HealthyBlue 2.0/HealthyBlue Advantage Member ... - CareFirst

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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
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 10 and 11: HealthyBlue: The Basics➤ Work wit
Page 12 and 13: CareFirst BlueChoice &CareFirst PPO
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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