible.The amount of money your employer hascontributed to your HRA will determine how muchof a “bridge” you have before your HealthyBluecoverage becomes available. In some cases, theHRA program may be designed so that the bridgecomes first, before the HRA funds can be used.This requires the member to pay out-of-pocketbefore using the HRA funds. Please refer to yourcompany’s HR representative for specific detailsabout your HRA plan’s rollover rules.What happens if I leave my employer?Should you leave your current employer; all fundsthat remain in your HRA will generally revert tothe employer.How are my medical and prescription drugclaims paid?When visiting your doctor, lab or urgent carefacility, you will likely be charged your normalper visit copayment or any portion of your benefityear deductible that has not yet been satisfied. Yourprovider will then submit a claim to CareFirstBlueChoice for benefits consideration. If you havenot already met your benefit year deductible, theclaim will be processed and a benefit determinationwill be sent to you and to the provider. The providerwill in turn seek any remaining payments fromyou. You will be responsible for the cost of yourmedical services until you meet your deductible.Remember, by seeking services from PCPs, yourresponsibility will be limited to the discountedamount or plan Allowed Benefit that our PCPsagree to accept as payment in full.Benefits of the BlueFund HRAThese deductible, coinsurance and copaymentamounts will be automatically transferred toyour HRA account and eligible expenses willautomatically be reimbursed to you on a weeklybasis. If your employer has selected anothercustodian for HRA funds, these rules will apply.ReimbursementReimbursement checks have a minimumreimbursement value of $25. Therefore, ifthe deductible, coinsurance or copaymentreimbursement totals for that processing week donot reach the $25 minimum, your reimbursementwill be delayed until additional reimbursement isavailable from your incurred claims.Prescription drug deductibleFor members with a combined medical andprescription drug deductible, your prescriptiondeductible and copayment amounts will also beautomatically transferred to your HRA accountand reimbursement for these amounts will beincluded with your HRA reimbursements formedical expenses. Your pharmacist will chargeyou CareFirst BlueChoice’s discounted cost forprescription drugs until you reach your benefityear deductible.Since prescription deductible information isautomatically transmitted to CareFirst BlueChoiceso that we may efficiently track your deductiblebalances, it is important for you to pick up yourprescription drugs from the pharmacy as soon aspossible. Pharmacies have their own guidelines forreturning medications to their inventory stock.If the pharmacy returns your prescription drugsto their inventory stock, any applicable deductiblewill be retracted. Each of these deductible andretracted deductible transactions will be recordedon your HRA account.What is the definition of a “QualifiedMedical Expense”?Your HRA funds are available to pay for qualifiedmedical services covered under your HealthyBlueHRA plan, as well as any additional health careexpenses deemed acceptable by your employer.36HealthyBlue Member Handbook

HSA and HRA PlansPlease note: Some HRA plans allowreimbursement for additional qualified expenses,determined by your employer, that are not coveredby your HealthyBlue HRA plan. These expenseswill not be applied toward your benefit yeardeductible. Your employer will have a completelist of eligible expenses. Only covered medicalexpenses under your HealthyBlue HRA plan willbe applied toward your benefit year deductible.How can I obtain HRA reimbursementfor qualified health care expenses notcovered by my HealthyBlue plan?If you have a BlueFund plan, qualified healthcare services and items not covered by yourCareFirst BlueChoice HealthyBlue HRAplan can be reimbursed through your HRAby faxing or mailing a claim along with thesupporting documentation to our BlueFundAdministration office. You can obtain an HRAReimbursement Claim form from our web site atwww.carefirst.com. Complete the form and fax ormail it along with any necessary documentation to:How can I track my healthbenefits?The more you know, the better you canmanage your health care needs. With aCareFirst BlueChoice HealthyBlue 3.0 HRAplan, you can tap into the power of theInternet to help you manage your benefits.CareFirst online tools, available atwww.carefirst.com, allow you to:➤ Keep track of your HRA balance➤ Check the status of a claim➤ Compare hospitals➤ Compare prescription drug costs➤ Request an ID card➤ Confirm or review eligibility➤ Find a doctor➤ Access health and wellnessinformationBlueFund Administration13511 Label LaneSuite 201Hagerstown, MD 21740Fax: (301) 564-5192You will have 90 days from the end of your benefit year to submit claims or have claimsautomatically processed for reimbursement through your HRA for services received duringthe ending benefit year. Be sure to contact your health care provider and request that he/she submit their claims to CareFirst BlueChoice before the 90 days expire for services thatneed to be processed through your HealthyBlue HRA coverage. Any claims for the endingbenefit year posted to your HRA after this 90-day period will not be reimbursed to you.You’ll be able to see exactly where your money goes, so you can make the best decision.Visit our Web site at www.carefirst.com for more information.If you have a HRA plan with another custodian, your reimbursement will be handled differently.HealthyBlue Member Handbook37

Definition of TermsAllowed Benefit:The maximum dollar amount allowed for servicescovered, regardless of the provider’s actual charge.A provider who participates in the network cannotcharge the member more than this amount for anycovered service.Appeal:A protest filed by a member or a health careprovider under CareFirst BlueCross BlueShield/CareFirst BlueChoice’s internal appeal processregarding a coverage decision.Authorization:The contractual requirement that the provider ormember notify and obtain approval from the planbefore certain services are covered for a member.Authorization is required for services such as, butnot limited to, non-emergency hospitalizations,certain outpatient hospital services, skilled nursingcare, home health care, outpatient surgicalservices, and durable medical equipment.Balance Billing:The practice of billing a member for the differencebetween the Allowed Benefit and the actual charge.CareFirst BlueChoice Service Area:CareFirst BlueChoice’s Service Area is a clearlydefined geographic area in which CareFirstBlueChoice has arranged for the provision ofhealth care services to be generally availableand readily accessible to Members. CareFirstBlueChoice will provide the Member with aspecific description of the Service Area at the timeof enrollment. The Service Area is as follows: TheDistrict of Columbia; the state of Maryland; and,in the state of Virginia, the cities of Alexandria andFairfax, Arlington County, the town of Vienna andthe areas of Fairfax and Prince Williams Countieslying east of Route 123.Claim Form:A form obtained from Member Services forreimbursement of covered services paid by themember.Coinsurance:means the percentage of the Allowed Benefitallocated between CareFirst BlueChoice and theMember whereby CareFirst BlueChoice and theMember share in the payment for covered services(e.g., 20 percent for lab services or X-rays).Complaint:A protest filed with the regulatory departmentinvolving an adverse decision, coverage decision,appeal decision, or grievance decision.Coordination of Benefits:A provision which determines the order of benefitdetermination when a member has health carecoverage under more than one plan.Copayment (Copay):The dollar amount that a member must pay forcertain covered services.Deductible:The dollar amount of incurred covered expensesthat the member must pay before CareFirstBlueChoice makes payment.Dependent:A member who is covered under the Plan as thespouse, domestic partner or eligible child of aSubscriber.Evidence of Coverage/Agreement:A document reflecting an individual’s or group’sagreement for health care coverage with CareFirstBlueChoice.Exclusions:Specific conditions, treatments, services orcircumstances listed in the contract for whichCareFirst BlueChoice will not provide benefits.Health Care Provider:An individual who is licensed or otherwiseauthorized in this State to provide health careservices in the ordinary course of business orpractice of a profession, and is a treating providerof the member; or a hospital, facility or other entitylicensed to provide health care services.38 HealthyBlue Member Handbook

Definition of TermsHealth Maintenance Organization (HMO):An organization that provides a wide range ofhealth care services through a PCP who rendersor coordinates all of your care to provide you withquality service while reducing medical costs.HIPAA:Health Insurance Portability and AccountabilityAct. This Act addresses many tenets of healthinsurance coverage including the handling ofPersonal Health Information (PHI) and theMember’s ability to receive credit towards his orher waiting period.Indemnity:Traditional insurance plans under which the healthplan reimburses the provider and the member ona fee-for-service basis after the patient has satisfiedany applicable deductible. These plans typicallyhave the highest out-of-pocket expenses, but theygive you the flexibility to seek treatment from anycovered provider.In-Network:A physician, health care professional or healthcare facility that has contracted with CareFirstBlueChoice, Inc. to render Covered Services toMembers.Member:An individual who meets all applicable eligibilityrequirements stated in Part 2 of the Evidence ofCoverage, is enrolled for coverage, and for whomwe receive the premiums and other requiredpayments. A member can be either a subscriber ora dependent.Preventive Health Care:Care provided to prevent disease or itsconsequences. It includes programs aimed atwarding off illnesses (e.g., immunizations),early detection of disease and inhibiting furtherdeterioration of the body. This includes thepromotion of health through altering behavior,especially by health education.Primary Care Provider:A CareFirst BlueChoice provider selected by or onbehalf of, the member to provide primary care andto coordinate and arrange other required services.Provider:An individual, institution or organization thatprovides medical services. Examples of providersinclude physicians, therapists, hospitals and homehealth agencies.Referral:A written authorization by the PCP for the memberto see a specialty provider.Specialist:A licensed health care provider to whom a membercan be referred to by a PCP.Subscriber:A member who is covered under the Plan as aneligible employee or member of the group, ratherthan as a dependent or the Member to whom theEvidence of Coverage/Agreement is issued.Out-of-NetworkA health care provider or facility that has notcontracted with CareFirst BlueChoice, Inc. toprovide Covered Services to Members.Practitioner:Professionals who provide health care services.Practitioners are required to be licensed asdefined by law.HealthyBlue Member Handbook39

IndexAppointments, canceling 10Appointments, making 10Appointments, scheduling guidelines 10Argus Health Systems 2Away From Home Care® 18BlueCard® Program 17BlueVision 20Claim forms 25College students 13Complaints 26Confidentiality 29Contact lenses 20Coordination of benefits 25Corrective lenses 20Coverage, continuing 28Coverage, ending 28Denial of benefits, appeals 27Dental care 20Emergency, definition 15FirstHelp 16Follow-Up care 15Frequently asked questions 12Health + Wellness 22Laboratory services 13Medical emergency, definition 15Medical records 11Member ID card, HealthyBlue 2.0 4Member ID card, HealthyBlue Advantage 5Member satisfaction 30Mental Health/Substance Abuse care 19My Account 14Other insurance 25Portability (HIPAA) 28Prescription benefits 8Primary Care Provider 12Prior authorization 9Provider directory 12Referrals 12Reimbursement, how to file a claim for 25Responsibilities, member 30Rights, member 30Specialists 12Substance abuse 19Traveling, care while 12Urgent care centers 1540 HealthyBlue Member Handbook

Policy Form NumbersDC HealthyBlue GroupDC/CFBC/GC (R. 10/11)DC/CFBC/HB2 EOC (10/11)DC/CFBC/DOL APPEAL (R. 7/11)DC/CFBC/HB2 DOCS (10/11)DC/CFBC/HB2 SOB (10/11)DC/CFBC/ATTC (R. 1/10)DC/CFBC/HB2 WELLNESS (10/11)DC/CFBC/RX3 (R. 8/12)DC/BCOO/VISION (R. 1/12)DC/BC/DENTAL RIDER (R.6/09)DC/BC/DHMO RIDER (7/03)DC/BC/DHMO RIDER INOUT (7/03)DC/BC/DHMO SCHBEN 10 CP (R. 10/07)DC/BC/DHMO SCHBEN 20 CP (R. 10/07)DC/BC/DHMO RIDER OON SCHED (R. 10/07)and any amendmentsDC HealthyBlue Advantage GroupDC/CFBC/GC (R. 10/11)DC/CFBC/HBADV/EOC (7/12)DC/CFBC/DOL APPEAL (R. 7/11)DC/CFBC/HBADV/DOCS (7/12)DC/CFBC/HBADV/SOB (7/12)DC/CFBC/ATTC (R. 1/10)DC/CFBC/HB3 WELLNESS (8/12)DC/CFBC/RX3 (R. 8/12)DC/BCOO/VISION (R. 1/12)DC/BC/DENTAL RIDER (R.6/09)DC/BC/DHMO RIDER (7/03)DC/BC/DHMO RIDER INOUT (7/03)DC/BC/DHMO SCHBEN 10 CP (R. 10/07)DC/BC/DHMO SCHBEN 20 CP (R. 10/07)DC/BC/DHMO RIDER OON SCHED (R. 10/07)and any amendmentsDC HealthyBlue Direct BillDC/CFBC/HB2/IEA (10/11)DC/CFBC/DOL APPEAL (R. 7/11)DC/CFBC/HB2 DOCS (10/11)DC/CFBC/HB2 SOB (10/11)DC/CFBC/ATTC (R. 1/10)DC/CFBC/HB INCENTIVE (4/10)DC/CFBC/DB/HB2/RX (R. 8/12)DC/BC-OOP/VISION (R. 6/04)DC/BC/DHMO RIDER (7/03)DC/BC/DHMO SCHBEN 20 CP (R. 10/07)DC/CFBC/DB/CHILD ONLY ELIG (R. 7/12)and any amendmentsDC HealthyBlue Advantage Direct BillDC/CFBC/HBADV/IEA (7/12)DC/CFBC/DOL APPEAL (R. 7/11)DC/CFBC/HBADV/DOCS (7/12)DC/CFBC/HBADV/SOB (7/12)DC/CFBC/ATTC (R. 1/10)DC/CFBC/HB3 WELLNESS (8/12)DC/CFBC/DB/HBADV/RX (7/12)DC/BC-OOP/VISION (R. 6/04)DC/BC/DHMO RIDER (7/03)DC/BC/DHMO SCHBEN 20 CP (R. 10/07)DC/CFBC/DB/CHILD ONLY ELIG (R. 7/12)and any amendmentsVA HealthyBlue GroupVA/CFBC/GC (R. 7/10)VA/CFBC/HB2 EOC (10/11)VA/GHMSI/DOL APPEAL (R. 7/11)VA/CFBC/HB2 DOCS (10/11)VA/CFBC/HB2 SOB (10/11)VA/CFBC/DB/HB ELIG (R. 2/11)VA/CFBC/HB2 WELLNESS (10/11)VA/CFBC/RX3 (R. 8/12)VA/BC-OOP/VISION (R. 6/04)VA/BC/DHMO RIDER (7/03)VA/BC/DHMO RIDER INOUT (7/03)VA/BC/DHMO SCHBEN 10 CP (R. 10/07)VA/BC/DHMO SCHBEN 20 CP (R. 10/07)VA/BC/DHMO RIDER OON SCHED (R.10/07)and any amendmentsVA HealthyBlue Advantage GroupVA/CFBC/GC (R. 10/11)VA/CFBC/HBADV/EOC (7/12)VA/CFBC/DOL APPEAL (R. 7/11)VA/CFBC/HBADV/DOCS (7/12)VA/CFBC/HBADV/SOB (7/12)VA/CFBC/ATTC (R. 1/10)VA/CFBC/HB3 WELLNESS (8/12)VA/CFBC/RX3 (R. 8/12)VA/BCOO/VISION (R. 1/12)VA/BC/DHMO RIDER (7/03)VA/BC/DHMO RIDER INOUT (7/03)VA/BC/DHMO SCHBEN 10 CP (R. 10/07)VA/BC/DHMO SCHBEN 20 CP (R. 10/07)VA/BC/DHMO RIDER OON SCHED (R. 10/07)and any amendmentsVA HealthyBlue Direct BillVA/CFBC/HB2/IEA (10/11)VA/GHMSI/DOL APPEAL (R. 7/11)VA/CFBC/HB2 DOCS (10/11)VA/CFBC/HB2 SOB (10/11)VA/CFBC/DB/HB ELIG(R. 2/11)VA/CFBC/HB INCENTIVE (4/10)VA/CFBC/DB/HB2/RX (R. 8/12)VA/BC-OOP/VISION (R. 1/12)VA/BC/DHMO RIDER (7/03)VA/BC/DHMO SCHBEN 20 CP (R. 10/07)and any amendmentsVA HealthyBlue Advantage Direct BillVA/CFBC/HBADV/IEA (7/12)VA/CFBC/DOL APPEAL (R. 7/11)VA/CFBC/HBADV/DOCS (7/12)VA/CFBC/HBADV/SOB (7/12)VA/CFBC/DB/HB ELIG (R. 2/11)VA/CFBC/HB3 WELLNESS (8/12)VA/CFBC/DB/HBADV/RX (7/12)VA/BC-OOP/VISION (R. 1/12)VA/BC/DHMO RIDER (7/03)VA/BC/DHMO SCHBEN 20 CP (R. 10/07)and any amendmentsMD MSGR HealthyBlue HSA/HRA Dual OptionMD/CFBC/MSGR/GC (R. 9/09)MD/CFBC/MSGR/EOC (R. 7/08)MD/CFBC/MSGR/DOCS (7/07)MD/CFBC/MSGR/HSA/SOB/CORE (R. 1/09)MD/CFBC/MSGR/HSA/HRA/SOB/HB2 (12/11)MD/CFBC/MSGR/OON/HB2 (12/11)MD/CFBC/MSGR/RX/HB (R. 8/12)MD/CFBC/MSGR/GS (9/09)MD/CFBC/DOL APPEAL (R. 9/11)and any amendmentsMD MSGR HealthyBlue Advantage HSAMD/CFBC/MSGR/GC (R. 9/09)MD/CFBC/MSGR/EOC (R. 7/08)MD/CFBC/MSGR/DOCS (7/07)MD/CFBC/MSGR/HSA/SOB/CORE (R. 1/09)MD/CFBC/MSGR/HSA/SOB/HB3 (8/12)MD/CFBC/MSGR/OON/HB3 (8/12)MD/CFBC/MSGR/RX/HB (R. 8/12)MD/CFBC/MSGR/GS (9/09)MD/CFBC/DOL APPEAL (R. 9/11)and any amendmentsMD MSGR HealthyBlue HDHP Dual OptionMD/CFBC/MSGR/GC (R. 9/09)MD/CFBC/MSGR/EOC (R. 7/08)MD/CFBC/MSGR/DOCS (7/07)MD/CFBC/MSGR/HDP/SOB/CORE (10/08)MD/CFBC/MSGR/HDP/SOB/HB2 (12/11)MD/CFBC/MSGR/OON/HB2 (12/11)MD/CFBC/MSGR/RX/HB (R. 8/12)MD/CFBC/MSGR/GS (9/09)MD/CFBC/DOL APPEAL (R. 9/11)and any amendmentsMD MSGR HealthyBlue Advantage HDHPMD/CFBC/MSGR/GC (R. 9/09)MD/CFBC/MSGR/EOC (R. 7/08)MD/CFBC/MSGR/DOCS (7/07)MD/CFBC/MSGR/HDP/SOB/CORE (10/08)MD/CFBC/MSGR/HDP/SOB1/HB3 (8/12)MD/CFBC/MSGR/HDP/SOB2/HB3 (8/12)MD/CFBC/MSGR/OON/HB3 (8/12)MD/CFBC/MSGR/RX/HB (R. 8/12)MD/CFBC/MSGR/GS (9/09)MD/CFBC/DOL APPEAL (R. 9/11)and any amendmentsMD HealthyBlue Group (Non-MSGR)MD/CFBC/GC (R. 9/11)MD/CFBC/HB2/EOC (12/11)MD/CFBC/DOL APPEAL (R. 9/11)MD/CFBC/HB2/DOCS (12/11)MD/CFBC/HB2/SOB (12/11)MD/CFBC/HB2/WELLNESS (12/11)MD/BCOO/VISION (R. 10/11)MD/CFBC/RX (R. 7/12)MD/CFBC/ELIG (R. 10/10)MD/BC/DENTAL RIDER (R. 4/08)MD/BC/DHMO RIDER (7/03)MD/BC/DHMO RIDER INOUT (7/03)MD/BC/DHMO SCHBEN 10 CP (R. 10/07)MD/BC/DHMO SCHBEN 20 CP (R. 10/07)MD/BC/DHMO RIDER OON SCHED (R. 10/07)and any amendmentsHealthyBlue Member Handbook41

Policy Form NumbersMD HealthyBlue Advantage Group(Non-MSGR)MD/CFBC/GC (R. 9/11)MD/CFBC/HBADV/EOC (7/12)MD/CFBC/DOL APPEAL (R. 9/11)MD/CFBC/HBADV/DOCS (7/12)MD/CFBC/HBADV/WELLNESS (7/12)MD/CFBC/HBADV/SOB (7/12)MD/BCOO/VISION (R. 10/11)MD/CFBC/RX (R. 7/12)MD/CFBC/ELIG (R. 10/10)MD/BC/DENTAL RIDER (R. 4/08)MD/BC/DHMO RIDER (7/03)MD/BC/DHMO RIDER INOUT (7/03)MD/BC/DHMO SCHBEN 10 CP (R. 10/07)MD/BC/DHMO SCHBEN 20 CP (R. 10/07)MD/BC/DHMO RIDER OON SCHED (R. 10/07)and any amendmentsMD HealthyBlue Direct BillMD/CFBC/HB2/IEA (1/12)MD/CFBC/DOL APPEAL (R. 9/11)MD/CFBC/DB/HB2/DOCS (1/12)MD/CFBC/DB/HB2/SOB (1/12)MD/BCOO/VISION (R. 10/11)MD/CFBC/DB/HB2/RX (1/12)MD/CFBC/DB/HB ELIG (R. 2/11)MD/BC/DHMO RIDER (7/03)MD/BC/DHMO SCHBEN 20 CP (R. 10/07)and any amendmentsMD HealthyBlue Advantage Direct BillMD/CFBC/HBADV/IEA (7/12)MD/CFBC/DOL APPEAL (R. 9/11)MD/CFBC/DB/HBADV/DOCS (7/12)MD/CFBC/DB/HBADV/SOB (7/12)MD/BCOO/VISION (R. 10/11)MD/CFBC/DB/HBADV/RX (7/12)MD/CFBC/DB/HB ELIG (R. 2/11)MD/CFBC/DB/HBADV/CHILD ELIG (7/12)MD/BC/DHMO RIDER (7/03)MD/BC/DHMO SCHBEN 20 CP (R. 10/07)and any amendments42 HealthyBlue Member Handbook

NotesHealthyBlue Member Handbook43

Notes44 HealthyBlue Member Handbook

The CareFirst BlueCross BlueShieldfamily of health care plans.840 First StreetWashington, DC 20065www.carefirst.com/healthyblueCareFirst is used as a collective reference for CareFirst BlueChoice, Inc. and CareFirst BlueCross BlueShield.BOK5448-1S (5/12)