HealthyBlue 2.0/HealthyBlue Advantage Member ... - CareFirst

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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
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 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: Health + WellnessUtilization Manage
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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