HealthyBlue 2.0/HealthyBlue Advantage Member ... - CareFirst

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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
Page 1: HealthyBlue 2.0 / HealthyBlue Advan
Page 4 and 5: Important InformationEmergency Assi
Page 6 and 7: Your HealthyBlue 2.0 Member ID Card
Page 8 and 9: HealthyBlue — The BasicsAs a Heal
Page 12 and 13: CareFirst BlueChoice &CareFirst PPO
Page 14 and 15: Frequently Asked QuestionsWhy is my
Page 17 and 18: Emergency and Urgent CareWhen you h
Page 19: Coverage Outside the AreaBlueCard
Page 23 and 24: Additional BenefitsHow to Access In
Page 25 and 26: Health + WellnessUtilization Manage
Page 27 and 28: Administration of Your PlanPersonal
Page 29 and 30: CareFirst BlueChoice’s appeal pro
Page 31 and 32: All health plans and providers must
Page 33 and 34: HSA and HRA PlansThis section is sp
Page 35 and 36: HSA and HRA PlansHSA Plan Questions
Page 37 and 38: HSA and HRA PlansHealth Reimburseme
Page 39 and 40: HSA and HRA PlansPlease note: Some
Page 41 and 42: Definition of TermsHealth Maintenan
Page 43 and 44: Policy Form NumbersDC HealthyBlue G
Page 45 and 46: NotesHealthyBlue Member Handbook43
Page 48: The CareFirst BlueCross BlueShieldf

HealthyBlue 2.0/HealthyBlue Advantage Member ... - CareFirst

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